The Importance of RMTs Understanding Pain

Wednesday, December 16, 2020 2:05:16 AM

Most people visit a Registered Massage Therapist (RMT) because they’re experiencing pain and are seeking treatment to help them relieve that pain. The RMT will assess their patient’s condition and devise a treatment plan to help them reduce their pain and improve their function. However, many RMTs don’t take the time to consider what pain is, and what it is not, and how that understanding can impact the focus of their treatments.

For many years, manual therapists including RMTs, and other health professionals believed that pain reflected physical tissue damage. We now realize that this understanding of pain is inaccurate. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Pain is meant to warn us of a danger so we can take action to avoid that danger. This a prediction of danger that doesn’t necessarily reflect the danger someone is in. Even if your tissues aren’t damaged, you can still feel pain if your brain concludes you’re in danger. The amount of pain a person feels depends on a variety of factors. These factors can include their cultural or religious background, past experiences, the amount of social support they have, their fear of future pain, mental health concerns, and more. It’s important for RMTs to consider these factors when developing a treatment plan for their patients. In particular, pre-existing beliefs about pain can significantly affect a patient’s pain experience, and treatment outcomes depend greatly on a patient’s level of pain catastrophizing and perceived pain control, so an RMT should be mindful of these factors.

Another important reason for RMTs to understand pain is so that they can educate their patients. Being educated about how pain works, especially when combined with manual therapy treatments and targeted exercise recommendations can help people reduce their pain and improve their functioning, especially after surgery or other potentially painful events. Understanding their pain can help patients increase their confidence and self-efficacy, which is an individual’s belief that they can accomplish certain tasks. This increased confidence and self-efficacy can lead to better outcomes for patients.
Peoples’ beliefs about pain influence the way they experience pain. If they believe pain is damaging, and have a lot of fear and anxiety, then they’re also more likely to avoid movement (which can actually be helpful for their healing process), believe that the worst case scenario will happen and are more likely to experience hypervigilance. By providing patients with more information about their pain, which can help reduce their fear and anxiety about it, RMTs can help their patients in their healing process.

So what practical steps can RMTs take to apply this understanding of pain to their practices?

One thing that RMTs can do is to be deliberate with the language they use with their patients. The language an RMT uses has the power to influence their patients’ pain experience and patient outcomes, especially if they use terms that can increase fear or anxiety, like calling a muscle weak or dysfunctional. Language that is more positive would include acknowledging the difficulties the patient’s pain experience has caused them, and focus on the positive results you think the patient should expect after your treatment plan. The RMT should be sure to take the time to listen to the patient describe their pain and be sure to not discount the patient’s pain experience, because when patients feel heard and understood, they are more likely to trust their RMT and play a more active part in their own recovery.
Having a greater understanding of how pain works will not necessarily have a major impact on the treatment techniques an RMT uses or the remedial exercises they recommend, although it may. Understanding pain will change the ways that RMTs communicate and relate with their patients. RMTs who have an understanding of pain have additional tools to help their patients with their health and recovery, and improve their patients’ outcomes.

References

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Mittinty, M. M., McNeil, D. W., Brennan, D. S., Randall, C. L., Mittinty, M. N., & Jamieson, L. (2018). Assessment of pain-related fear in individuals with chronic painful conditions. Journal of pain research, 11, 3071–3077.

Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020 May 23:10.1097/j.pain.0000000000001939.

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Tags: pain science, biopsychosocial, pain