This whole pain science “revolution”

Posted on March 26, 2014

(Last Updated On: April 1, 2016)

Preface: I find the pain science world valuable. I’ve learned from it (such as here), become better at what I do from it, written about it (one example) and continue to follow it. There are some bright people doing great things in that arena. I’ve never had any personal issues with anyone from that world, nor do I plan on it.

When I was 16, I had a serious ankle sprain playing football. I was running a route, got my foot caught in the turf on the crappiest field ever, and promptly hit the deck. Eventually, I got up, walked to the sideline, and after a few minutes was running around again. No big deal. I had turned my ankle too many times to count. Before I could get back on the field it was halftime.

During halftime our horrendous athletic trainer made me lay down, elevate my foot, and ice it. As I’m sure is shocking to no one, when halftime ended, I got up, tried to walk, and realized I was crippled. 20 minutes of not moving, icing, along with calming down during halftime, let me really feel what just happened to my ankle. I wasn’t going to be running again for a couple of weeks.

Maybe 10 minutes into the third quarter my teammate goes down. Ankle injury as well. In fact, a few hours later while we were in the hospital, we learned we both had high ankle sprains. While I never had a high ankle sprain, I had many sprains, and many other injuries before. My teammate had suffered bumps and bruises, but they were pretty minor. This was easily the most serious thing he had experienced. (He hadn’t been playing football as long as me.) While my family and I went, “Eh, I guess we should go to the hospital and get some X-Rays to be sure it’s not broken,” my teammate’s family was more like “We’re going to the hospital. Now.”

About two weeks later my doctor told me I shouldn’t worry about doing any more damage to the ankle. It was only a pain issue at this point. If I could tolerate it, I could play. And playing was important with the playoffs around the corner.

I’m immediately out practicing and get hit near my ankle injury. My coach -who wouldn’t normally worry- yells out if I’m ok. After the initial scare wore off, I told him I was fine. Nothing to worry about. I played that week, and a week later my teammate was also playing.

Years later, when that teammate and I were college roommates, we would talk about that ankle experience. It was common for us to say, “Man, it hurts just to talk about.” We still had pictures of our ankle from right after the injury. Pictures we eventually deleted. Looking at them felt no better than talking about the injury.

“You think you’re better’n me?”

If you at all follow the pain science crowd, you quickly realize one of their big plights with, well, it seems everyone, is the science hasn’t become more mainstream. There is some genuine effort on their part to disseminate the information, but, they just can’t seem to figure out why they’re having trouble doing so.

Too much revolving around health and fitness becomes polarizing. What’s great to one person is the end of the world to another. Worse, and this is where I get pissed off, it’s not “This is great, and that’s not.” No, it’s “What I do is great, what you do isn’t, and therefore I’m a better person than you.” This is not always explicitly said, but most human communication is not.

It doesn’t take long to get this feel from many circles. CrossFit and Paleo are prime examples, which is why I’ve gone after them at times. (Is anyone else tired of seeing CrossFit status updates and Instagram Paleo meals?) Not because Paleo is some terrible eating style, but because people who eat Paleo go, “Yeah bro, I’m Paleo, what are you?” In a tone so obviously saying, “If you’re not Paleo, what’s wrong with you? Wait, you eat GRAINS?! Oh my god oh my god oh my god.”

These are quotes I repeatedly hear and read from the pain science world:

“This is one of the most important articles you will ever read.”

“There is a revolution going on in how we understand pain.”

“Will our profession ever learn?”

I once heard a smart guy, from a different field, say,

“I have no special talents. I am only passionately curious.”

The pain science crowd seems to be going the other way here, no? If they’re doing something revolutionary, and most others are not, they would be doing something special, right?

I grew up in New Jersey. What often seems to be the most hated state in America. In college I would travel to my buddies schools in various states. We would be out at a bar or some house party, trying to talk to girls, you know, the typical college guy lifestyle. Invariably, this happened:

Girl “Where are you from?”

Me “New Jersey, how about you?”

Girl [UTTER LOOK OF DISGUST] “Oh, that’s…cool.”

Whenever I asked the reason for the disdainful look I received answers of “All New Jersey people are terrible.” If the person had been to New Jersey, then it was customary to hear “I’ve been there. The whole place smells like a landfill.” (Being in school while The Jersey Shore was on didn’t help.)

The point is, New Jersey people are considered some of the biggest dicks in all of America. We curse, we honk, we’re blunt, we apparently smell, but I can tell you, at least in my hometown, you went out of your way to never act like you were better than somebody. Being so close to Manhattan, there are parts of New Jersey that are about as wealthy as it gets. I had friends with elevators in their houses, friends with heated driveways, mini golf course in their backyard, and you would never know it.

I think the first part of the pain science world’s problem is this. When you say things like “This is the most important thing you will ever read,” act like you so clearly know better than others, or state you’re part of a “revolution,” you isolate yourselves. To the point people don’t care if you’re right, they don’t want to deal with you regardless. It’s not the abrasion people have trouble with -though that doesn’t help- it’s the egotism. My friends and I won over plenty of people in college. Not because we weren’t a lot of what people expect in New Jersey, but because we didn’t act like we were better than those not from there. I’ve verbatim heard, “Those guys are from New Jersey but they’re actually alright. Down to earth; just looking to have a fun time.”

The second part of the problem has to do with this whole “revolution” bit.

Revolution screen shot

I suppose the second definition is being suggested.

Here are some of the major tenets that have come from pain research:

  • Pain is normal.
  • Pain is contextual.
  • Many things can affect pain. Your beliefs, level of fear, past experience, etc. The degree of pain is individual.
  • The degree of injury is not always related to the degree of pain.
  • We can become extra sensitive to pain.
  • Be careful in how you talk to people about pain. Just talking about pain can cause pain.

