Pain is an incredibly nuanced topic, but it’s such a common issue. We don’t even bother asking people in our seminar, “Hey, who in here has experienced pain?” It’s part of the human experience.
Nietzsche and DMX both said, “To live is to suffer, but to find meaning in the suffering, there’s something to that.” DMX and Nietzsche have like the same [laughs] outlook on this, which I always find funny.
Here’s how this went down. In 1977, this physician, Dr. George Engel, came up with this new theory on how pain actually occurs in people who experience pain. They called it the biopsychosocial model which basically means there are biological, psychological, and social inputs into the pain experience.
This is suggesting that not only biological causes, which we could categorically discuss, like tissue damage, or nociception, which is basically the nerve endings that carry stimuli to the brain being stimulated, and thus causing pain. Those are biological causes.
Psychological causes include mood states, depression, anxiety, attitudes towards different activities, etc. Social inputs include social learning, conditioning, cultural understanding of pain and that experience.
All these things come together to manipulate the pain experience that people have. Different contexts, even with the same injury, can cause different amounts of pain.
Prior to that, we had this biomedical model which basically means, if you had pain there was some tissue damage, some structural abnormality that caused pain. It didn’t really account for all of the wide variety of different pain symptoms that people had from the same “injury” or defect.
It didn’t account for people who had a limb amputated yet still had pain in the amputated limb. We call it phantom limb pain, so conditions like that. We needed a better model to represent like, “What the heck is going on?”
This was in the ’70s. The problem is, the average time it takes to adopt a new medical change is like 17 years. That would have put us in the mid-90s before the biopsychosocial model really gained traction. It hadn’t gained traction until the mid-2010s, like teens. We’re still fighting an uphill battle.
We were actually exposed to this in medical school our first year, but we were too dumb to really even conceptualize it. We didn’t have a mental model to accept like, “Well, this pain’s super complicated. Maybe there’s more to it than just lactic.”
“Oh, you’ve knee pain because there’s tissue damage.” Maybe it’s more complex than that. “You have low-back pain because it’s always a herniated disc,” when, in fact, it’s usually not a herniated disc that’s causing low-back pain.
What happened was, we had both graduated from medical school. We were out in residency and working with people. We just got sucked into the rabbit hole of pain science.
In the field of pain science, this stuff has been researched and been discovered for years, and years, and years. We basically uncovered a mountain of evidence that was always there, but we weren’t familiar with it.
What’s happened then is our ideas of what caused this pain and how people experience pain, and then therefore, how to treat quote/unquote pain has all morphed. We feel this is such a huge issue, especially as far as it goes to people, being a barrier for people participating in exercise.
We are charged with bringing some of this knowledge to the masses. Then also, in the context of injury rehab, return to activity, huge, huge deals.
We feel we’ve got to put out good information on this. Then, in addition to that, we also feel compelled to prevent the spread of misinformation, which we feel again just builds these false narratives and harmful narratives around people.
Like, they’re fragile. If you do things wrong, you’re going to get hurt. You should be afraid of these exercises because they’re particularly injurious. Anything that creates a barrier to people participating in exercise.
Right now, we think that pain is a complex experience that has biological, psychological and social inputs. That combined with the person’s environment and their own personality, they experience pain in different ways.
Which means that you and I could have the same injury, “same” biological issue, but given different contexts and different experiences and different previous social learning and conditioning, we could have completely different symptoms.
We could both have, for example, three-level herniated discs. The L4-L5, L5-S1, S1-S2, all herniated. You could have debilitating pain that you can’t walk, whereas I could go pull a deadlift PR than that or vice-versa based on different sort of context and experiences.
Putting out this information has been cathartic in a way. It helps us understand it and then also be able to express frustration with treating pain previously. In addition to that we feel it’s really helpful to the field for what I would consider the initial step of management.
What do you do with somebody who’s got pain? One of the first things you do is education. That’s literally one of the first recommended treatments for many of these pain issues. We get to start to get the ball rolling there early on.
We have a lot of resources, and we continue to put out more resources to give people more information that they can internalize. That will help them on their journey.
That’s a brief — well, not so brief — way of talking about how we got here and then what we’re trying to do. It’s a huge topic, and I think that we’ll be writing about this until Barbell Medicine is no more. Which is fine by me because I like this stuff, it’s super interesting to me.