Is Pain Science Patronizing?

Hey, it's Chris. Today's video is probably going to upset some people. I'm probably going to get a few unsubscribes. I'll probably get the odd angry email as well. Despite that, I'm going to do it anyway because that's what I think is true. And it wouldn't be the first time that's happened because today I'm talking about pain science, which I know triggers some people and people have strong opinions on either side. And I'm going to talk about pain science and what I think it's missing and what I think we get wrong with it and how pain science can actually be detrimental to patients. Now, full disclaimer. Having scared some people with that, I'm a big fan of pain science, or as some people would just call it, science, but the knowledge, you know, that I came across this after I've been out a few years, that actually the structural biomechanistic model isn't explaining everything. I'm really glad I found that out. And discovering that pain is influenced a lot by top down beliefs and the context and that pain can occur in the absence of injury and injury can occur in the absence of pain, that was all great. It was a very tough six months when I found that out because it cast into doubt all these ideas that I've been working on and it made me think, oh my God, I've yellow flagged everyone into maintenance care forever and I've been freaking people out and using this horrible language. Luckily I got through that. Things are okay, but pain science has massively informed what I do as a chiropractor. It's really informed my work with patients and it's really informed my approach to communication and, and the content and material that I put out for clinicians as well. It's a big part of that. I think it's great. I really like that it's there, but it's not an all encompassing benevolent good. There are downsides. This particularly the way I see it being practiced. And I think one of the biggest issues with pain science is that it can be used incorrectly. Very patronizing. The idea that by using a certain bit of language, by using one word, by using misaligned or probably not torn, but like out of alignment or wonky or a bit unstable. The idea that using that once is going to create yellow flags in somebody and a lifetime of anxiety and chronicity in every patient is patronizing and frankly a little bit disempowering to patients. The idea that they're all so fragile that, that this could happen as a one off like come on, that's really not true. And that looks as people as incredibly fragile and that thank God that we're here as the hero. The doctors who are going to correct that and save them from this language. It can be quite doctor centered if it's done badly. I have patients who I've known for quite a while who will talk and go, yeah, my back's gone out of line again. Oh, it's popped out of place or oh yeah, I'm misaligned again. Or I'm wonky. And they come in. These are active copas people who generally do very well, no yellow flags. And they come in and we treat them and a couple of sessions and off they go and I don't see them again for a while and then they do something again because they got carried away with gardening or they just lifted a box that was way heavier than what they were used to and they come back in and go, oh, it's gone out of alignment. These are psychologically healthy people who don't have a recurring issue of chronicity down to all these yellow flags and fear avoidant beliefs. They treat their back like it's and start trying to re educate them, which sounds like a camp or something that I'm going to come in and go, actually John, all your beliefs about your back are wrong and incorrect and this isn't happening. And that's what's happening. And it's important that you know that because otherwise it's disempowering. It's going to change the way you move, it's going to change where you think about things and you're going to get anxiety and that's going to scare you and that's going to turn the volume up on this pain. Like if I said this to some of these patients, it would clearly not go down well and it wouldn't help them. All that would happen is they would think Chris has lost his marbles a little bit. Maybe I'm gonna go find another chiropractor. So it's not that this stuff is wrong, it's just that.