Tune in to find out what Lester Jones wants people challenged by pain to discover? Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Lester Jones.
About Lester Jones
Lester Jones is a senior lecturer at the Singapore Institute of Technology. Lester was the Inaugural Chair of the National Pain Group within the Australian Physiotherapy Association. He is a Graduate Researcher in the Judith Lumley Centre at La Trobe Univerity. Check out his research profile.
Lester encouraged viewers of this video to look into the following papers: http://doi.org/10.1038/nn.3628
http://doi.org/10.1016/j.math.2014.01.010
http://doi.org/10.1080/13562517.2016.1248390
Transcript
What’s the one thing that you want people challenged by pain to know about?
So, I guess I’m going to be a little bit disruptive to start with, Josh. I’m going to just change the question a little bit. Because I think what I’m interested in is not what people what I want people to know about, but actually what I want people to discover. I think that works a little bit better with how I work and think about pain. I guess the thing is that I want people to discover, the one thing I want people to discover, is that pain is a whole person experience. Over the years I’ve developed a bit of a mantra that pain is always complex but sometimes it presents simply. That really reflects I guess what we understand about all the contextual things that influence the pain experience. But today I thought I’d sort of focus a little bit more on one aspect that I found really interesting which is pain vulnerability, and this was presented in a paper by Franziska Denk, Stephen McMahon, & Irene Tracey. Essentially what they’re saying is that over the lifespan someone’s protective system, their body’s sensitivity I guess, can actually be primed, in a way, that so that they’re actually more primed to experience pain. I think that’s really interesting because I guess a lot of effort has been focusing on the transition between sort of acute and chronic presentations of pain. But in fact, maybe what we’re missing, is what’s happened before the pain even starts, so I think that’s really, really fascinating.
I guess that the process that I sort of follow is that I often talk to patients about this concept of an “over applied protection”. I guess with that, I’m thinking that the person’s system has got to a point where it’s protecting more than it needs to be. I guess that that’s probably not the right way of putting it because I think there’s always a need for why this protection exists. But certainly it’s more than what it needs to for any tissue-based problem. I guess that the impact on the patient then, and why like why I think that’s important for the person to just discover this, is that when they realize that there’s more than just a tissue-based influence on their pain they actually can find new ways of developing or managing their pain and addressing the pain concerns that they have. So yeah, that’s probably the overview of it. Would you like me to share an example with you, Josh?
Yeah, I’d love to hear how you explain that to a patient.
I guess one of one of the things that I use is the pain and movement reasoning model which is a reasoning tool that I developed with Des O’Shaughnessy. Often I’ll present that to the patient as part of the pain education process.
If I can perhaps share an example of a man who I saw he’s in his 60s and he was he was frustrated, I suppose, that people really hadn’t been able to explain his pain to him. And he probably had a very patho-anatomic sort of view of pain, which I guess is normal, because from an evolutionary perspective that’s how our pain system set up: to sort of persuade us to look after the part that’s vulnerable. His frustration was… he had been to many, many physiotherapists and doctors to try and unpack what was going on, yet he still couldn’t understand it. So with this process, what I’d normally do is: I’d sit down with someone and I’d say “so this is how I understand pain” and then I just explain the components of the pain and movement reasoning model, which consists of local issues around the tissues themselves, and usually being able to feed in what the person’s told me in the history taking can be really helpful there. So, with this guy I was able to include his understanding of his pain in that story. And then we talked about perhaps more biomechanical, or regional issues as we call it in the model, and then finally we talked about the more central modulation influences. And I could see that he really started to engage with that.
That was followed by one of those really nice long discussions where you just feel privileged as a clinician that someone’s sharing deeply their story with you. He basically explained that in his childhood he suffered quite a lot of poverty and bullying as a result of that. He reflected that he really finds that he still gets quite upset about that stuff, even though it was many years ago. So I guess as part of him discovering this new way of thinking about pain, or at least identifying that there were these other influences that were about him as a whole person, it meant that he was then able to start to suggest himself… you know come up with pronouns himself… about how he might be able to manage this. And so, his suggestion was essentially that he thought his pain probably wouldn’t improve very much until he started to address those issues from his childhood.
I guess that for me when he came in in the door that day, he was feeling helpless and hopeless, I guess. By giving him a new way of thinking about pain and helping him to discover this, I suppose new knowledge I guess, he left being hopeful. And I think that’s really important: that we sort of at least can make that transition with someone, so that they can feel a bit more optimistic when they leave our clinical practice.
I think this is the fascinating thing. Once you once you sort of start to understand that there’s so many other contextual influences. There’s a physio colleague [I] used to work with at La Trobe, Sarah Barradell, who’s done some great work on threshold concepts. Essentially, what it’s saying is that threshold concepts are the point where you can’t go back. Once you’ve changed your knowledge about something, you can’t go back. For example, the times that I’ve used that it’s probably with pain, it’s probably once you realize that pain is constructed by the brain and other sort of experiences or contexts and it’s not in your tissues, then you can’t go really go back from that. Once you understood that, and accepted that, you can’t go back the other way. That’s an example of a threshold concept, that once you get there you can’t go on.
So, I guess that’s the thing that I wanted to share today: that essentially that I feel that if we can help people discover that pain is a ‘whole person experience’ then wider opportunities arise for how their pain is managed and addressed.
Fantastic, thanks so much for that Lester, that’s really informative. Thanks for your time.
No problems.
Credits:
I think the use of behavioral experiments is to me almost essential education. I think that’s why physiotherapists are in such a privileged position for that role, because we can then give people safe places to try things.