A different approach to your pain

Chronic pain is a growing problem

More than 20% of adults in many western societies experience chronic or persistent (long lasting) pain, mostly back and neck symptoms. And there is good evidence that this is increasing suggesting that the traditional, mainstream way of treating pain just isn’t effective for many people.

Traditional medical approach (pain is directly related to damaged or unhealthy tissues)

The truth is that, despite significant developments in our understanding of pain over the last few decades, most healthcare professionals have a pretty outdated understanding of it, one which often results in patients feeling confused and struggling to get better. This overly-medicalised model focuses on medical tests in the body part that hurts as the explanation for patients’ symptoms. Scans are typically used to identify the ‘responsible’ tissues and it is assumed that improvements in symptoms should follow once treatments that restore ‘normal’ bodily function are implemented - often medicine, injections and or surgery. We are not suggesting that tissue quality is unimportant, just that it is only one of many reasons why we experience bodily symptoms and why, on its own, this model fails to help a large proportion of patients in pain. Clearly, experiences of acute (short lasting) pain are useful; they teach us to be aware and to take action when we do have serious injury or medical problems such as malignancy or infection. Acute pain is therefore essential for our survival; imagine not having prior warning that you had acute appendicitis for example. But you cannot scan pain, in just the same way that you cannot scan hunger or the feeling of being tired. You could assume that a tissue that no longer looks pristine is responsible for pain, but research tells us that this is a flawed assumption. However, despite its limitations, this bio-medical approach remains very appealing possibly because it is logical and easy to understand. We grow up learning that things only hurt when they are damaged; it is ingrained in how we think.

Modern biopsychosocial approach (pain is your brains opinion of how safe you are)

A more modern scientific understanding of pain is to view it as part of an overall protection mechanism that the brain and nervous system creates, along with autonomic, immune and endocrine responses when it concludes that the body is somehow under threat. These systems work in a continuous and coordinated manner rather than functioning separately and this is happening all the time without us being aware of it. Evolution has given us a fairly basic in-built ability from birth, but we largely learn to feel pain through our unique life experiences when we have reason to believe (largely subconsciously) that, in any given situation, it is appropriate or expected.

Ideally, as we develop, our nervous system learns to filter, low level sensory ‘noise’ that would otherwise be unhelpful, overwhelming and inefficient before it reaches areas of the brain where sensory inputs are turned into conscious experiences. In patients with persistent pain, however, small, harmless fluctuations in these sensory inputs (which in healthy individuals would be treated as ‘non-newsworthy’) increasingly gain access to these brain areas where they infer harm as their cause and encourage pain accordingly. Sleep deprivation, stress, fear and avoidance of movement, catastrophizing (assuming the worst) and altered mood states all have the effect of worsening pain by maintaining vigilance to symptoms which are predicted in any given situation.

We often see people who are, for example, chronically stressed, fatigued and perhaps depressed whose pain is very real and yet there is no history of injury and scans and blood tests appear quite normal. Conversely, research reliably tells us that asymptomatic populations (people with no pain) are likely to have the same MRI findings as individuals of the same age who do have pain. Pain can be thought of as a conscious experience resulting from the largely subconscious perception or prediction of an ‘unhealthy body state’. It is not a direct and inevitable result of fluctuations in bodily physiology and tissue quality, most of which are quite normal.

On reflection, most patients will tells us that they developed pain gradually over time and for no obvious reason rather than following an acute injury. And, even when it does coincide with a sudden forceful event, time and mother-nature will take care of most things, even severe injury, within a few months. The ongoing experience of pain is largely due to a poorly calibrated, overly-protective nervous system rather than something that continues to be ‘wrong’ with the body. Think of this like a faulty car alarm; you want the alarm to go off when someone really is trying to break in, not just on a windy night; the car alarm, just like someone’s pain, is very real but the reason for the alarm is not anything to be worried about and the alarm is no longer a marker of damage or harm.

Our Results

The good news is that persistent pain is actually very responsive to more modern treatment approaches applying the latest research in pain and cognitive neuroscience. We see amazing outcomes in patients with all types of quite chronic conditions including persistent back pain, neck pain, pelvic pain, fibromyalgia, headache (including migraine) and other common chronic pain conditions. Click on the button below to learn more about our complete treatment programme.

Patient Reported Outcome Measures (PROMs)

We do not just make claims about our treatment results, we ask our patients to provide this independently. We use several outcome measures (questionnaires) to assess the effectiveness of their treatment. We appreciate that this can be time consuming but it is really important to gather data about what we do so that current patients can see their improvements, potential patients can be confident in starting a treatment programme and that various governing bodies in healthcare are able to see how we are doing. We send these questionnaires to patients before and after their treatment and are very grateful to them for their time in completing these.