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Life Can Be A Pain In The Neck

By Noigroup HQ Patient examples 11 Apr 2013

Why me? is so often the big question for  many patients : Why me? Why did my pain turn chronic instead of going away? Maybe, if we can attempt to answer this question, we could work from here and in the process unravel the coping mechanisms that this person’s remarkable and beautiful brain has constructed, for the good, and wellbeing of its livelihood and transport vehicle – the body.

During our clinical examination how often do we actually treat from  a truly biopsychosocial place? How often do we ask the question “how do you actually feel?” and “what is on your mind?” and want to hear the answer?

Are we prepared to enter into the realms of our patients’ thoughts, feelings and emotions? We are increasingly better educated in how the brain works with its “hardware” and “wetware” and its capacity to construct the most incredible coping mechanisms as it believes that it is for the good of the being. However, has anyone seen a thought under a microscope or anything more than a blur on an MRI scan? And yet, a thought can be so powerful in creating a patient’s reality, as each thought will trigger subsequent feelings! I have witnessed again and again that when one addresses the patient’s thoughts and feelings and is brave enough to handle the often dramatic outflow of powerful emotion (such as sadness, anger and despair) a shift occurs in their process of recovery. Then, working integratively and depending on the patient’s needs, one might consider engaging the help of a psychotherapist into the caring team.

My patient with her “pain in the neck” was in the middle of a very messy divorce at the time she fell off her horse and hurt her neck. Did her brain highjack this event and embody her process of grief -related to her difficult divorce – with its intense emotions and stages (denial, anger, despair, negotiation etc.) through her ‘pain in the neck’? Is the on-going pain and suffering ever going to resolve if, hypothetically, the primary wound, the divorce, is still wide open and unresolved? In our clinical examination are we actually prepared to go into the realm of thoughts, feelings and emotions by listening and asking how our patients are feeling, what they are thinking and how their psychosocial side of life impacts on them? Are we ready to really care about their answers, and even give the occasional hug where that might be appropriate? I am convinced that the big hug I give my ‘pain in the neck’ patient every time she comes in,  is probably one of my most effective ways of treating her and expressing my genuine care – which in response opens her own amazing ‘drug cabinet within the brain’. When did you last give a patient a hug, a ‘squeeze of serotonin’? Apart from my hugs and other care via physiotherapy, she is now also seeing a psychotherapist to help her find ways to cope with her divorce. I am glad to report: her “pain in the neck” is now improving!

– David Bolton


  1. As an osteopath in the UK, our governing body might not approve of hugging our patients. However ,I sometimes do, as it is the appropriate human response to the interaction that is taking place. I often suspect that we as a profession are guided to model ourselves on the blank reflective persona of some psychotherapists, therefore missing out on the huge benefits that we can shower on our patients by true communication aided by touch. But of course the risk of dropping the professional mask is that it is possible to get it wrong and to be hauled up for inappropriate behaviour. We therefore need to be brave, trust our instincts and be true to our own nature.

  2. “Did her brain highjack this event and embody her process of grief -related to her difficult divorce – with its intense emotions and stages (denial, anger, despair, negotiation etc.) through her ‘pain in the neck’?”

    — I’d say yes definitely, no question about it.

    “Is the on-going pain and suffering ever going to resolve if, hypothetically, the primary wound, the divorce, is still wide open and unresolved?”

    — That’s a hard one. She might get addicted to your hugs at such a vulnerable time and start wanting more (if you catch my drift). If that’ happens she may not have any good reason to allow the neck pain to resolve. Then when you cut her loose it might dredge up all the abandonment issues again. Yikes!

    — My feeling is that the pain of divorce just needs to be integrated, ie. accepted by the patient’s ego. We can assist by first being open, honest and accepting of our own short-comings and vulnerabilities. A patient will sense immediately a therapist who is self-accepting and happy, and will take this opportunity to unload the “story”. But even when the story is not told, healing can happen. I think the subconscious takes note of the attention to the body part being treated and puts two and two together, eg. “if my neck pain is respected and treated carefully and gently, that means I don’t need to feel shame about my divorce”. Something like that.


    1. davidboltononoi

      Thank you for your comments – I agree, you have a point there in relation to patients potentially getting emotionally attached to me or my hugs. One has to be obviously very aware and use this way of relating sparingly and with great care. As David Butler pointed out, it is an advanced clinical skill that depends on the psychological maturity of the practitioner (not his/her age), and I do not advise everyone to hug their divorcing patients – far from it!
      I did experience a barrier for further improvement of her ‘pain in the neck’ when treating this particular patient solely with physiotherapy. When she started to address her psychological and emotional distress in her psychotherapy, it helped her to integrate the deep grief and loss she went through because of the breakdown of her marriage. Are these big life events such as divorce ever resolved? Probably not and therefore I like your use of the word ‘integration’ because I agree with you: that is what we are aiming for – not ‘fixing’ but integrating. Then the path was laid for her neck pain to finally improve.
      David Bolton

  3. I know where you’re coming from. I had a patient with a hideous chronic pelvic pain condition travel from overseas to see me. At the end of the session she gave me a big hug, and I think this was as helpful as anything I might have taught her or done with her in the session.
    On the other hand, I’m in two minds about the body metaphor issue. I have to say I detest the Louse-Hay style style of interpreting chronic pain – e.g. my patient is “pissed off” with something because she has a chronic bladder pain syndrome. In my experience (because I work as a naturopath as well) this is alarmingly common among naturopaths, because they have no idea what any of the major mechanisms behind the pain may be. I think it’s interesting, but we have to be careful not to go too far with it.

