We all have different tolerances to different things such as how long we can concentrate, exercise, or put up with some people. I for one know that I have a very low tolerance for those who wear barefoot toe-shoes, have man buns, or take offence at everything they disagree with.
Our levels of tolerance both physical and psychological are due to many things such as our genetics, previous exposure, experiences, and even our education. Some people can tolerate exercising more than others because they do more of it, some can tolerate stress better due to previous experiences with it, and some can tolerate other people better because they have been taught to.
However, it is clear that more of the human population is becoming more intolerant of many things such as foods, textiles, and medications. And more people these days are also less tolerant of change, diversity, and differences of opinion, and many are intolerant of any difficulty or discomfort in their lives.
Our World Today
Most of us living in the modern developed world have a life of convenience and comfort. A world where we have ample access to food, water, shelter, and wifi. A world where you have technology and gadgets to make your life easier and effortless. A world where you can buy a device to put your socks on in the morning, a duvet that makes your bed, or a machine that opens your jars. We don’t even have to go to the supermarket anymore to lift our jars off shelves and carry them in a basket with home delivery and even unpacking services on demand.
We are living in a world where effort and exertion have mostly been removed, where any effort, struggle or strain is considered unnecessary and often avoided. Don’t get me wrong, this modern-day lack of difficulty does has some amazing positives, I for one am not complaining about my 5G wifi signal, my central heating, or my online grocery delivery. But the sheer amount of convenience and ease we have in our lives today also has drawbacks.
One of these drawbacks is that we have lost sight of what is actually difficult, hard, or inconvenient. What we consider challenging these days simply is not. Missing a meal, losing your wifi signal, or having to walk up the stairs because the lift broke are not difficult or serious issues, yet our modern lifestyles and lack of exposure to them often make them feel so.
Our Pain Today
This I believe is no different from our experiences of pain. Having a sore knee, an irritated shoulder, or some low back pain is often not a serious medical issue that needs to be assessed and treated. Most of our grandparents would not have seen a doctor or therapist for such things, instead, they would have just carried on understanding that things hurt from time to time.
If we were to look back just 2 or 3 generations I bet we would see that most people would NOT seek medical attention for back, knee or shoulder pain unless it was serious or had other sinister signs or features. This was of course due to access to medical services being far less back then, but I also think it was due to a difference in culture and attitude towards pain as well.
I often ask myself when I have a pain or an ache, what would my grandad do… and most of the time it would be to ignore it and crack on!
Many think that all pain and discomfort should be reduced or removed immediately. I think a lot of things that hurt just need to be tolerated and endured for a period of time. I truly believe that by reducing and removing pain too soon, too quickly, and too unnecessarily healthcare is contributing to society becoming less and less resilient to pain.
Earn Your Health
And if you want your body to look after you and give you less pain, you need to look after it. Many think being healthy is easy and an automatic right. It’s not. Of course, there is the lottery of genetic luck to get through first to avoid any congenital disability or disease. But if you have come out of that with good fortune then good health has to be earned with some hard work, self-control, and discipline, and the inconvenient truth is that many musculoskeletal conditions today are often consequences of our convenient lifestyles.
However, regardless, of why things hurt from time to time the key point is that often nothing needs to be ‘done’ for it other than reassuring the individual that it’s not serious, it will ease with time, and they will not harm themselves if they feel some pain on movement and they should try to carry on as normally as possible.
However, as much as some patients don’t like hearing this, a lot more healthcare professionals don’t like doing this even more. Many healthcare professionals just don’t feel comfortable telling people in pain that nothing needs to be done for either financial or egotistical reasons. Personally, I think many musculoskeletal conditions are over-treated with healthcare professionals pandering to patients while natural history makes them look good.
Frustrated
And please dont think this is just me being mean, cold, uncaring, or discompassionate, this is just me being open, honest, and frustrated at a system that I think is going the wrong way and screwing things up right royally. Healthcare has undoubtedly helped humanity hugely by reducing disease and pathology and increasing our lifespans. But healthcare has also inadvertently caused harm by making humanity less resilient and less tolerant to pains and problems due to its over-treatment.
