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Pain Management

Myth #1 – Your Body is Not Like a Machine but a Finely Tuned Orchestra

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Back in the 1980s, we used to think that pain relatively simple and proportional to damage.

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The body is like a machine” analogy was an intuitive one, but like many many biases and heuristics, it was wrong. It’s wrong because it gives the impression that there is nothing we can do to influence our physical health and function. That getting back pain and arthritis is simply a consequence of ageing, like a car that’s breaking down and there is nothing you can do but get replacement parts.

In the 1980s functional MRI scanning revolutionised neuroscience, discovering neuroplasticity and more broadly, bioplasticity. This means that the body and the brain are changeable, like plastic and if we stress the body and the brain, it will adapt and get stronger.

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We now know that our genes and ageing are like a loaded gun but it’s our lifestyle that pulls the trigger.

Your body is not like a machine at the mercy of the environment but instead is like an orchestra that, although still influenced by the environment, is changeable and can improve.

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The analogy that the body is like a finely tuned orchestra originated from David Butler and Lorimer Moseley in Explain Pain (2003). I have slightly adapted it here as I find it a useful way of explaining to my patients how the body works.

The brain is like a conductor unifying the orchestra, setting the tempo and shaping the sound of the ensemble.

The instruments can be broken down into the biopsychosocial factors:

  • Biological factors (eg, tissue damage, reduced range of motion or muscle strength)
  • Psychological factors (e.g. beliefs, confidence and self-efficacy)
  • Sociological factors (e.g. family, friends, environment)

These instruments combine together to produce the music with the direction of the conductor (brain).

Just like neurons, musicians need practice and the number of musicians used for performance will depend on the complexity of the performance being played.

Sometimes a new musician needs to be trained from scratch like new neuron pathways need to be trained after stroke for example. Other times they just need to be strengthened with practice to produce a better sound for the conductor.

Occasionally soft tissue is damaged which can create a lot of (nociceptive) pain which will need to be replaced by new tissue, like parts of an instrument that needs replacing when it’s been overused.

Other times however it’s the nerves that can cause (neuropathic) pain which needs to be re-tuned like the strings of a guitar playing out of tune.

Looking at your body this way, you should see that you are able to adapt and grow pain management to minimise your risk of pain and maximise your function and overall quality of life.

You have the ability to fine tune your body to help it to perform the way you want, just like a finely tuned orchestra performing in a venue.

Like all analogies, it isn’t perfect, and it’s not supposed to be. It is simply another way of explaining the complexity of pain to help patients improve their coping strategies, pain and function, especially the musical ones.

Article composed by Stuart at Health by Science

Read Stuart’s previous blog about sports physio or check out our blogroll. If you need help with pain management and live in or around Edinburgh get in touch with us now. Call: 0131 210 0002