For someone to experience a minor twinge, a bit of tension in an area where they had never felt that before is very different from them either a) having felt it many many times before, in varying degrees, over a period of years with this being just one instance of many or b) having felt this pain in the context of seemingly unrelated chronic pain over a period of years. In both cases, what is of primary interest to me as a therapist is how the complaint they are presenting is complicated by their relationship to pain. It isn’t uncommon for clients to come to me with what seem like very minor complaints, a little bit of tension, some minor discomfort, to be indicative of a much more pervasive problem.
I think feeling pain regularly changes the way we experience pain. Pain is both a physiological response—a pain-sensitive neuron firing and sending a signal to the brain— as well as the interpretation of that signal by the brain. The first relationship is captured in the word ‘transduction’ which is the transformation of an external condition, such as damage to tissues, into an electrical signal that is sent to the brain. It’s the same idea for light-sensitive neurons in the eyes, touch or taste-sensitive in the mouth, etc,. In every case, a signal is transduced when it is changed from one form into an electrical form that can travel along a neuron. The second relationship, that of interpretation by the brain, is captured in the word ‘integration.’ A signal is integrated when the brain receives that signal and does something with it. In the case of light-stimulus from the eyes, it’s turned into a picture. For auditory stimulus, we hear sound. For pain, well it’s complicated.
Pain can be experienced differently by different people and to different limits. Somewhat unhelpfully, the difference between how much pain one can withstand before, say, passing out is confused with how much pain someone can withstand before physically reacting by, say, tensing up. In my experience, everyone can withstand a lot of pain in the former sense—more pain than I would ever wilfully administer. But in the latter sense, in terms of how much pain one can experience before tensing, becoming anxious, wanting to escape, feeling uncomfortable (even in the most minor, almost imperceptible way) there is a very large discrepancy between individuals. Some people can withstand a lot of pain merely as an interesting sensation while others can only withstand a very small amount of sensation before either they or their bodies tense up.
That last part is kind of funny: “either they, or their bodies.” I don’t really want to admit that these are different things, but it’s kind of helpful to pretend like oneself and one’s body are somewhat distinct. It’s helpful because it makes sense of why someone’s body might react to pressure by twitching or tensing up (either locally or distantly (such as when someone’s shoulders tense with pressure applied to a tender point on their foot)) while the individual is totally unaware. It is sometimes difficult for either me or my client to tell if their face or jaw is tensing or if their diaphragm or breathing rate in general is being affected by their body’s reaction to what we’re doing. Sometimes people obviously tense up and when they do it is easy to bring it to their attention and generally easy for them to admit and recognize it and then start to do something about inhibiting it. But when it isn’t obvious, it’s difficult to address.
For some people, even when the amount of tension they are holding is intense, such as their muscles literally appear to be clenched with ropes of muscle easily visible, they still don’t feel the tension. To me, that indicates a very real disconnect between the sensation being sent to their brains and their ability or, and i say this tentatively, willingness to interpret and experience those sensations. To be clear, I am not making a value-laden judgment concerning experiencing pain. I think it’s pragmatic if not sometimes sensible to ignore or suppress pain in order to get a job done, to get through one’s day and accomplish what needs to be accomplished. But those instances when ignoring or suppressing pain is applied ought, I think, be applied sparingly and within a greater context of addressing why that pain is occurring and how one, generally, ought to react to it in a way which is productive.
Ignoring pain over a long period of time can, I think, create an odd disconnect with pain, tension, and discomfort in general. It isn’t that common that that disconnect is extreme, but when it is, it can be very difficult to work with. A client may experience tension and discomfort in the bodily sense over a long period of time (in that their body reacts to it by splinting or guarding, increasing the tension and pain) yet consciously only feel it once it has gotten to such a point that it overcomes their ability to ignore it. Once it does get to that point, it might only appear as an innocuous, innocent, or mostly irrelevant discomfort but in reality is expressive of a much more pervasive problem.
It can be difficult yet very rewarding to help someone reconnect with their bodies. Feeling ‘pain’ on the table is often more interesting and invigorating than actually painful. People often report their painful sensations via vivid metaphor and genuinely fascinating simile rather than say, a pain scale. One of my favourite examples of such simile was one client’s description of the pain behind their knee elicited by a trigger point: “it’s like droplets of water hitting a tin roof.” I honestly think they reached a better understanding of what their pain felt like by going through the process of describing it to someone who didn’t feel it. In doing so, one must focus and appreciate it as a sensation and then convey that sensation into words, integrating it into other parts of their brain. Furthermore, it encourages them to take part in the therapy more actively. By describing, by experiencing, and most importantly by experiencing the release of pain, I think my clients develop a healthier and more complete relationship with pain and discomfort.
Though I encourage my clients to do what they think they need at the time, which might sometimes include working past pain, I also try to encourage them to entertain the idea of exploring their discomfort under safe conditions, such as conscientiously stretching, doing self-care, practicing restorative yoga, or visiting me in my office.