If you want some proof then go look at the BMJ global burden of disease studies you can see that low back pain now consistently causes more disability and costs society far more than any other medical condition across the world, and this is despite many advances in our so-called modern pain management treatments.
In summary what healthcare is currently doing for musculoskeletal pain just isn’t working and something needs to change. Personally, I think this should start with more healthcare professionals recognising that they over-treat it, and all humans recognising that pain in life is inevitable, but suffering it is optional.
As always thanks for reading
Adam
“Personally, I think this needs to start with more healthcare professionals recognising that they over treat pain and many patients recognising that pain is inevitable, suffering is optional.” Adam, I think many people experiencing pain would not agree with you that their suffering is an “option”.
Hi John, sorry but I have to disagree, as someone who has experienced pain many many times for both short and long durations I can confidently say that mindset determines if you decide to suffer with it or not… Cheers Adam
Egocentrism?
Possibly… but the point of the blog is not about me, you, or any other individual… its about society and its attitude to pain in general
Love this post, but I wonder if mindset isn’t the correct way to think about it because it implies it can be something so easy to change. I love the more philosophical side of things, because it ultimately informs how we think and thus approach health care. But if someone not only sees the world, but has shaped their entire life, meaning and defined their happiness based on a certain philosophy that doesn’t promote change or consideration of other viewpoints, their ‘mindset’ could be difficult to change.
I see a lot of crossover with how we view happiness. Vox has a great article with researcher Carl Cederstrom that details the shift in philosophy, that I think correlates well with ultimately this change in ‘mindset’. That now we define our happiness as an individualistic pursuit based upon self actualization and improvement, which ends in ultimately, happiness as a right, not a privilege. Therefore, if happiness is seen a right, it can be easy to see how people define pain, an unpleasant sensation that can also limit our capabilities and ultimately what drives our sense of self and happiness, as a negative entity and ultimately exactly what you see and written about here Adam.
https://www.vox.com/science-and-health/2018/9/4/17759590/happiness-fantasy-capitalism-culture-carl-cederstrom
The addition to this is now we have technology that also drives us to skim read which ultimately affects our ability to read, comprehend and process new information and thus respond well when presented with new information, we’ve created the perfect storm.
https://www.theguardian.com/commentisfree/2018/aug/25/skim-reading-new-normal-maryanne-wolf
Totally agree Adam I run a functional restoration program for people who are living with chronic pain for which physiotherapy has not helped. Just yesterday I had a patient tell me that although his pain remained at the same level he felt 90% improvement following treatment.
The course is very much about education. We discuss pain mechanisms, body repair processes, pacing, lifestyle changes, psychological perception of pain, exercise benefits etc. Along with the education we run a gym session in the afternoon for good honest hard work and exercise.
Now going back to this gentleman he has a very heavy manual job that he is now completing without issue. His words to me were that his pain was now a “background issue” it was still there but it didn’t bother him because he chose to focus on improvements such has improved flexibility, improved strength and endurance and a generally healthier lifestyle.
Through reassurance, education and exercise this patient improved his quality of life and reduced his suffering without his pain changing at all.
Now the likelihood is within 6 months of implementation of this way of thinking and living the patient will be pain free. Contrast this with a patient who is coddled and overdiagnosed that develops an external locus of control and makes no meaningful changes to their life. Now that is the type of patient that will report years of pain with no improvement despite receiving a lot of ‘treatment”.
Suffering is definitely optional. That’s the difference between the paraplegic who find gainful employment and continues on with their life and the “fibromyalgia” patient who goes on permanent disability/welfare and jumps from one health care provider to another trying to find the “miracle cure”.
Same with at fault drivers vs. not at fault drivers when it comes to MVA’s. Majority of “chronic whiplash” patients are not at fault drivers while the at fault drivers just carry on with their lives.
