Guest blog by Richmond Stace, Specialist Pain Physiotherapist & Multidisciplinary Pain Coach
Chronic pain is the number one global health burden. It affects more people than cancer, heart disease, and diabetes combined. Yet, it remains poorly understood across much of society, including in healthcare and the workplace. For occupational health professionals, this presents a significant challenge. Pain is invisible. It fluctuates. It doesn’t always follow expected patterns. And for the person living with it, pain can feel all-consuming – impacting mood, motivation, sleep, relationships, confidence, and ultimately, their ability to work.
So how do we better support people with persistent pain in the occupational setting? The answer begins with understanding what pain really is…
What is pain? Pain is what the person says it is, and where it is in their body, according to the definition by Margo McCaffery, which I learned in my nurse training in the 90s. This is a good start point because it validates the person’s narrative, which is vital for creating a caring collaboration. Within this collaboration, the opportunities for making positive change arise. Pain is personal and subjective. You cannot see pain or measure it well. So, you must listen to the person.
What’s is pain’s purpose? Pain, whether acute or persistent (chronic), is not just a symptom. It’s a lived experience of the whole person. Like hunger or thirst, it is a need state, asking for attention, care, and change. Pain isn’t demanding to be ‘got rid of’ – it’s asking for a shift. A shift in thinking, behaviour and living. Pain is shaped by biology, past experiences, beliefs, expectations, emotional state, context, and environment. When certain conditions come together, pain is felt. That means pain always has a purpose.
Is chronic pain maladaptive? A common view in healthcare is that chronic pain is “maladaptive” – it no longer serves a purpose. I don’t believe that’s true. This idea arises from the absence of visible damage or pathology. But pain is poorly related to these. We know this from decades of research. Persistent pain isn’t without meaning. When someone shares their story, you often hear the deeper needs behind the suffering. From their story we can clarify two essentials:
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What do you need to move forward?
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What goals are meaningful to you?
So, instead of waiting for your pain to go away to start living, you begin living now for things to get better.
Pain is not generated where you feel it. The place in your body where pain is felt – such as your back, neck, or knee – does not actually produce the pain. Modern neuroscience tells us that pain is generated by a dynamic interaction between multiple systems in the body: the nervous system, immune system, endocrine system, and autonomic system (Kiverstein et al., 2022). These systems work together like an orchestra, constantly predicting what’s going on both inside and outside of you as one unified experience. This ‘orchestra’ uses past experiences, beliefs, expectations, memories, emotional state, and context to make sense of the sensory input coming from the body and predict its meaning. It’s making best guesses about what’s happening for you. You don’t experience the world – or your body – directly. You experience a version of it that’s constantly being updated and adjusted.
This means pain is not simply about what’s happening in tissues. It’s about how your systems are predicting and updating predictions (learning) about the world – including your environment, your history, and your sense of self. Pain is deeply personal. It reflects your whole lived experience.
Part two coming soon…
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Richmond Stace is a Specialist Pain Physiotherapist and Multidisciplinary Pain Coach. |