Before our Thanksgiving blog, we discussed how the NeuFit® Method and the Neubie® electrical stimulation device can be used to treat chronic pain. This week, we are going to continue our focus on chronic pain starting with a look at “The Threat Bucket”. This is a way of looking at the physical and mental sources of strain and threat as a framework for unlocking the cycle of chronic pain.
Since pain is a response to any type of threat, it’s possible to trace it back to physical damage as well as to things that “shouldn’t” necessarily be painful, including poor sleep quality, negative reactions to food, stress at work, conflicts with family members, or other issues and environmental challenges. We find that helping patients understand both the physical and non- physical factors that contribute to pain plays an important role in overcoming it.
We use a metaphor called the “Threat Bucket”. In the process of searching for the causes of chronic pain, we consider every possible threat and toss it into an imaginary bucket. Some are physical, others are psychological. Some are real and others imagined. We put all real and perceived threats into the bucket because the brain perceives every one of these inputs as a threat. When the bucket fills up to a certain threshold, it triggers an output of pain.
For example, if a patient is dealing with an old shoulder injury that didn’t heal properly or scar tissue that prevents movement in certain tissues, that goes into the threat bucket. If they have a high-stress job they’re afraid to lose, or if they’re having problems with their partner, we add that to the threat bucket too. Why? From the brain’s perspective, the possibility of losing a job or a partner is a legitimate threat to survival. In response to that threat, the brain may trigger a pain signal as a way to say, “stop doing that” or “do something different.”
When working with chronic pain patients, there are some additional questions we ask when we’re trying to figure out what may be filling up their threat bucket:
- Have they had any head injuries or any physical injuries in other areas of the body that might seem unrelated to the pain?
- Do they have any scars?
- Have they had any unusual or significant stressors in their professional or personal life?
- Does the pain happen at certain times of day—or only on certain days? If so, is there something that seems to trigger the pain?
- What about their eating and drinking habits? Can they connect any changes in diet or alcohol intake with the onset of pain? • How would they rate the quality of their sleep? Do they notice a difference in their pain level when they get a good night’s rest versus when they stay up late or have trouble sleeping?
The more information we can gather from the answers to these questions, the easier it is to identify the relevant contributions to each patient’s threat bucket—and work neurologically to address them.
Whatever the Input, Pain is the Output
Regardless of its contents, when the threat bucket overflows, the brain triggers an output signal of pain. As with protective patterns like tension and inhibition, pain is another expression of the brain and the body protecting itself. It’s the brain’s way of telling us to avoid moving or loading certain areas of the body.
Even if the cause is more physical than psychological, it’s common for people to experience chronic pain in the same place(s) in the body. This is because for a pain signal that is a response to a non-physical threat, like losing a job, there isn’t a “job loss” bone or muscle where the brain can signal pain. Instead, the brain will use existing, well-rehearsed pathways to signal pain. Since the brain is constantly working to conserve energy, it doesn’t make sense to invest in building an entirely new pathway for the pain. Instead, even in the case of non-physical threats, the brain sends pain signals to the same places repeatedly to minimize energy expenditure.
Next week, in part three of our focus on chronic pain, we are going to look at software- versus hardware- sourced pain and how NeuFit addresses both as well as thoughts on treating psychologically based pain. We will also introduce you to the concept of proprioception (and why it matters) as well as share some additional techniques for addressing chronic pain.
Let’s charge forward to better outcomes together!
*This discussion is based on the ‘bio-psycho-social model’ of pain and the threat bucket imagery was adapted from Dr. Eric Cobb.