Managing persistent pain

Pain doesn’t have to mean tissue damage

Until fairly recently it was assumed that pain results from tissue damage and therefore if no damage is found, then the pain must be imagined. We now realise pain is a mix of biological, psychological, and social factors and so AT’s use of psychophysical re-education is well-placed to teach students how to manage persistent pain.

Bracing won’t help long term

Two randomized, controlled trials on large samples showed that AT lessons reduce persistent pain in the lower back and the neck. If a person has learned the habit of bracing to avoid pain during movement, they may now find that what reduced pain in the short-term is now perpetuating it. Motor control, postural control, and balance are all affected.

Mind and body need to work in harmony

Instead of focussing on the painful area and trying to fix it, AT looks at how mind and body work together. This makes sense because if the brain decides the person needs protection, pain is felt. If the nervous system becomes over-sensitized, then the person begins to associate that movement with pain. Using AT, the student experiments with movement while consciously coordinating the whole body.

The benefits of touch

The use of touch in AT helps the student return to adaptive and supportive postural tone, which is what keeps you vertical. Pain may cause activity to move from deeper muscles to more superficial ones, that fatigue easily. Normalizing postural tone normalizes neuronal excitability, allowing the brain to correct inaccurate predictions and be less reactive to a stimulus. Non-specific effects of AT, such as feelings of safety, being calmed by touch, and having confidence in one’s teacher all have therapeutic benefits.

Self-efficacy

Rather than repositioning the student’s posture, the teacher helps with remapping and proprioception. The student isn’t having something done to them, but is rather paying attention to their whole system in a non-judgmental way. Performing a feared movement with less or no pain increases the student’s sense of self-efficacy - important in pain management. The process isn’t quick; it’s like learning to turn down your pain dial one notch at a time so you begin to feel more in control.