. Sullivan MJ, Adams H, Martel MO, Scott W, Wideman T. Catastrophizing and
perceived injustice: risk factors for the transition to chronicity after whiplash injury.
Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S244-9
I am going to chime in here because this is an important opportunity for developing a sense of awareness that seems nearly absent in the formal orthodoxy promoted by PT. Adam, you are certainly entitled to your opinion, afterall this is your blog. On the issue of “suffering” and what constitutes this subjective experience, it is the same argument I hear when “pain” is substituted. The abysmal appreciation by biomechanists (most PTs) of psychological foundations of Self, personality, beliefs, and mental illness etc., prevents a more effective application of therapies. Just because you claim that you have experience in pain does not generalize beyond your shores; it is irrelevant to what suffering feels like for others in pain, whether physical or psychological. Few clinical psychologists would agree that one should just think positive thoughts and that would dispel the suffering of depression, for example. Its not about you. Its about the person suffering.
I can’t speak for Adam, but I don’t think he was saying to just gloss over suffering with positive messages. I read it as a call to society to reframe our way of thinking about “suffering” and pain. If I am in pain for whatever the reason, I can do 1 of 2 things. I can suffer because of it, or I can thrive despite it. The pain/discomfort/anxiety/etc might still be there, but the mindset is different and the latter keeps me moving forward. By moving forward, I may be able to eventually move past it. If I just allow myself to suffer, I may never get past it. This is NOT easy to do, but as therapists I think we can absolutely help people in educating them about what pain is, factors that can affect it, and how movement and mindset can help keep them moving forward.
Einstein – I fear the day technology will surpass our human interaction. The world will have a generation of idiots!
Too much crap information easily available and too much good information stifled. Keep spreading the good word sir.
Completely agree. As a physio working in australia i find the biggest barrier to this is financial. Musc physio in australia is almost completely in the private sector and i cant find a boss who wants to pay me to effectively educate and reassure people they arent broken. Very frustrating as this is what is needed with a majority of patients i see
Unfortunately most practices seem to primarily focus on retention rates with no intention on tracking patient outcomes
But, but, I like avocado! “No tolerance required.”
Hi Adam,
Thanks for continuing to promote your practical and common sense approach to pain management which empowers our patients and improves short and long term outcomes and which for those of us who use it is a no-brain option ! However, as common sense sometimes may not always be that common is still very noticeable how many physios (independent of age or experience) struggle with trusting exercise based rehab and still feel the need to over assess/treat or deliver manual techniques in order I think to feel like they have “fixed” the patient. Could it be insecurity on their part ? Or maybe the training pathway embeds in them the biomedical approach ? On a positive note I also believe that with the persistence of physios who use the active approach to rehab instead of passive alternatives that as we empower and educate our patients they may well become the channel through which the message flows to the wider population.
Finally, keep up your great work as I think it is making a huge difference to our profession.
Philip Phelan Physiotherapist Dublin
Sent from my iPhone
>
Always a thought provoking, perception challenging read Adam – thanks!
I’m with you all the way Adam!! Lets spread the word!!
Fantastically well said Adam!
Technology has given us everything we could ever want and at the same time it has stolen everything we ever needed
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
Upton Sinclair
Until the healthcare profession is not reimbursed for treating/overtreating nothing will change. I firmly believe if there were a billable code for an exorcism we would have continuing education , certifications, and in clinic seance’s.
Thanks Adam, a good read. The world has gone totally insane. It’s all about the money, a fraction of the care is about efficacy, it is a complex interwoven hairy problem. Just off to my seance, Jane
“Many think living pain-free is an automatic right. It’s not. It’s a privilege that has to be earned with hard work, self-control, and some discipline. If you want your body to look after you, you need to look after it. ”
PREACH!!! ?? SO. VERY. TRUE.
Self care, self care. ?
I agree that we frequently overtreat pain. A motivated patient will generally get better regardless of what the physician does.
