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Connecting the Dots.

When it comes to pain, are you missing two thirds of the pain problem.


Do you know that there are three areas that influence pain?

The cause of pain and therefore the most effective methods for treating it are bio-psycho-social. This means that there are three interconnected, equally important areas to target if we want to effectively treat chronic pain and other health issues. 1.biology / physical (bio), 2. psychology / emotional (psych), and 3. social factors. These three areas overlap to both produce and reduce pain and symptoms. Because your brain is connected to your body 100% of the time, your social health, emotional / psychological health and physical health are intricately and inextricably intertwined.

Not surprisingly, these three domains are all interconnected and intertwined. Taking care of one domain affects all domains because your brain and body are inextricably interconnected. When it comes to pain, exclusive focus on the “bio” domain of pain misses two-thirds of the pain problem.

Pain = Biology + Psychology + Social Factors


1. Biological / physical components of pain and health issues include genetics, age, tissue damage, mechanical and anatomical dysfunction, inflammation, immunological issues, and movement dysfunction. It is important to say that these components will always be a part of any treatment regime in chronic pain. However, they are not the main or only components. Also, nutrition, sleep and lifestyle (which are biological) habits play a vital role in our body and brain’s response to pain. These biological factors are commonly treated with medical interventions such as medications, manual therapies, and surgeries. While these interventions are often helpful for acute and shortterm pain, research suggests they are considerably less helpful for chronic pain.


2. Psychological components of health are less commonly addressed, in part because, until recently, we didn’t closely link these to physical pain. The psychological domain of pain includes cognitive, emotional and behavioral factors - thoughts, emotions, beliefs— the meaning we assign to our pain, memories, prior experiences, expectations and learned coping behaviors. Emotions like anxiety, depression, anger and helplessness also commonly and understandably occur when we’re sick or in pain. You will learn throughout these episodes that negative emotions amplify pain. It is important to become aware of how our thinking and past adverse experiences have set up neurocircuits in our brains that have a much greater influence on our pain than we believe.


3. Social, or sociological includes cultural, societal and socioeconomic factors; adverse childhood events like trauma, family factors and relationships. Also, in this domain are environmental context and social support. Humans are social animals and we evolved to need each other to survive. Research has shown us that our brains and bodies release health promoting chemical in the presence of others and health suppressing stress hormones when we’re lonely and isolated. Indeed, being isolated at home, missing work and social activities and stopping hobbies and other activities makes pain worse. The opposite is also true. When you improve social functioning, you can also reduce your pain. Social components also include socioeconomic, cultural and environmental factors like race, income, unemployment, access to healthcare, inadequate housing, abuse and trauma.

As we have said before in other articles, these three domains are all interconnected and intertwined. Taking care of one domain affects all domains because your brain and body are inextricably interconnected. When it comes to pain, exclusive focus on the “bio” domain of pain misses two-thirds of the pain problem.


Pain = Biology + Psychology + Social Factors


The game of Connect the Dots.


Do you remember as a child playing the game Connect the Dots? Where there were dots on a piece of paper and as you connected one dot then the next the full picture would be revealed to you. You had to connect the dots correctly to get the full picture. Identifying a patient’s diagnosis can be compared to a complex game of Connect the Dots. Even the most skilled practitioner needs a few dots connected prior to formulating an accurate idea of the overall image. The patient’s history, symptoms, lifestyle factors stressors, and physical activity all provide information and “dots” to formulate a clear final picture.

Just as each individual dot is important to create the final picture, each aspect of a person’s life provides clues into their diagnosis and why they may be experiencing pain or having persistent symptoms. If you fail to systematically connect the dots or try to guess the final image with too few dots, the picture won’t be clearly defined, or an entirely different and inaccurate picture may unfold. Placing too much emphasis on certain dots, such as diagnostic testing and imaging, posture, specific muscle weaknesses, or movement patterns, may lead to prematurely drawing conclusions and potentially, a wrong diagnosis. This is especially true when it comes to the complex nature of determining the causes of pain.


The conclusion of this analogy is that thoughts, beliefs, emotions, mood, perceptions and context can adjust pain volume. If thoughts, beliefs, and emotions can amplify or reduce pain, this means that you have more control over your pain than you may have realized. In fact, you can take control of your pain dial by managing (1) stress and anxiety, (2) mood, (3) attention, (4) interpretations and understanding of pain and (5) learned coping behaviors.


You’ve got this!


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