Understanding Pain: Insights for Remedial Massage Therapists

Pain is a universal yet complex human experience, one that often defies simple explanations. Both Pain, The Science of the Feeling Brain by Abdul-Ghaaliq Lalkhen and The Sensitive Nervous System by David S. Butler provide valuable insights into the mechanisms of pain and its implications for clinical practice. For remedial massage therapists, understanding these insights is crucial for effectively assessing and treating clients experiencing pain.

Lalkhen (2020) emphasises that pain is not simply a direct result of tissue damage but a subjective experience shaped by the brain’s interpretation of various signals (p. 58). Pain is an output of the brain, influenced by past experiences, emotions, beliefs, and contextual factors (p. 78). This perspective challenges the traditional view that pain equals injury, urging therapists to consider the broader biopsychosocial model during assessment. For example, a client presenting with chronic lower back pain may not have ongoing tissue damage but could be experiencing persistent pain due to the brain’s heightened sensitivity and protective responses (Lalkhen, p. 105).

Butler (2000) builds on this concept by exploring the notion of the "sensitive nervous system," where the nervous system itself becomes a source of pain due to central sensitisation (p. 17). Central sensitisation involves an amplification of neural signalling within the central nervous system, leading to heightened pain perception (Butler, p. 35). For a remedial massage therapist, this means that pain may persist even after tissues have healed, and treatment must address not only the physical body but also the nervous system's sensitivity.

Assessment, therefore, must move beyond locating "tight muscles" or "knots." Therapists should listen attentively to the client’s history, exploring not just the onset of pain but also lifestyle factors, stress levels, emotional well-being, and previous trauma (Lalkhen, p. 122). Butler (p. 68) recommends using sensitive questioning and observation to identify signs of a sensitised nervous system, such as widespread pain, unpredictable pain patterns, and emotional distress.

In treatment, both authors advocate for a gentle, patient-centred approach. Lalkhen (p. 156) highlights the importance of creating a safe and reassuring environment, as a calm and trusting therapeutic relationship can help down-regulate the nervous system’s threat perception. Butler (p. 134) suggests that graded exposure to movement and manual therapy can gradually desensitise the nervous system. For example, rather than applying deep, painful pressure, a therapist might use gentle, non-threatening touch combined with client education to reduce fear and re-establish normal sensory processing (Butler, p. 142).

Education itself is a powerful treatment. Explaining the science of pain to clients, as recommended by both Lalkhen (p. 160) and Butler (p. 147), can empower them and shift their perspective from fear and helplessness to understanding and active participation in their recovery.

In summary, Lalkhen and Butler reveal that pain is far more than a signal from injured tissues; it is an experience created by the brain and influenced by many factors. For remedial massage therapists, this understanding opens the door to more effective, compassionate, and holistic care. By addressing both the body and the nervous system, therapists can help clients navigate their pain with greater hope and resilience.

Both of these books are in my clinic and form part of my ongoing commitment to professional development.  Not into reading books?  There is also a great pod-cast series that came of out of Covid-19 in 2020, where an Australian Physiotherapy Clinic (Body Logic) hosted an amazing series where clinical researchers and clinicians speak to leading researchers and patients about their understanding of pain.  I often recommend certain episodes for my clients to help them with insights and tips that may assist with their lived experience. 

References:

1. LALKHEN, D.A.-G. (2022) Pain: The science of the feeling brain. S.l., LONDON: ATLANTIC BOOKS.

2. Butler, D.S. (2000) The sensitive nervous system. Adelaide, SA: Noigroup Publications.

3. Empowered Beyond Pain Podcast Series  https://bodylogic.physio/trailer/