“How’s that physio?” – chatting about chronic pain

Two men are chatting in their local pub in Dublin.

 

‘So how are things Frank?’

‘Ah, you know, grand. Well not great really actually – the old back and the sciatic is really giving me gip still.’

‘Didn’t the doctor send you for physio for that?’

‘Yeah, yeah, I had me appointment today.’

‘Was she nice? Did ya get a rub, did ya?’

‘Jaysus, I couldn’t believe it, this fine looking young one comes out into the waiting room…and calls in the old dear who was sitting beside me. And then my fella comes out. Big baldy fella, Austalian or New Zealander or something. Big muscles on him too – wouldn’t look outta place in the back row of a scrum, ya knowwarrImean?’

‘Ah Jaysus, where’s the justice in the world eh?’

‘So anyways, he gets me in to the room and starts asking me all these questions. Millions of them. How long has it been going on, what makes it worse, what makes it better and all that stuff. But other stuff too like, how do I feel about the pain? Jaysus – How do I feel? I feel like it’s a pain in my arse so I do. “No”, he says. “Are you worried about the pain?” Am I worried? No. Well. Maybe. I sometimes wonder if it’s ever going to go away. And he’s nodding his head and looking all sympathetic and that.’

‘So did he actually do anything for you’.

‘Well this is the thing. He got me moving and bending and poked around in me back and arse and did all these funny tests like hit me with the hammer and touching me with cotton wool and seeing if I could feel it. And this one test where he got me to stretch out me leg and Jaysus it was agony – like electric shocks down me leg.’

‘Sounds nasty.’

‘Ah it was grand. But then he gets me filling in all these forms and stuff. Said he wanted to know a bit more about my thoughts and feelings about the pain. Feck sake, “I don’t need a loada forms to find that out” says I. “I can tell you now – I’m feeling fairly ticked off with the pain and I thought I was gonna get some physio today.” Anyway I had to tick all these boxes.’

‘What? Sure how’s that physio?’

‘I know. Anyway after all the questioning and form filling and stuff, he sits there thinking for a minute. Kinda beard-stroking – cept he didn’t have a beard ya knowwarrImean? And he says “Right I’m going to explain my examination findings to you and talk about strategies to help get you better”. “Great says I”. But then he wheels out one of those big white boards and takes out some coloured pens.’

‘What? Jaysus – it’s not school is it?’

‘I know. So he writes the words “Chronic pain” up on the board. And says “you have chronic pain’. “You’re telling me says I. It’s fecking something chronic alright.” And he says, “Now some people refer to chronic pain as meaning pain that is really bad but in actual fact chronic pain simply refers to how long you have had the pain.”‘

‘What?’

‘Yeah, so he goes all into this massive explanation about how acute pain is when you have an injury and you get all these little cells called inflammatory cells that are basically helping you to heal up. And that the pain in acute pain is useful.’

‘Useful?’

‘Yeah – useful – I kinda get what he’s talking about though. It’s like, if you broke your leg and you didn’t get any pain – sure you’d just walk around on it and it would never heal or it would set wrong or something. It’s kinda like the pain is protecting you.’

‘Oh right yeah’.

‘And he told me about these kids that are born without the ability to feel pain and how they get hundreds of fractures and burns and other injuries without even realising it and end up in wheelchairs and that.’

‘So he’s saying that pain is a good thing then?’

‘Well its good in that it protects you from making an injury worse. It warns you not to do something that will harm it. But then he starts talking about how after about three months all the healing is done and dusted and that those inflammatory cells are all gone and that then in most cases the pain just goes away but in some cases (like me – just my luck) it continues and that this is called chronic pain.’

‘Oh right. So is that why the anti-inflammables don’t help anymore?’

‘Yeah exactly. You see he told me all about what happens in your nerves and brain and spinal cord when you have pain for a long time.’

‘Your nerves? Sure you wouldn’t have problems with your nerves Frank – you’re not a nervous type are ya?’

