To me, so much of what makes up someone’s chronic pain management are the experiences they’ve had along the way.

• Your scans revealed nothing was amiss in your body, so you’re questioning whether you imagined it.

• The “cause” of your pain was treated and it didn’t go away, so you’re mortified that others think it’s psychosomatic.

• No signs of ongoing damage and “there’s nothing to be done from a medical standpoint”. You accepted a referral to a psychologist, feeling like you must be damaged emotionally. Or you didn’t accept the referral - you’re not depressed, you’re in pain.

• Your symptoms feel like a mystery- they never quite fall into a clean diagnosis, so you keep seeking any test, procedure, or appointment that might legitimize your chronic pain.

Something is happening here? Let’s break each of these down.

One of the biggest contributors to these experiences many women have had is that chronic pain has been erroneously labeled a mostly biomedical problem. By biomedical, I am referring to physical, mechanical, and anatomical. For many years, scientific medicine focused on identifying and addressing the physical causes (and fixes) of pain. This makes sense as a place to start, right? Most of us feel like pain lives in our bodies. Would it freak you out if I told you that this “start” to understanding pain, which began as a physical understanding, is from the 16th century?

Today, a 400-year-old model for understanding pain is still the one most commonly used by medical health professionals. This approach, when used alone, is outdated, and unacceptable, and we know that it doesn’t address all of the issues of chronic pain.

Strangely, we can easily dig into literature and see decades of research acknowledging that pain is biopsychosocial. The revolutionary model that often stands out the most is the Gate Control Theory (from the 1960s!) which points out how the pain that we feel is impacted by multiple factors including biological/physical, but also beliefs, emotions, social factors, coping behaviors, and context, to name a few. Astonishingly, there is tons of literature highlighting the fact that pain lives in the overlap of many biological, psychological, social, and contextual factors.

Yet for decades, when providers talk about, teach, and treat patients, it is often treated as a purely biomedical problem with biomedical solutions with pill after pill and procedure after procedure. In fact, in an evaluation of pain medicine curriculum in medical schools, it was found that 96% of UK and US medical schools and nearly 80% of medical schools in Europe had no compulsory teaching dedicated to pain medicine. This tells me that those perceived to be at the top of the food chain in the medical world are not getting the education that they need to adequately respond to societal needs around chronic pain.

Now let’s go back to those experiences you may have had. Looking at scans of the body to find a physical cause, finds no physical cause. Using medication or procedures to treat, results in no, or not enough, physical improvement. A physical diagnosis that you don’t quite fit into. Without proper education on how to educate you, a provider might be at a loss to explain your chronic pain to you and how to approach it, leaving it to feel like a mystery. Or worse, leading us to feel like it is imagined, psychological, or illegitimate chronic pain.

A biomedical picture of your chronic pain is not the most comprehensive or all-inclusive way of looking at it. And if we only treat pain from one (bio) approach, we are missing the other 2/3 of the problem (psych and social/contextual). I’ll be talking about this biopsychosocial model and how pain is multidimensional more this week on instagram and in later blog posts.

And if you’re curious to learn more about your pain coping style, you can try my free quiz.

But what I want you to understand today, is that this is NOT. YOUR. FAULT.

Chronic pain has been treated from this biomedical model for so long and we as patients have, understandably, embraced this culture too. We’re all looking for a fix, right? Let me paint a picture of how easily this happens.

We present to our provider’s office with low back or other pain that is starting to make our life feel smaller and smaller. The provider orders x-rays, grabs the nearest spine model, and describes “a bad disc”. What’s happening here is that the biomedical model is set in place: we learn that the presence of pain is due to old or ongoing tissue damage and something is wrong, physically. The provider focuses on addressing the “bad disc” and the patient experiences the hope that the treatment, or fix, will make it go away. There is a cure!

How many times have you encountered something similar? Hope, instilled at an appointment for your chronic pain. Appointments followed by disappointing results. I imagine that if this scenario worked out for you, you wouldn’t be sitting here reading my blog. And look, we should rule out red flags and use medication or procedures as part of a treatment plan for addressing pain. These treatments work really well for acute pain, or pain that hasn’t been around for very long. A biomedical approach to pain is also an important part of addressing chronic pain.

But chronic pain that has lasted for years begins to take on a whole new shape. And what if we viewed chronic pain as a phenomenon that is shaped and molded by the unique person experiencing it? All pain is real, personal, and impacted to varying degrees by our unique biological, psychological, and sociocultural context. When the complex nature of pain isn’t fully appreciated, those with chronic pain are left to feel scared, damaged, crazy, and marginalized.

Say it with me: My pain is real. My pain is personal. My pain is multidimensional.

Believing that your pain is real and personal is the first of five building blocks of my pain philosophy and educational approach. You deserve treatment for your pain that acknowledges this first and foremost.

If the treatments recommended to you over the years haven’t reflected this truth, it’s okay. This is a great place to begin. Keep following along, and we’ll fill in the empty spaces together. Know someone who needs to hear that their pain is real too? Send this journal their way. Let’s start dropping the stigma around chronic pain.

Education provides the power to take the next step in managing your pain. You want to do the things you enjoy (or even basic daily activities) without flaring up your pain. For a limited time, you can grab my free video tutorial to get you started:

3 Simple Steps to a Balanced Day... Without the Flare-Ups.

This free video tutorial is dedicated to helping women with pain begin to find confidence to return to the moments, activities, and people they love the most.

References:

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979.'

Shipton, E. E., Bate, F., Garrick, R., Steketee, C., Shipton, E. A., & Visser, E. J. (2018). Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain and therapy, 7(2), 139–161. https://doi.org/10.1007/s40122-018-0103-z