Understanding the beast of chronic pain video has several purposes: firstly, this understanding is in and of itself, a therapeutic tool. Multiple fMRI studies have shown that as little as 30 minutes of pain education can significantly reduce chronic pain. Score for you!

Secondly, understanding pain helps to reduce fear of movement and anxiety around re-injury. Two for you!

Lastly, this knowledge will help you to utilize the pain care tools I am about to share today. Three for you, none for pain!

Real life stories help to illustrate often-dry science of chronic pain.
Here is one to help you grasp the concepts of DIMs and SIMs.

The Problem: somewhere in the last few months I’ve developed a rather nasty neck tension. Every time I bent over, I got super dizzy, and that dizziness gotten progressively worse as the time went on.

{Truth be told, there was a constellation of symptoms that went way beyond the annoyance of dizziness, but for the sake of simplicity, dizziness is what we are gonna focus on.}

Possible solution #1: stop moving the head. Don’t bend over. The end.

Possible solution #2: investigate potential causes of said dizziness. Figure out baseline bench marks – how much can I bend forward before dizziness strikes? Start incrementally increasing range of motion from that bench line marker. Line up self-care tools to reduce neck tension. Look into changing my work set up… The laundry list goes on…

If this was you, which one of those possible solutions are you more likely to lean into?

Me?

I spent several months in and around solution #1. 
During that time tension and dizziness progressively worsened.
It wasn’t until one day I went ” Holy crap! I am afraid to even turn my head,” that the light bulbs started to flash like crazy. That’s when I finally realized that  I  steadily dug myself into a DIM pain cave.

Welcome to DIMs and SIMs.

A full disclosure on DIMs and SIMs: this framework is the brain child of NOI group – an Australian research center leading the current “explain pain” revolution. I’m just a mere messenger.

Let’s review pain science that you {hopefully!} already know:

~ pain, without exception, exists to protect and preserve you.

~ all of the body parts contain sensors that trigger constant messages to the brain about the current state of the body. Some sensors respond to heat or cold, some to stress, and others to movement. Some sensors only respond when things are getting dangerous – too much heat or cold, too much stress chemicals, too much stretch. These messages are not pain – they are simply electrical impulses.

~ your body can only send danger messages to the brain, not pain messages. The brain “listens” to the danger messages, considers them up in the context of your current situation, and then may or may not make pain. Pain is made by the brain.

~ your brain will make pain when it concludes that your body tissues are in danger and you need to do something about it. That’s why pain is not an accurate indicator of tissue health: it’s job is to get you change your behavior, not to tell you what’s going on in that neck, spine, or shoulder…
Some people with extensive injuries have no pain; some folk have no injuries and yet are in incredible amount of pain.

How does the brain make the decision to make pain?

Turns out, it is all about the context….

Context is the location and current situation you find yourself in, along with your beliefs, values, understanding and knowledge that your bring with you {that’s why pain education is such a powerful tool!}

Meet your DIMs and SIMs:

~ A DIM (danger in me) is anything that is dangerous to your body tissues, life, lifestyle, job, happiness, your day to day function – a threat to who you are as a person. The more DIMs you have on your plate, the more likely your brain is to create pain.

This is why getting results of your MRI without due pain education {by the way, did you know that those scans are hugely inconclusive when it comes to pain?}, hearing words like “you should’ve move this way,” or plain getting mistreated and taken advantage of by medical staff can all amp up the pain.

~ A SIM (safety in me) is anything that makes you feel stronger, better, healthier, more confident, more in control – within and about yourself.

Recall “possible solutions” from the beginning of this e-mail.
“Solution #1” silently signals to the brain that moving isn’t safe anymore, which adds more DIMs to the scale. Tension and dizziness increase, and so a negative feedback loop is created: the less I move, the more I fear; the more I fear, the less I move.

More on DIMs and SIMs in the weeks to come.

In the mean time try this exercise: set a timer for 5 minutes and write down a list of today’s DIMs and SIMs. Once you have the list, tear it up into small pieces and throw it out. Repeat for the next 3 – 4 days and access your pain levels at the end of that time.