My pain origin story

It depends.

These two words used to frustrate me more than I care to admit. While in school to become a physical therapist, these two words were my professors favorite way to answer. To nearly every question, I would hear, “it depends”. Back then, when I was young and naive and thought answers were absolute, I did not receive this well. Now, I can look back and smile, knowing they were right, but also knowing they usually ended the answer there and that is far from the end.

My school was very evidence based, like most medical institutions. It relies on results of rigorous research to drive its curriculum and how it teaches students. But because we are humans and not machines, research doesn’t always translate to real life. There are a few more variables that cannot be controlled in life outside of a lab. This is the conversation I wish happened after every one of these infamous “it depends” answers. But it never happened. I am not sure why. Of course, most of our professors had a plethora of clinical experience. They knew that what they taught was not always going to work perfectly. Yet, they never dove into the nuance with us. Perhaps it is something we needed to learn on our own, with time. (To my professors credit, they also drilled into our heads that there is no such thing as a “cookie cutter” approach to physical therapy.)

It is shocking to know that in all three years of my schooling, we never once discussed the complexity of pain directly. The only time I recall briefly discussing pain was when they were teaching us how to complete a group of tests that would identify people who did not have a physical origin of their pain. It was directly implied that these people were making up their pain. That there was no way they were in pain because the tests showed inconsistencies in the physical presentation. At first, this made sense to me, until I used these tests on my first patient with complex pain as a student.

I can still remember how frustrated this patient was because of her pain. I tried every technique I was taught, and then let my clinical instructor try all the things he knew, and nothing helped. Her pain persisted. So I completed these tests, and they were all positive. Part of me wanted to assume what my professors had taught me; she was making up her pain. But a bigger part of me knew that was not the whole story. This woman was suffering and it was impacting her life in many ways. It was very much physical but perhaps something else too.

After that first experience, many more followed, all with the same pattern. According to the research, these people were not experiencing physical pain, so there was nothing we could do for them with physical therapy. Again, this did not land well with me. I knew there was more to this pain thing than I had been taught. There was a complex and nuanced answer beyond, “it depends”, and I was going to seek a better understanding.

It has taken many years and many patients to further develop my personal understanding of pain. It has evolved so far from what I believed 15 years ago while in school. Every day, every patient, seems to teach me something new about pain. Now, I am so grateful for this complicated and somewhat mysterious thing we call pain. I will admit, I still get frustrated often, but most days, I am more excited to talk about pain and all the subtle and not so subtle ways it shows up in our lives.

In some ways, this is my origin story of why I am so obsessed with talking about and teaching about pain. There are many more parts to the story, some deeply personal and others involving other patients that I will never forget, but this is not the time or place to dive deep. I suppose the universe planted me exactly where I needed to be to further develop my special interest in pain.

Rarely, a day goes by without me thinking about pain and how it is woven into each of our lives. It is beautiful and tragic at the same time, and everything in between. If only I could tell everyone I meet one thing about pain, it would be this…

Pain is a necessary part of life. You cannot and will not live a pain free life. Pain is not a disease, it is the body’s attempt to communicate with the mind. To attempt to live a pain free life is to play a game you will never be able to win.

In our current paradigm, the medical system is attempting to eradicate pain from our physical body in so many different ways. My profession is built on this premise of removing pain. This is why people seek my care. Yet, here I am, attempting every day to help people find a friend in pain rather than simply removing it for them. Sometimes I am met with blank stares by those who hold a solid belief system that pain is all bad. Other times, people will melt with relief when I start to explain pain in a new way, as if they have known this quiet truth all along.

I am okay with both reactions these days. I know that all I can do is plant a tiny little seed of an idea in someone’s mind. I can offer an opportunity to shift perspectives around pain. Because when our perspective shifts, when our story changes, suffering diminishes. And people do not come to see me because they are in pain 90% of the time. They come to see me because they are suffering because of the pain they are experiencing.

Pain impacts more than just our physical body, it impacts our wellbeing in every realm of life. This can be devastating for many people. After working in this field for so many years, I can confidently say that even when the tests say pain isn’t physical in origin, it does not mean a person is making it up. Pain can show up in so many different ways and just because it is less visible, it does not make it less valid.

So, of course, my professors were right, it does depend. But that is far from the end of the conversation. Pain depends on an individuals lived experience. Pain depends on the stories and perceptions we hold around it. Pain depends on how well the mind and body are connected and communicating. Pain depends on the way the world frames it for each individual. Pain depends on far more than we can begin to grasp fully.

And this is why I will continue to start conversations about pain. This is why it is part of my mission in life to de-stigmatize pain. This is the essence of rewilding pain. This is what I will continue to do every day in big and little ways. I will plant seeds and offer opportunities to view pain through a different lens. Take it or leave it but don’t be shocked when somehow I weave pain into every conversation.