Although on holiday it was a pleasure to try and give some reassurance to a lovely fifteen-year-old girl suffering from persistent, multi level back pain who had been advised to give up all sporting activities except swimming- she is a fit, vibrant, outdoor girl who loves to be active! Her story included wearing a rigid spinal corset for three years before undergoing spinal surgery two years ago to correct part of her scoliosis – the thoracic component.
Whilst trying to “tell the pain story” in Italian I began to reflect on my own understanding and beliefs concerning the construction of the experience we usually refer to as pain.
Taking the Osteoarthritic hip as an example, following surgery to remove the offending “source of pain” the patient often, even after many years of suffering, awakens pain free.
So how is that possible?
Was the source of pain purely nociceptive with removal of the hip joint causing the “signals” to cease?
Was the pain spinal, and centrally driven by the “issues in the tissues” and turned off when the signals stopped?
Or, was it the expectation, on the part of the patient, that surgery would “remove the pain” with only central mechanisms then taking credit for the pain relief?
I wonder what the result would have been had the patient awoken with the incision, drains, drips etc but the surgeon had only performed a sham operation without replacement. Would the relief have been equal?
My point is, why did this young lady begin to experience pain in the first place? Was she suffering “simple physiological back pain” from too much texting? Did investigation then discover the scoliosis, and was the seed then planted that “That’s a bad one. That must be painful. That has to hurt forever“.
With her present belief systems, has surgery failed as far as pain relief is concerned because she has only had part of her scoliosis operated on?
If she believes the biomedicalists then her pain has to continue- particularly with the suggestion that further surgery is needed to correct other levels. Are we to blame that this poor girl is in pain. Had we not found her scoliosis would a “new boyfriend” have solved the problem? I really don’t mean to be cynical here.
I would be interested in people’s thoughts concerning peripheral versus central…
(On Location, but not brain dead)
David Bolton, MCSP MMACP MSOM, has over 40 years of clinical experience in the field of neuromusculoskeletal medicine. After qualifying in 1971 from the Royal Army Medical Corps School of Physiotherapy, David spent 24 years living and working in Switzerland, running a busy and very successful private practice as well as providing specialist physiotherapy services to the Swiss Alpine Downhill Ski and Ski Jumping Teams, the Swiss National Karate Squad and the Menuhin School of Music.
In 1997 David decided to down size and move his practice back to his roots in London. Setting up in Chelsea Harbour, David now specialises purely in acute and chronic, therapy-resistant pathologies, biopsychosocial thinking being the core of his treatment philosophy. Recently David has been invited onto the education committee of the Faculty of Musculoskeletal Medicine which is a sub group of the newly formed College of Medicine London. In his free time David loves to escape on his Bonneville or spend the day fishing.