Anyone who is experiencing any kind of pain is experiencing some kind of a threat and our job as physiotherapists is to identify and reduce that threat. However, when it comes to chronic pain this is often not so simple, as perceived threats are often multi-faceted; often a combination of physical, psychological and social; hence the bio-psycho-social model was developed.

In the presence of Pain System Hypersensitivity (PSH), pain will continue to persist as long as the person perceives uncertainty or a threat to survival exists.

Therefore the first thing any healthcare provider must do in order to reduce a patient’s sense of threat, is to make them feel heard and confident that you understand their problem. Threat is increased when people feel unheard or dismissed.

The next biggest threat that exists is the sense of uncertainty. In times of uncertainty, the nervous system craves some form of certainty and some sense of control. We can facilitate our patients to gain that sense of control by offering them a few conscious breaths and a variety of non-threatening physical movements to increase their sense of certainty.

Suffering is experienced when we attempt to control things we cannot control. If pain is the experience that cannot be “controlled” at any moment, the best thing one can do is to immediately focus on experiencing things that one is able to control; everything from the breath to a specific movement of the body.

If a person is experiencing debilitating back pain where no movement of the spine is possible, then an option to regain a sense of control will be to focus on moving the fingers, the elbows, the shoulders, the neck, the ankles, etc. all combined with mindful breathing. You get the point!

Next we can focus on the day to day activities they can still do despite their current “uncontrollable” condition; activities such as calling and speaking with a friend, enjoying a delicious meal, going for a 5 minute walk, looking at and savouring a sunset, etc.

This is pretty much what The Pain Truth program is all about… giving people control!


“In times of uncertainty, the nervous system craves some form of certainty and some sense of control.” – B Jam, PT

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