The Authors, Lorimer Moseley and David Butler, and friends, in their own words.
For more information, or to purchase The Explain Pain Handbook: Protectometer from anywhere around the world, check out protectometer.com. Or purchase via Amazon UK, or OPTP.com throughout the US.
Be sure to check out protectometer.com for other resources and to join the DIM SIM Community
The DIMs/SIMs community website not loading here. Anyone else?
Last time I checked, people seemed to be posting things that made them feel pleasure/displeasure more so than safety/unsafety. I know pleasure can reduce pain temporarily, but there are many potential problems in using pleasure to modify pain. In any case, is activity-generated pleasure different to the chemically-generated pleasure from opiates? Both are highly addictive. Do feelings of safety have a longer lasting effect on pain? Are actions the most reliable way to alter subconscious thoughts, (since this is where emotions come from)?
Maslow’s hierarchy of needs lists a few safety needs, such as money for housing and food, bills etc. I tend to think his ‘love needs’ are a type of safety need also. If no one loves us, we can easily end up on the scrap heap of society with no one to help. Many chronic pain clients will struggle financially and have fractured relationships. How on do they go about creating feelings of safety?! I can’t think of any way other than pain relief – and yet pain relief depends on them feeling safe! Even pleasure could be out of reach since pleasure usually requires money and an absence of anhedonia.
Haven’t been able to replicate a DIM SIM community loading error – if it continues could you email me details (browser being used, whole page/part page not loading etc)?
I think while some SIMs can be pleasurable, this is not a necessity – take knowledge for example. Having accurate, up to date and usable knowledge about the body and about pain might be one of the most powerful SIMs that we know of.
One thing we have noticed in these early days of DIMs and SIMs and the Protcetometer, is that the SIMs that most people first think of are often those that are more explicitly pleasurable – walks on the beach, having dinner with friends etc. These SIMs fall into the category “things you do” or “places you go”. But when we dive deeper, looking for SIMs (or DIMs) that “hide in hard to find places” they are often found in other categories – “Things you hear…” or “Things you say” and then “Things you think and believe”. Many of these are not necessarily pleasurable, but do add to a sense of Safety in Me.
Interesting question in regards to the length of effect of pleasure and safety. The Protectometer framework suggests that SIMs and DIMs are in constant flux. Opening MRI results and reading “multi level degenerative disc disease” could be a ‘permanent’ DIM for someone – their pain increases, they change behaviour, quit their job etc etc. Getting in early and telling the story that “we grow like trees” and “the kisses of time are rarely dangerous” might be a ‘permanent’ SIM.
Having a pleasurable ‘cuddle’ with a loved one might provide a short term reduction in pain – understanding pain and knowing that loving someone and being loved is a powerful SIM itself might last forever?!
On love, well here’s Lorimer:
“Your question was really about what would I most like to solve if someone said, “Here’s 5 million bucks to solve a problem.” I would love to find out the best way that we could convince anyone; well if I was to be super speculative and not a scientist. If I took off my scientist hat and put on my normal human in relationships hat. I reckon if we could convince everyone that they are both loved and are loving, we would drastically reduce stuff like chronic pain. To love and be loved I reckon is probably the strongest biological drive I would imagine. Any human who is absolutely convinced that they are physically safe from everything will not experience pain. How can we capture that sort of stuff? How can we capture the fact that some people, you give them a really dangerous stimulus and if they think it’s from a mistress, it doesn’t hurt. Or if they’re in the right context, hanging from a ceiling, a suspension artist with hooks through the muscles of their back, it doesn’t hurt. This excites me because it makes me think there’s a potential there to grab whatever it is and teach it or deliver it to people who are on the edges of our society because of their persistent pain. They’re misunderstood, they’re stigmatized, they can’t work, they can’t go to school, they can’t cook for the family, they can’t have sex with their wife, whatever it is. There is a capacity in the human to solve this problem, I’d just really love to see that.” from here: http://smartdrugsmarts.com/pain/
There’s a reason why Sarah-Bella has a tat on her shoulder with “2 (heart)+B(heart)’d” !!
Thanks once again Tim.
The safety message of knowing that radiological findings are largely unimportant is powerful and well established. We can all use that on a daily basis. Also the idea that body heals itself in most cases without any outside assistance.
I can think of a few other safety messages which are unrelated to pleasure. I had a bunch of them written down – openness, empathy, non-judgment, etc. They all had one thing in common and that is they are expressions of love. So I agree with Lorimer’s assertion, that love really is the crux of the matter. Why does BiM spend so much time and effort researching what is of secondary importance? Where are the research papers on love as therapy for chronic pain? I know love is the last taboo, but seriously, isn’t it time Physio came out of the Dark Ages? Pleasure-seeking simply won’t cut it as a long term solution, and nor will the accumulation of knowledge.
Looking back through history, who has done the most in depth and detailed research on love? Answer: the poets, the sages, the mystics, the shamans, the holy men, the gurus and the saints. As long as one is VERY selective, there’s more to learn here about the art of healing than anywhere else I’ve looked in the science literature. Techniques which make a real difference. Techniques which require skill and knack. Science has it’s place, but it just seems to fall short all the time.
“Have you learned yet that you only suffer when you think about events or feel about them, that you don’t suffer from events themselves? Have you learned yet that every thought about yourself is a thought of the past, that worry is thinking and that all thinking eventually leads to worry, fear and insecurity? If so, each time you go to think, or catch the thinker thinking even about “good” things like last night’s movie, don’t [do that]. Stop. Have you learned yet that every feeling is a feeling of the past and that every “good” feeling soon changes and eventually becomes the feeling of doubt, confusion, boredom or sorrow? If so, stop believing your feelings; don’t act on them; wait”.
It might not have been so clever of me to distinguish between pleasure-seeking and love. At least not without defining the word ‘love’. The ancient Greeks had 6 different words describing different types of love, and I find this a very useful reference:
We all know that ‘eros’, for example is highly addictive, probably more so than opiates I’d guess. A dose of this will abolish all pain very quickly… until it wears off that is. Some get addicted, some progress to a different kind of love. My feeling is that addiction (whether it be food, sky-diving or eros) is more likely when the ‘higher’ expressions of love have been thwarted in early life. That’s why it’s so incredibly healing to be on the receiving end of it. The higher expressions of love are not addictive – that’s their nature.
But back to pleasure. Whilst single-event pleasures seem unhelpful for many chronic pain clients, stacking pleasures (“SIM stacking”, to coin a phrase) can be used to give a decent sized boost to the CNS. Decent enough to make a difference to pain levels and function. Then the client is like – “ohhh, I get it!”. They experience the link between mind and body.
Say a client stacks 5 pleasurable activities/thoughts into a day and achieves good pain reduction. How do we prevent addiction? How do we prevent ‘come down’? Is this a better approach than opiates? To what extent should ‘higher’ expressions of love be encouraged in the Protectometer process?
This is worth a look.
EG – Addiction to pleasure can’t be all bad – but we hope that a Protectometer process will open up awareness that there may never be 5, but more likely dozens, maybe more like 50 or more identifiable SIMs. The more they are identified, the more the suppression of DIMS and you could argue that the “comedown” will be to a level of less sensitivity. Higher expressions of love should be sought in the Protectometer process and may be particularly relevant in say a chronic pain state in a person in palliative care.