“Medicine is the art of entertaining the patient while nature cures the disease.” -Voltaire
Adam, your original post, and the comments of those who agree with you, support my view that health care professionals are inadvertently contributing to the stigma borne by those who experience persistent pain without discernible ongoing nociception.
I am unsure as to how or why you think my views here are contributing to the stigma of those in pain? I recognise only to well that many people in pain are treated terribly by both the modern health care system and many of those that work in it, I see it day in day out and its getting worse. I am actually trying to help change this by highlighting how society, media, technology, education is adding to the problem not helping it. I feel you have misinterpreted my point John.
Adam, have you considered that chronic pain sufferers may already be feeling inadequate because they cannot measure up to their own and/or their societies’ expectations? Feelings of shame, isolation and self-loathing can be their lot in life. I cannot agree with you that such suffering is “optional”.
Yes John, I have and I see it in people daily. However, my job is to turn that around and try and help them see how they can continue to function with pain, how pain shouldn’t define them or stop them doing want they want to do, and how suffering it is a choice.
Adam, for some it is not a choice.
John, unless pain is being inflicted under torture then everyone who has pain has a choice about choosing to suffer with it or cope with it. But this again is getting way of topic of what the blog was trying to discuss which is in my opinion our species is becoming less tolerant to pain… not about specific cases or individuals!
Adam, I have no way of assessing the truth of your opinion that “our species is becoming less tolerant to pain.” However, could it be that physical therapists (together with physicians) are becoming increasingly frustrated by their inability to relieve the pain of their patients? This would induce them to take on board the argument that you have presented, thereby shifting the blame away from themselves.
That’s a good point I hadn’t considered… I will do now! However I don’t treat Pain, I treat people! And I’m my opinion many people are becoming less tolerant and suffer to easily! But I do accept I am also perhaps becoming less tolerant too! Thanks for making me think a little harder! I need to go and have a lie down now!
Good post and ideas.
The point is if natural history could heal the problem so what is our rule? And in some patients they have some rest before PHysio why nat history did not do anything for them?
And the last point is when a patient could releive by a thing immediatelly why we do not apply that? Why tell him ” you will be good in 4 weeks “.
We have to believe and accept that ” peoole needs quick probl3m solving approch now but we have to learn them it is not always true for all MSK problems
Great article again! I had this experience just the other day, as a sports massage therapist who is training as a physio and has been lucky enough to train under some brilliant physios (and some less so) I really support the need to give patients the right information to help them live life with or maybe without pain and for them to understand that their pain isn’t necessarily an injury. Now in my line of work I see many people who as a physio student I believe need strength work and a small can of man up but unfortunately until I am qualified it’s the massage life for me and that’s what they’ve come to me for. I do however offer them information about the true nature of pain and the likelihood of their problem self resolving where appropriate but I am constantly shocked by how many people just don’t want to hear it and want to come back for another massage (even when I’m basically telling them not to… Bank account doesn’t look great as a result!) I sometimes wonder if people seek validation from a health care professional in that their pain is justified and that they need a plaster and a lollipop but they’ll soldier on and low an behold it’s all better in a months time. Sorry for the rant but my question is.. When you’ve given them all the tools and information that will help them, how do you get them to buy into that?! It’s the bit that involves them putting in some effort on their own but in the long run saves them money and keeps them living their life working to a pain reduced/painless life but it seems as if they think that is as likely as seeing a purple unicorn dancing dancing with a lepricorn! How do you get them in board?!
Thanks for yet another great post!
We work hard on exactly this problem with pain management at a specialized hospital for neck- and back-related pain and disability (both specific and non- specific), and we see a lot of people with non-specific pain, that cant handle their own situation. We try to use for example CFT in our work, but sadly the health care system makes it hard to get to the bottom with peoples problems, before they are sent back out of the hospital.
People need to be teached in understanding pain and pain management, instead of just going to the doctor and get drugs an MRI/CT scans for no reason.