Dealing with chronic pain conditions poses special problems for therapists in my field because tissue damage plays a relatively minor role in sustaining the pain experience. The research on this is clear: with chronic pain the main issue is sensitivity. And sensitivity is only distantly related to the state of a person’s tissues.
It’s a natural reaction. Your neck hurts, so working where the pain is just makes sense. But what if there’s nothing much wrong with your neck? What if whatever damage that may have been associated with your painful experience has long since healed as much as it is ever likely to heal? What can bodywork do then? And why do you still hurt?
Let’s deal with the last question first. Why does someone’s neck (or back or hand or shoulder or whatever) hurt if there’s nothing much wrong with the tissues in that part of the body? The answer to this is complex but what it boils down to in the end is that a great many things contribute to anybody’s pain experience like fear, anxiety, previous experiences and expectations, a variety of social and cultural factors and so on. And these are different for each individual. When pain persists long after tissue damage has resolved all these factors are contributing to something called central sensitisation. Your brain is continuing to perceive threat and is creating and sustaining pain to protect you. The pain is real; it’s just not closely related to the state of your tissues.
It’s not really clear yet why this happens. But happen it does. A lot. Chronic pain is a very big and growing problem everywhere but especially highly developed wealthy societies.
Can bodywork help with this then? The short answer is yes, it can. For one thing, someone who is experiencing persistent pain is very likely to be protectively guarding the part of their body where it hurts. This muscular holding is damaging and bodywork can help to relax tense tissues and so ease discomfort and help to promote movement. Movement is important because it helps to re-programme the brain – “See, you can move your neck without making things worse!”
Bodywork can also address the central sensitisation directly by easing stress, calming the individual whose chronic pain is strongly influenced by fears and anxieties. Therapists who are aware of the special challenges of chronic pain can assist their clients to take advantage of the window of opportunity created by lowering stress by directing them to various exercises and other self-help measures. There is no single approach that works for everybody; in fact, it is essential that every client’s chronic pain experience is thoroughly explored to draw out the particular features that create and sustain it.
I’m going to provide a few references for those who wish to better understand chronic pain and its treatment.