Chronic Pain: It's More Than Mechanical

Shifting healthcare explanations from cause-based to mindbody management


How do we get to the point where our pain prevents us from feeling normal? How can we get back to feeling functional?

These are the questions that motivate individuals with chronic pain to seek healthcare providers’ expertise. Unfortunately, many people leave their appointments more confused than confident. As the field of chronic pain expands, outdated treatment practices expire. However, many healthcare providers continue to offer explanations for chronic pain which do not serve their patients and clients.

Mechanical dysfunction is by far the most commonly cited explanation for chronic pain used by healthcare providers. Perhaps you’ve heard that the wear and tear on your joints is the issue, or that your hips are out of alignment thereby causing tension. Historically, this is how the medical system quantified the pain experience. It was believed that the source of pain resides at the site of the symptoms. Therefore, if you “fix” the area that hurts, the pain will decrease. Here’s the truth – humans are not cars. We are more complicated than our individual parts, and sometimes replacing them does not make us feel as good as new. What’s worse is that these mechanical justifications for physical discomfort are both reductive and problematic for the person seeking support to manage their chronic pain.

For an example, let’s use arthritis. Arthritis is a natural aging process whereby the support structures in our joints thin and become less pliable. In fact, most people have some amount of arthritis starting in their twenties! So how can we begin to understand that two people of the same age can both have arthritis in their knees, yet one has debilitating pain and the other runs three times a week without symptoms? Perhaps we can begin to make sense of this difference by explaining how our body “normally” processes sensations. To do this, we must acknowledge an extremely important piece of the pain puzzle: the brain.

The Connection Between Mind, Brain and Body

The brain and body do not function separately. In fact, they are in constant communication. Your body senses the world, and that information is transmitted through our nervous system to and from the brain.

The "mind" comprises all of those experiences, thoughts and memories that are not made up of brain tissue, but are stored in the brain nevertheless.  To use technology as an example, our brain is the hardware (the computer) and our mind is the software (the program we “run” on our brain). Human minds are complicated, each with our own beliefs, emotions, and behavioral responses that shape our personal experience of the world. In other words, we all run different versions of software.  

For example, you may feel a light brush across your arm as you walk down the street, so you turn your head to see if you’ve bumped into something or if a leaf fell on your shoulder. In that brief moment, your body alerted your mind to a stimulus and your brain instructed your body to check out what it might be... and perhaps do something about it.  In a person without chronic pain, it is perceived as non-threatening. If there was a leaf, you’d brush it off. If you bumped a stranger, you’d say “excuse me.”

But what if your brain was running chronic pain software? What if you had shoulder pain for a number of years and so had a whole filing cabinet of experiences reinforcing that sensation at your shoulder really hurt? This brush then might elicit discomfort, so you wince or grab your arm. In other words, some chronic pain can be described as the experience of otherwise non-threatening stimuli being perceived by your nervous system as dangerous.

So how do we increase body tolerance to these perceived threats?

Ultimately, it is not by telling people that their knees are crumbling from the inside. When healthcare providers use mechanical explanations for chronic pain, it only perpetuates misconceptions and worse, leaves the patient feeling helpless.

By healthcare providers using a mind-body approach to chronic pain education, the client is set up to feel supported in managing their pain experience. They receive concrete strategies that emphasize autonomy such as deep breathing, guided meditation, or graduated return to movement. Lifestyle changes such as improving sleep quality, increasing physical activity, and promoting good nutritional habits also go a long way towards balancing the nervous system.

If our mind shapes our response to pain, then we can alter our input to help reformat our reaction to discomfort. It is a steep slope to reach the ultimate goal of pain-free function. It is the healthcare provider’s responsibility to provide a walking stick on this journey rather than pummel the client with an avalanche of explanations that hinder their climb.

About Laura Baehr, PT

Laura Baehr is a physical therapist, scientist, and dance artist who melds her interdisciplinary training in order to inspire strength, confidence, and quality of life through movement. She earned her clinical doctorate in physical therapy from Temple University and her undergraduate training includes a dual degree in dance and neuroscience from Muhlenberg College. Laura is currently pursuing her PhD examining the biopsychosocial contributions to the development of chronic pain following neurological injury. She hopes to contribute to the field of rehabilitation sciences through her clinical and research background in order to shift healthcare and community perspectives on the importance of healthful movement in the management of pain and wellness. In addition to her scientific interests, Laura is a professional dance artist, movement teacher, and Pilates instructor in Philadelphia.

Please note: This article is made available for educational purposes only, not to provide medical advice. The views expressed in this article are those of the author, which do not necessarily represent those of Curable or other contributors to the Curable site.

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