Response to a ‘Painful’ Controversy

[Editor’s Note: Tom is responding to this article, written by Nick Ng:]

Dear Nick Ng,

You flatter the excerpt from my recent interview by raising it to the level of neurological treatise, thank you.

Less convincing is the use of unnecessary words like ‘sect of followers’ (lol) and ‘maverick’ – are such editorial comments really necessary to your point? (As well as being mutually contradictory).

If I had posted it, I would have given it another title, for sure. I first saw it on your site – but having reviewed it now, I will stand by most of it.

First, I have and claim no knowledge of neurology.  The clip’s confusion between nociception and pain, that you rightly pointed out attests to that, though without a camera in my face, I do know the difference. Of course not all nociception is registered as painful.  Does all pain registration arise from nociception?  I am less sure about that – what do neurologists think?

The true dynamics of consistent and chronic structural body pain are only just being uncovered, IMHO.  The work of Lorimer Mosely and others has impressed me, and as far as I can see, Moseley’s work reinforces my point.

I did spend an evening in London in 1985 with the marvelous pain scientist Patrick Wall – now there was a maverick!  He came with the BBC to a firewalking event seeking to debunk it.  He took a lot of measurements – the surface of the coals ran to 415o C – hot enough to melt aluminum.  I walked on that fire, and so did he, with his shambling gait.  He later hypothesized that the dampness on the bottom of the foot created a layer of steam between the foot and the fire to explain the total lack of burns on any of our feet.  That may be, but the coals were as cool and crunchy as breakfast cereal under my skin, and the act of faith in putting my bare foot onto 30’ road of shimmering red still ranks as one of the more interesting forward steps I have taken this lifetime.

Anyway, back to business:  I am neither a scientist, a doctor, nor a researcher, and I am not attempting to play one on the internet. Apologies if the set of metaphors in the clip causes consternation among neuroscientists or confusion among practitioners. In context (it was a 2-hr interview), I was speaking of the experience of the bodyworker and the client, not the neurology of pain.  I am aware of CNS involvement and support modern education about recursive pain.

Second: I would certainly put Ida Rolf’s definition (don’t know where she got it): “Pain is sensation accompanied by the motor intention to withdraw” up against that IASP one you quote: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

‘Unpleasant’ – now there’s an objective word!  And ‘emotional’ – What is emotional pain if it is not sensed?  And would this definition cover an experienced masochist?  Rolf’s definition covers observable behavior – of a starfish, for instance, withdrawing its arm from a noxious stimulus.  If I am observing someone else – which is the constant job of a manual or movement therapist – how am I to know when things are unpleasant and emotional?

Answer: By observation of behavior, and in the case of pain, I challenge you to show me some unaccompanied by the motor intention to withdraw, which can be felt by a sensitive practitioner whether the client acts or not.  It is my finding that the outer corner of the eye is often the place to first catch the expression of this inner intention – and thus adjust treatment.  Tracking the client’s experience via this and other behavioral signs allows the practitioner to get the most done with the least struggle.

Finally, the IASP definition acknowledges one of my main points: that tissue damage can be actual or potential:  Putting your fingers in ice water, a standard pain gauge measurement, involves significant pain but no tissue damage.  Cancer can cause extensive tissue damage without pain. Pain – and here Lorimer’s snake story is so illuminating – is an opinion.

But it is my ‘three kinds of pain’ argument that really seems to frost your consultants.  Again, I am talking the politics of experience, not neurology, and I stand by the concept. By ‘pain coming into the body’, I mean the kind of impingement that raises the alarm for tissue damage – stubbing your toe, a laceration, being bruised by a bodyworker – the usual.  More carefully stated: ‘sensory endings are impinged upon and send signals to the brain which are interpreted as pain’.

‘Pain stored in the body’ is absolutely my experience. As Mr. Erickson points out, people form themselves around patterns of stillness in the body, creating compensatory areas of hypertrophy, atrophy, and fibrotic ‘ densitication’ (Stecco). When these unmoving spots are identified and touched, they evince pain (however defined) with even a touch so light that it would be easily accepted even an inch away.  Enlivening these tissues, breaking the sensori-motor amnesia loop (Hanna), hydrating these tissues, CNS reorganization – whatever is really happening, I do not know – often involves strong sensation for the client.  But this can fall on the pleasant or unpleasant side of the spectrum depending on the psychophysiological state of the client and the skill of the practitioner.

When these tissues are released – whatever the mechanism, and I look forward to be enlightened as to what precisely occurs – a similar touch no longer elicits pain or unpleasing sensation, the pain is ‘gone’ from that tissue.

My experience – whatever the neurology that ultimately explains or denies it – is that many people, the world over in a variety of cultures, are carrying such stored pain as a result of imitation, compensation, sequelae of trauma in the usual array of disuse, misuse, and abuse.  I even stand by the assertion of ‘inherited’ pain – surely anathema to the scientific – though I make no claim as to the mechanism – DNA, cultural – of such ‘ weltschmertz’.  Stored pain – but I am happy with ‘a particular pattern of sensori-motor acture’ if you prefer – creates a sensation of additional ‘weight’ and sluggishness in the soma, but is seldom if ever felt as ‘pain’ in daily life – we simply move around it.

I am well aware of the lack of research correlation between postural set and pain, but I am allowed to hold a contrarian view of this until all the evidence is in.  I’m a posture ≠ pain denier.

‘Pain leaving the body’ – that really got your experts’ goat – is definitely a metaphor, but again a useful one.  Of course, neurologically, the signals simply cease or are interpreted differently in the CNS, nothing is actually ‘leaving’.  But the experience in the room when a pattern resolves – I speak here of a whole-body pattern of compensation letting go, not just the release of a single tight muscle or trigger point – is that a great load of this restrictive silent pain has left the body.  I hope you have had that experience, it is a privilege and one of the more satisfying rewards of being a bodyworker. Call it a metaphor, call it unbearably New Age, but it is a good description of the feeling.

Finally, let me wholeheartedly agree with you that good therapy does not have to hurt. In my 40 years in this field, I have seen all permutations of benefit, modality, and pain. Good therapy can hurt or not hurt, so can good physical training. Exercise to the point of pain can be helpful to train in some characteristics and physiologies, and light pleasant movement is wonderfully healing in other situations. Deep manual therapy on the painful side can be amazingly healing, or it can just be stupidly brutal. I have seen very light, absolutely non-painful therapy do significant good, but elsewhere badly done light touch therapies can do significant damage to one’s coordination and physiological motility. I know this firsthand: I set someone off for several weeks in my first class of cranial osteopathy using no more than a nickel’s worth of pressure.

All permutations are possible, and the rule then must be ‘Caveat emptor’ – make sure you’re with someone who knows what they’re doing, whatever it is.

Again, my apologies if I have strayed into purely neurological territory and led my ‘adherents’ astray in so doing; that was not my intention, as it is not my subject.  I really do not mind you taking me to task in that arena.

Lumping Anatomy Trains with this amateur foray into pain seems a bit churlish.  Anatomy Trains is about myofascial force transmission and not neurology.  No cult, no need to drink the Kool-Aid – just a straightforward referenced attempt to map functional myofascial connections – take it or leave it as you will; it requires nothing but a willingness to try on a new point of view.

Increasing amounts of dissection and strain transmission evidence is supporting the type of applicable holistic ‘tensegrities’ Anatomy Trains (and others) propose – but we will save that discussion for another post.

— Tom Myers, November 14, 2014