Chronic Pain and Bowen Therapy*
Most Bowen therapists would consider themselves well acquainted with pain. After all, pain is probably the most common reason people have for seeking our help. It’s also fair to say that most of our new clients will be suffering from a longstanding pain condition, if for no other reason than the fact that we are not likely to be the first person people will call on when they are in pain. By the time someone comes to us they will have probably at least sought medical treatment and often a number of other, more well-known and more frequently recommended therapeutic interventions.
We know from clinical experience that Bowen has a very good record when it comes to treating chronic pain. Why this might be so is explored further below. But frequently clients with this condition do not respond as well as we would hope. Possible reasons for this lack of success are also discussed later in this article.
“It’s not in the Tissue”
The mainstream understanding of chronic pain has shifted significantly in recent years. It is now broadly accepted that these long term pain conditions are much more brain-centred than previously thought. Essentially what we have is a central nervous system disorder characterised by hypersensitisation to painful stimuli. There may be some pathology or residual injury present at the site of the pain but the response to it is exaggerated, excessive and often in itself harmful.
The reasons this hypersensitisation to pain gets set up are complex but typically include fear/anxiety, faulty proprioception, and stress. These can lead to protective guarding, various avoidance behaviours (such as to exercise), immune system impairment, inappropriate or stressful movements and postures, and so on which can perpetuate the problem or make things worse.
People with chronic pain conditions often develop a morbid, ineluctable understanding of their problem. This is wholly understandable. They’re likely to have been told they have a “slipped” disc, or a “frozen” shoulder. Or that one of their legs is longer than the other. Or that, ”The men on our side of the family are all prone to that” or “My friend had it and it took years to get better”. And these are just examples of what health professionals and well-meaning friends and family say. Many more horror stories await those who do an internet search for information on their painful problem.
And it’s not just the unrelenting nature or negative descriptions of their condition which affect those with chronic pain. Their attempts at solutions can also lead to gloomy pessimism. Sufferers often go through a stage of lurching from one therapy to another looking, with increased desperation, for some magic bullet which will make their pain stop.
There is now compelling evidence that our experience of pain is strongly mediated by what we think about it. Consider these two findings about back pain: the most powerful factor predicting how soon people return to work after an episode of low back pain is whether or not they expect to return to work. (Schultz et al 2004) And: people who get MRIs take about twice as long to come off disability (and 8 to 10 times more likely to get surgery) than others with the same type and level of back pain. (Connell, 2011)
Typically, bio-mechanical interventions for chronic pain are unsuccessful or result in only short-lived relief. Research suggests that over reliance on these treatments leads to disappointing outcomes because there is a failure to address the various psychological/neurological factors listed above.
There is pretty good agreement among pain researchers that what is needed is systemic calming. Medication or manipulation of tissue may contribute to this, by creating a window of opportunity through the temporary suppression of pain. But significant results may also require relaxation techniques, mindfulness, postural and movement education (body awareness), appropriate exercise, improved sleep, nutritional changes, stress reduction, and quite a number of self-help measures. In addition to this list we may add various talk therapies through which chronic pain sufferers can be helped to re-frame their perspective on their problem.
Clinical Implications for Bowen Practitioners
It is thought that Bowen strongly engages the client’s parasympathetic nervous system. Since the parasympathetic system is very much about the systemic calming experts are telling us is needed when dealing with chronic pain, it follows that an approach which, at least initially, emphasises this aspect of our work will be particularly effective when working with clients suffering from persistent pain conditions.
If we are to fully realise the benefits of Bowen Therapy, however, we should also be aware of the psychological/neurological features of chronic pain. One of the leading experts in the field of chronic pain argues that clinicians should understand and work from the principle that it is the perception of threat to tissues that determines the experience of chronic pain not the state of the tissues or the actual level of threat. It will not be helpful to add to our client’s negative view of their problem by what we say and, similarly, we can help to give them another way to look at their pain by our careful choice of words. The importance of this should not be underestimated.
Some Bowen therapists will have additional skills which they can offer clients with clients with chronic pain. For example, we may be able to offer useful advice about self-care strategies designed to increase confidence and provide some measure of control over pain or we may be qualified to suggest nutritional changes. For the rest of us, it may be preferable to develop a solid referral network.
This is just a short list of easily accessible resources for exploring current pain research and understanding. Some of these contain extensive references for those interested in developing a deeper knowledge.
A short pain video – all you need to know in 5 minutes
Ingraham, Paul, “Pain is An Opinion”
Mosley, G. Morimer,“Reconceptualising Pain According to Modern Pain Science” http://www.bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/
O’connell,*Neil.. “On shiny pictures and poorer outcomes: spinal MRI &back pain” http://www.bodyinmind.org/spinal-mri-and-back-pain/
O’Sullivan, Peter, a leading chronic pain researcher and developer of Cognitive Functional Therapy
Schultz et al. “Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model”, Pain. 2004. PubMed #1471539
*First published in "In Touch" the member's magazine of the Bowen Therapists Professional Association of the UK, in January, 2014.