Know Pain, by Debbie Patterson

My name is Debbie Patterson. I am a Registered Physiotherapist in the provinces of Ontario and Alberta. I am also a member of the Canadian Physiotherapy Association and a founding member of the Pain Science Division of the Canadian Physiotherapy Association.

Over 35 years ago, I became aware that despite my competent biomechanical assessments and treatments, there was a significant number of my patients who just did not respond well. As I thought about these patients, and conversed with them, their main concern was rarely about their range of motion or their strength, but it was much more about the fact that their pain persisted, and it changed their lives so drastically.

 This realization changed my professional focus as a physiotherapist from the orthopaedic or biomechanical/biomedical approach to assessment and treatment, to investigating the pain system. My career path changed. I wanted to better understand the science of pain and all its contributing factors. I wanted to learn how to assess and treat people’s pain.

I read everything I could about the science of pain, and I joined the International Association for the Study of Pain. This investigation of pain science introduced me to the Biopsychosocial Model of Pain. There were very few courses to take in pain science at the time, but I have to say that my patients became my most important teachers. They were able to describe their pain to me and tell me how it interfered with their lives. They shared their goals and dreams of being able to increase their function and improve their quality of life. Many others shared their frustrations and their despair with the medical system and well-meaning health care providers who had no answers for their pain, except to “learn to live with it”. In my mind that answer wasn’t good enough. I developed an incredible compassion for these people, and a strong desire to be part of their recovery from pain.

As I started to increasingly assess and treat people with complex and persistent pain conditions, I increased my scope of practice as a physiotherapist to be knowledgeable and skilled in the treatment of not just the biomechanical aspects of their pain, but also the many other factors that could not only aggravate their pain, but also be reasons why they had pain.

Within the Biopsychosocial Model, we must recognize that everything about our patients matters. Their thoughts, emotions, attitudes, beliefs, memories, stressors, financial situation, and relationships are now understood to be important drivers to pain, and reasons why pain can last and increase. For example, I had a patient with a history of over 10 years of low back pain. None of the physical treatments he received, for example physiotherapy, chiropractic, massage therapy or even exercise changed his pain until we started working on his problems with sleep. We started treating sleep using Cognitive Behavioural Therapy for Insomnia, and within 8 weeks, his pain significantly improved.

I have had many other patients whose pain is primarily a response to the stressors in their lives. If the stressors are not identified and individual solutions to the stress response identified, then it is not likely that their pain will change. We know that there are many solutions to dealing with the stress response. They include learning how to turn on their relaxation response with deep breathing exercises, meditations, gentle non-threatening touch, gentle non-threatening movement, problem solving, and positive affirmations about their ability to change the stress response.

I realized that clinicians often forget that pain is an unpleasant feeling in their patient’s body that moves their body to protect them. We need to ask “Why does their body need protection at this moment?” It is because anything that their brain perceives as dangerous or potentially dangerous can trigger their pain system to turn on and stay on until the danger has been dealt with. Pain signals decrease and often are eliminated when the brain and the pain system no longer feel threatened but feel safe.

I started to see myself as a physiotherapy pain coach to help my patients relieve their physical, emotional, social suffering and distress. It was important to show them that it was possible to increase their function and quality of life. That meant that the person in pain was the expert in their pain. After all, they lived with it 24/7. As my patients started responding well to this approach, I developed a passion for sharing what I knew with other physiotherapists, and health care providers. Bahram Jam a registered Physiotherapist who founded APTEI – or the Advanced Physiotherapy Education Institute, gave me the incredible opportunity to be an APTEI instructor. I was able to reach hundreds of physiotherapists across the country.

My own learning continued, and I came face to face with the incredible science of Neuroplasticity. I read about the decades or more of Neuroplasticity research, often very poorly received in the medical world. I could start to frame everything I was sharing with patients as treatment as potential for positive neuroplastic changes. And if the brain as the processor of everything about who we are as human beings could change, then could we not change pain? It was such a challenge. There now was science that gave me the ability to confidently give patients the hope that indeed their pain could change. It might not be easy; it isn’t a quick treatment fix. But it was possible. And that is exciting!

The goal became to return the pain system to its normal function as a protector, a warning system for danger or potential danger, rather than a system that quite literally became overly sensitized, high jacking people’s brains and their lives. There are so many different approaches that can create positive neuroplastic changes in their brains. One very effective way is to identify what their individual brain perceives as dangerous, and what is safe. The goal would be to find solutions for the danger signals, and to strengthen the safety signals. The way to do that is to find a health care provider who can help them explore their individual danger and safety signals and direct them to ways to practice strategies that will work for them.

My passion for sharing this information with health care providers continues. I have been an invited speaker to many events. I now offer live and recorded webinars for physiotherapists and other health care providers. And most importantly at this point in my life, I want to mentor professional care providers. I provide this service online with physiotherapists who can come with their appetite to learn about pain, and how a physiotherapist can assess the pain system, evaluate the results, develop, and deliver a treatment plan with the patient as the most important person in the transaction.

Not only has this approach to pain treatment been life changing for me as a health care provider, but it has also been a very important part of my personal life. I have recognized my increased compassion for suffering, distressed people in other relationships. My understanding of who we are as whole human beings has expanded. Life happens and this understanding has shaped my own personal responses to experiences of pain and suffering.

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