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Illusion of pain???

Thoughts today brought to you by Drs Tasha Stanton and Greg Kawchuk’s research on spinal stiffness.

As well as Cory Blickenstaff’s ideas of manual therapists as contextual architects

I feel like the bulk of my day is spent altering patient’s ideas. Whether it’s about how their body works, how strong and adaptable it is, or how it is capable of so much more. Sometimes it is about an idea, fear or belief they have about how fragile/broken/degenerated their body is, and sometimes it is about why they are hurting.

The beliefs and ideas they carry are common and may have emerged through being immersed in a culture that has made back pain a medically urgent event due to the “long term consequences” of having a “bad back”. During other encounters, it is revealed that the ideas are more complicated and have been planted there by another health care provider, whether that is a medical doctor, another chiropractor, or a PT, RMT, DO… (label your favourite therapist here.)

I believe we, as practitioners (but also the general public), should have a better understanding about human perception of reality so to better inform our interactions with experiences such as pain. I feel it would lead to less unnecessary suffering in the world.

We have rather robust evidence that our experience of the world, including our bodies within it, is not a direct representation of the physical world but a reasonable estimation, which is constantly being revaluated and recreated. Perspective and our prior beliefs play a role in how we view the world and our experiences in it

Examples of this include optical, auditory and tactile illusions, but also certain pain experiences. (sausage finger, McGurk effect, thermal grill illusion)

We tend to accept the illusions of our visual or auditory senses more readily than that of our tactile senses but accepting that pain, which is both a sensory and emotional experience is possibly an “illusion”…

That is a harder idea for most to accept.


I believe that there are several reasons.

1. Much of the time, we have pain experiences that correlate well to potential or actual tissue damage. This fact makes the prediction error of pain self-fulfilling… sometimes (more on that in another blog)

2. We tend to have a hard time discounting emotional events as being illusory as they are what we “felt” and how can what we feel be an illusion???

3. Pain, as an experience, is generally a very salient (important to us) event, so how could we get that wrong? How could it be “fake”.

These are just a few of the issues I feel we may have with accepting that sometimes pain is an experience driven exclusively by our perception of what is happening, rather than any actual threat to our tissue integrity.

I want to take a moment to clarify that the experience of having pain is NEVER “fake” or “not real” as we may infer from the word illusion. What I am suggesting is that the experience of pain may not be an accurate assessment of the situation, which is exactly what the other illusions are… an inaccurate evaluation of the information.

I don’t typically confront this directly, when treating patients, but I do believe that most of the positive effect I have on patients stems from this idea of changing their perception of their body and/or their ideas about pain. Occasionally the changes occur during conversations that we have in the treatment room, other times it is a rapid change in their ability to perform a task after a treatment. It doesn’t seem to matter whether it is through a direct discussion about how they are not damaged, broken or deteriorating, or through manipulation of their body that then changes their perception of their capabilities. In the end, the greatest changes I have with patients is when they are less fearful, feel more capable and are empowered to be able to take control of whatever was negatively impacting their life.

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