First, there’s a lack of consistency. The pain science crowd says all of this -this revolution- has come in the last ~10 years. Yet, David Butler and Louis Gifford -two often referenced figureheads of the pain world- said in the first line of this paper, in 1997,

“In the past three decades, a scientific revolution has occurred in the understanding of the experience of pain.”

So, 10 years ago we started a revolution that, apparently had been already going on for more than three decades? What was the second definition for revolution again? Something about change being “sudden, extreme, or complete”?

Then there’s this often cited study, from 1994, which found 64% of asymptomatic people had abnormal spines. Such as bulges, stenosis, herniations, etc. People with “damaged” spines had no pain. Again, this was found a decade before the revolutionary decade started.

I bet we can go even further back though. Like, hundreds of years back. Maybe even thousands. Let me rewrite those bullet points for clarity:

  • Pain is normal

Everyone experiences pain. It’s not some aberration of the human experience. If you sprain your ankle, you, and most people, will feel some pain. That said,

  • Pain is contextual

If other things are going on, you might not feel much pain. For example, if you’re in the middle of a football game, where you’re distracted, you have tons of adrenaline pumping, you might not feel much pain. Once you calm down, you’re relaxed, you look at your swollen, bruised ankle, you may feel a lot of pain.

  • Many things can affect pain. Your beliefs, level of fear, past experience, etc. The degree of pain is individual.
  • The degree of injury is not always related to the degree of pain

If you’ve never had a particular injury, having one may cause you to experience more pain than someone who has. Say you never had an ankle sprain before. The first time you have one may be really bad. You might be thinking, “Oh god, what happened? What am I feeling? Am I ok? Did I break something?”

Whereas if you’ve had a bunch of ankle sprains before, where you know you’ll be fine in a couple of weeks, you might not think much of it. You might be frustrated, have some pain, but it probably won’t be terrible.

Because not everyone will have the same past experience, same pain tolerance, etc. it’s unlikely two people will have the same pain response to the same injury. There are going to be some differences. While you may start playing football again after two weeks, a teammate of yours may need an extra week.

  • We can become extra sensitive to pain.

After a previous injury, it’s possible to become sensitized at that site. If you’ve had, I don’t know, let’s say an ankle injury in a football game, and have something hit that ankle in practice, you could be more likely to feel pain than if the same thing happened at the other side. Or if the same thing happened and you didn’t have the previous injury. Due to the past experience, your body may build some natural defense against something further happening to that ankle.

  • Be careful in how you talk to people about pain. Just talking about pain can cause pain.

“Years later, when that teammate and I were college roommates together, we would talk about that ankle experience. It was common for us to say, ‘Man, it hurts just to talk about.'”

You know that “Mind = Blown” GIF?

Mind blown GIF Jenna

For the majority of pain science tenets, I find myself using this:

Stanley not-impressed

For the angry bro about to come at me, this is where you reread the preface.

I’m not using the story from the beginning of this post to show I had some amazing understanding of pain as a 16 year old. I use that story because I lived it, I know many others have had a similar pain experience, and I’m sure many humans in the last thousands of years have as well. I mean, does anyone really think you need an extensive science background to get this? That someone is going to hear the above bullet points and go, “HOLY SHIT. I, uh, oh my god, I would have never thought that.”

A few days ago I’m at dinner with my girlfriend. We start talking about a shoulder injury she had while playing softball as a teenager.

“My shoulder completely came out of the socket. I immediately grabbed it. I actually wasn’t in that much pain, but it was freakin’ scary. And then I pitched the entire next day.”

“There was a long time where opening a door could be painful. Actually, sometimes it wasn’t too painful. It was more being scared I think. It would sometimes pop in and out, and it was scary.”

(Other things, such as fear or context, can influence pain. While pitching: Not much pain. While opening a door: More pain. )

“Yeah, I don’t know. I know a shoulder dislocation is painful for a lot of people, but I think I might have a higher pain tolerance. Growing up playing so many sports. Plus, my dad had a lot of injuries. You just kind of get used to dealing with things.”

(Degree of damage doesn’t necessarily dictate degree of pain. Pain is individual. Past experience can influence pain.)

“In fact, just talking about it right now, I can feel it throbbing a bit.”

(Talking about pain can cause pain.)

“I’m sure it’s all worn out in there, but who cares? It’s supposed to be.”

(Beliefs can dictate pain. Many people equate a joint being worn out with being in pain.)

My girlfriend, who has zero biology or pain science background, understands this “revolution.” She understood it as a 14 year old -when she had her original injury- well before any of this “paradigm shifting” research came out.

Does anyone really think she is alone? That only a few people have had experiences like the above? No, of course not. Whether it’s themselves, or someone they know, people already know a lot about pain. They might not have been able to articulate it like we’ve been able to the last decade or so, but they already intuitively understood it. Cavemen understood this stuff. Speaking of cavemen, I had football teammates I tutored -who didn’t know what a fraction was- who understand the “most important information I’ll ever read.”

This isn’t a revolution. None of us are causing some perennial shift in our conception of pain. We’re all just inching our ways towards a better understanding of things. We’re not going from a Blackberry to an iPhone; we’re going from the iPhone 4, to the 4s, to the 5, to the 5s… Not revolutionizing, but incrementally improving. If you want to see what it takes to revolutionize something, read Einstein: His Life and Universe. Because this isn’t General Relativity. Hell, screw the revolution aspect. Reading that book is a good lesson in humility.

Einstein I have no special talents quote

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Posted in: Miscellaneous, Pain