  4. Thanks for post David and for the responses.

    Thanks too for saying you occasionally hug patients. Brave?. I have been discussing the post with young students who find hugging a patient unimaginable. It is such an advanced clinical skill – for some people the touch on the shoulder is inappropriate.

    But I wanted to ask about psychotherapy and I am feeling a bit “thick” as I don’t know much about modern psychotherapy. The profession has obviously suffered some bad press last century and I believe that the meaning of psychotherapy is a bit loose, especially outside the UK. Freud of course, and Klein would come to many people’ minds, but where has it gone since? Could you help me (us) with some direction on modern psychotherapy, perhaps some readings?.


    1. davidboltononoi

      Dear David, thank you for your comments and thank you for the challenge! “What is modern psychotherapy?” is a difficult question indeed to answer and I do not feel qualified to do so. However, Daniela Schoeller, a psychotherapist and senior member of my integrative medicine team here at Limbus Practice would like to share her views on the subject:-
      What is ‘modern psychotherapy’? A psychotherapist is attempting an answer…:
      Maybe I start by telling you what it isn’t: there is rarely a couch involved or talk about oedipal matters, ‘bad breasts’ or ‘penis envy’, nor is it necessary for the average client to come more than once a week or for countless years. Not all psychotherapists have beards – I don’t. It doesn’t even have to cost as much as one might think, because there are training institutes that provide good, well supervised therapy at very low costs.
      There are so many approaches and types of psychotherapy out there that I am not even attempting to describe them and their various philosophies and stances in relation to the psyche, pain and suffering. However, what I can say is how in my opinion psychotherapy should be experienced: as a place where it is possible to be authentic without fearing judgment and where things are explored that are usually not spoken about (the ‘dark’ places, feelings, experiences). This happens in a safe and confidential environment with someone, who not just has the knowledge on the subject but also knows from experience (clinical & personal) and their in-depth work of own psychotherapy (personal) what the client is talking about. As a psychotherapist you can only guide clients to and through places you have been to yourself, not necessarily literally but in deeply knowing about the very human experience of grief, despair, rage etc. Interestingly many studies point in the direction that what makes therapy really work is the relationship between client and therapist, not their specific approach. Empathy and compassion towards the clients, a real understanding of their dilemma and struggle, as well as good self-awareness of oneself are vital ingredients the therapist needs to bring for this relationship to work. Other useful qualities both therapist and clients are profiting from are: honesty, acceptance, patience, trust, non-judgment and an open mind.
      In the past most approaches to psychotherapy focused mainly on the mind and ignored the physical self, the body, as much as ‘orthodox’ medicine (with a biomedical outlook) did not appreciate even the existence of the psyche of their patients. I am glad to say that there are psychotherapies out there that will now have a more integrated approach, including the body explicitly as the very important vehicle of the Self. They are interested in exploring the relationship between mind and body, looking at pain and suffering on all levels. That will allow for a deeper understanding and experience of how mind, feelings and body do interact and affect each other, which is interestingly now all supported by the findings of modern neuroscience.
      My recommendation to any potential client of psychotherapy would be to question their therapist in the first session about their approach and school of thought, the length of their training, whether they had their own therapy (more than a year), what they think about the relationship between body and psyche and any other question they might have. No good, well- qualified and experienced therapist will have a problem with that! They will have been through at least six years of academic study and training, are in on-going supervision, and therefore will invite such questions and cherish clients who ask them.
      By the way, people who enter therapy are not just the ones who have experienced a difficult childhood or traumatic events in the past or present. More and more people come because they are longing and searching for a deeper sense of purpose, meaning and values in life. They might wonder about their identity and question who they really are. Many people find that they are stuck in ‘doing mode’ and do not know how ‘to be’ anymore – with themselves, with silence, with others. Often the confrontation with impermanence, change and endings (separations, injury/illness, aging, loss and death) bring about such questions, which tend to cause confusion and grief. However, addressing such issues can also lead to tremendous psychological growth. People who enter therapy – however low they might feel in that moment – have a tremendous amount of courage. They are the brave ones who are willing to face themselves and their pain – and do something about it. I feel privileged to work with them as their therapist!
      In general I would say that psychotherapy can help people to become and then stay more present, aware and mindful of themselves, the impact they have and their experience of life – whatever the challenge might be. That is, in my opinion and clinical experience, helping people to avoid the incredibly common emotional and psychological ‘shut down’ that tends to happen, which can lead to persistent depression and possibly even more serious physical manifestation of their internalized, suppressed suffering. So many people are numb nowadays rather than fully alive, which is such a shame and potentially a bit of a waste of life, I would dare to say.
      Psychotherapy works, you know…but like many good things: you will only find out if you try and experience it yourself!
      Daniela Schoeller, Dip. Psych. MA Psych. & David Bolton, Limbus Physiotherapy & Psychotherapy, London

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