Up to date thinking
The idea that our thoughts can fundamentally alter our pain is powerful stuff – it’s just about as far away from the out of date notions of ‘pain receptors’ and ‘pain pathways’, as you can get. Like pain, you can’t see a thought, but we know that both pain and thoughts are real and involve complex neuroimmune interactions. If a person says “it hurts”, then no one can say it doesn’t – there is only one witness to the event.
When Explain Pain was first published in 2003, there was a very curious response to the section on “Thoughts and beliefs are nerve Impulses too”. While some readers, especially physical therapists were outraged “you want us to be counsellors and psychologists too!”, and others felt lost “how do I even start talking about this stuff with my patients?”, patients seemed to ‘get it’, and many sent in notes explaining that they finally understood their pain – especially the odd ups and downs that they experienced, and wondered why nobody had explained this to them before. Of course there were some psychologists who were just a bit amused… “you’ve only just realised this now!”
You are not your thoughts
Delving into this territory can be tricky and requires tact, appropriate knowledge, getting a bit philosophical at times – “you are not your thoughts”, and often, the right stories and metaphor. We introduced the notion of ‘thought viruses’ to people experiencing pain, therapists and clinicians in Explain Pain, and it has spread and been picked up around the world now.
Thought viruses are DIMs
The idea of thought viruses fits perfectly within our new paradigm of DIMs (Danger In Me neurotags), SIMs (Safety In Me neurotags) and the Protectometer.
Thought viruses can be powerful DIMs – and likely to be found across the seven categories, for example:
Things You Hear, See, Smell, Taste and Touch – hearing “you have the back of an 80 year old” or seeing normal, age related changes on x-ray (that remain unexplained and threatening)
Things you Say – “I am riddled with arthritis”
Things you think and believe – “movement is dangerous” or “pain is forever”
Thought viruses will also:
Powerfully influence the Things you do – “I am not bending forwards” is a logical consequence of the thoughts, beliefs and other thought viruses above.
Have a real biological effect on the Things happening in your body, such as inflammation.
Finally, thought viruses might be picked up from the People in your Life or the Places you go.
Knowledge can be like a ‘Thought Vaccine’
We’ve made a short clip that we hope therapists will be able to use to introduce the idea of thought viruses (and their ‘vaccines’) to patients. You could watch it in your clinic, have it playing in your waiting room, or perhaps set it as some homework – we know that good education uses multimedia, and hearing new ideas in different ways can help it to ‘stick’ and influence future behavior.
I can imagine a short introduction that might go something like this,
“We’ve been talking about your pain and your brain over a few sessions now, and I want to introduce you to the idea of ‘though viruses’ – these are things that we hear, think or say that are scary and threatening – they are nearly always incorrect, but can be powerful enough to maintain or even increase your pain. Let’s watch this short clip and then we can have a chat about it more – maybe you have a few thought viruses that we need to deal with, what do you think?”
We’d love to hear some of the thought viruses that you have come across out there, as well as how you ‘vaccinated’ against them, and let us know how you use the clip – leave a comment below.
– David Butler and Tim Cocks
This is a powerfully illustrative case study from a critical care doctor at Sydney Uni hospital:
“As an intern I had the privilege of spending a term attached to the Palliative Care service. Perhaps the most difficult and surprising pain case I was involved with was a man in his mid-forties with cancer of unknown primary metastatic to his vertebrae. Despite all attempts to control his pain in an outpatient setting with conventional opioids, adjuvant analgesics, radiotherapy and eventually continuous subcutaneous infusion of methadone and ketamine, his oncologist was unsuccessful in gaining control of his pain and he was admitted under our team with a pain crisis.
To this point his management had remained focused on treating the biological origin of his pain, the vertebral metastases. One of the Palliative Care consultants suggested that we take a step back and construct a formulation of the patient. During the interview between our consultant and our patient we discovered that he was a single father with a 12 year old daughter and an estranged family. He was aware that his life-expectancy at this point was measurable in months and was entirely pre-occupied with concerns over his daughter’s care and well-being after his death. Through the assistance of our Social Workers we were able to contact his estranged family inter-state. A family meeting was arranged after some planning our patient’s sister agreed to become his daughter’s guardian after his death.
Throughout the process of solving this social problem, we noticed our patients pain scores decreasing and his mobility and self-care abilities increasing. Once we had achieved closure on the issue of his daughter’s ongoing care, our previous analgesic strategies become remarkably effective and we were able to discharge the patient home with a continuous subcutaneous methadone infusion which allowed him functional independence.
This case is a powerful illustration of the way in which emotional and psychological turmoil can greatly influence the severity of a patient’s pain. It also demonstrates that a narrow approach to diagnosis may fail to identify the true complexity of patient’s pain and lead to treatment failures which are frustrating for both the treating team and the patient.”
Nick Sinfield Physiotherapist UK
Digital Life Sciences
Thanks so much for sharing this Nick – it really is a powerful story.
Dear David, Dear Tim,
A beautiful and highly useful video. I personally believe that, even in the very first therapist patient interaction the sufferer should leave with some pain knowledge and at least one vaccine against their inevitable thought viruses.
” Hurt does not necessarily mean harm” has got to be one of the earlier ones to inject for their journey to recovery……
Yes, such a key point – every time you meet a patient is an opportunity to share some useful, analgesic knowledge – we hope that these short clips can form part of a broader curriculum and allow therapists and clinicians Explain Pain more easily, efficiently and effectively.
(just wrote a post about hugs – will be published soon – and thought about your lovely idea of hugs as ‘advanced clinical technique’!)
I have been suffering from chronic pain in my back and legs for 5 years now. Explain pain got me out of a wheel chair and to begin the road to independence and increasing function. Education was a big part in my recovery, thanks to my physio in a rehab hospital. Now i can walk up to an hour and got to a regular gym. This recent post has got me thinking about my current problem with constant and nasty flare ups. I just have to look at a different weight machine at the gym and the pain kicks off, i think i can now relate this to my initial injury cased by over exercise and sports. I need a vaccine for the fear of repeating the injury, although i do know that wont happen now the the education i have. Thanks for the information!
Thanks so much for taking the time to share this with us. It’s comments like yours that keep us going and sharing this information in new ways.
All the best with your ongoing journey to recovery
Thanks for the lovely video
A great friend was involved in a nasty hit and run accident some time ago. In the aftermath he was attending a physiotherapist for his substantial injuries and recalled the physiotherapist saying
“Oh well of course, you are a sitting duck for developing CRPS”.
To this day he cannot quite recall why this declaration was made but he says he never forgot the “sitting duck “ remark. He said that there was part of you that wondered did the clinician see something in you you didn’t see and was therefore right? I suppose it shows that without the slightest hint of malice even a well-meaning physiotherapist can cause powerful thought viruses to linger for many years with a casual remark.
On a good note he felt that “desensitising the burglar alarm in the brain” and “hurt does not necessarily mean harm” have been some of the most empowering and powerful vaccines against escalations in his pain.