‘No not that kind nerves – like the little wires in your body that carry all the signals for you to feel anything or move anything.’

‘Oh okay right.’

‘So yeah he tells me all about brain scanning studies and stuff.’

‘Jaysus do you think they’ll find one when they do you?’

‘Ah now. This is serious. So apparently right, there’s this part of your brain – I think he called it the sensory cortex or something. So anyway this bit of the brain is used for processing all the information about what we feel. Like if I rub your leg – the leg part of the cortex lights up.’

‘Right so what though?’

‘Well you see, normally we don’t have a big area in the cortex for our back or our arse. Funnily enough though we have huge areas for bits that need loads of sensation like our fingertips or our tongue and our – as he put it “genitalia”.’

‘Hah – did ya tell the wife that – that the physio said you had a massive langer in your sensory cortex’.

‘Hah – brilliant. Good one Jerry, good one!’

‘So anyway the boffins in the labs, they’ve done all these brain scan studies and they have shown that when people have chronic back pain – like pain for ages and ages – that the area in the cortex for the back gets massive. It’s like our brains get really good at sensing the pain.’

‘Oh is this kinda like you know the way they say that the London cabbie driver has this massive overdeveloped area in their brain from learning the knowledge and that?’

‘Yeah basically. He wrote this big long word on the white board – “neuroplasticity” and says that basically our brain responds and changes as a result of how we use it.’

‘What’s all this got to do with getting rid of your pain though?’

‘Well, he said that because the nervous system is where the main problem is when the pain is chronic, that we need to treat the nervous system and that there are lots of ways of doing that.’

‘Like rubbing it and stuff?’

‘No – he said that massage and things don’t work very well when the pain is mainly in the nervous system. That we had to use all these other strategies.’

‘Other strategies? What the feck does that mean?’

‘Yeah I know. He writes all these other things up on the board like Mindfulness and goal-setting, and breathing exercises and physical exercise and something called cognitive behavioural therapy and a load of other things I can’t remember.’

‘Right, Jaysus. Doesn’t sound like physio does it?’

‘Not really no. But you know I think there might be something in it. I mean he’s the first person I’ve seen – and I’ve seen loads – who actually seemed to fully get and explain why five years down the line I still have pain. And, he did this really thorough examination where he checked all me nerves and discs and joints and everything and showed me there wasn’t anything serious going on’.

‘But wharabout the scan ya had? Didn’t that show all these discs out place and that?’

‘No, no. He looked at the scan in fairness to him and he told me about this big study that was published that showed that by my age – most people have at least two discs kinda bulging out – that it’s normal and not necessarily the cause of any pain.’

‘Okay right. So did ya get any treatment in the end?’.

‘Well no but yeah. You see the explanation of chronic pain – or “Explain Pain” as he called it is the first part of the treatment. He told me about this guy in Australia – funny name – Lorimer or something. And he did this bit of research which basically showed that people who had chronic pain improved just by having a session where they learned all this stuff about chronic pain and what happens in your brain and nerves and that.’

‘How does that work? How can you get less pain from just talking about it?’

‘Dunno really. But to honest I kinda feel a bit better already myself. Its cause like I know that there’s nothing too serious going on and I think this bloke seems to think I have a good chance of improving things. So I’m happy to give this a go.’

Right. Fair play’.

‘The funniest bit though – it really is like being back in school. I’ve got bleeding homework.’

‘Homework? What?’

‘Yeah, I’ve gotta make a list of all the things that I am having difficulty with because of me back and then he’s going to help me set goals for these things.’

‘Right. Fair play.’

‘I said to him at the end – did he reckon I’d be good at Irish dancing after all this treatment. “Yeah’, he says, “I don’t see why not.” “Great”, says I, “coz I was never any good at it in the first place”. He got a good laugh outta that one.’

‘Hah! Good one Frank. Good one.’

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