Exploring Pain & Touch October 2022

by Christine Petrides

This month on Pain Geeks we are exploring the theme: Pain & Touch. We have two great readings and a humanities picked for this month and we can’t wait to explore them with all of you.

Pain & Touch is a particularly interesting topic for many allied health care providers as we often use our hands or other instruments to touch others in practice in hopes to modify the experience of pain.

We use our hands for a variety of things, among them to touch, to soothe, to comfort, sometimes to change the input, to show, to teach, to guide, to model. Touch is multimodal.

But of course, when we touch there is always the toucher and the receiver… both experiences are riddled with so much; Previous experiences, intent, consent or lack thereof, comfort level, hope and expectations, awareness and interpretation.

So often in clinical practice we use touch with the intent to decrease pain, yet ironically we use a variety of tactics that can be painful (from our hands to literal hammers and needles), to try and invoke that response. Often it works. Massage feels good for most people, trigger points therapy gives relief, and people feel better. And although the effects are often transient they are immediate most of the time and quite satisfying.

Of course we have also seen the pendulum swing especially in the physiotherapy world of no touch, no manual therapy, and working only in the cognitive realm. Claiming that touch creates dependency and relegates the patient to a passive, unmotivated person. The premise being that we can reason people out of pain and talk through the “drivers”. That an explanation should be enough.

More than likely you have swung yourself through this clinical pendulum and are beginning to see that the truth is somewhere in the middle. We can’t put humans in a box and attend to only one part of the biopsychosocial model for a biopsychosocial being. It’s always all happening simultaneously and we need to be able to hold that in mind as we think about what might help this person sitting in front of us.

Some other things I find really interesting to think about when I think about this topic of pain and touch is how do we really know how to categorize touch? Like, what is painful touch? Is there such a thing when everyone responds differently? The same for therapeutic touch. When I hear therapeutic touch, I’m thinking about soothing, calm, gentle touch, but that contradicts so many of the manual based therapies for pain out there. When something is therapeutic does that only mean that it affects pain? What about all the other responses/affects it can elicit? Who decides what is worthy of being therapeutic? Is keeping touch away from someone potentially unethical when they ask for it and tell you that it helps them?

I think this is a fascinating topic, filled with unending nuance, and something we should take very seriously as touch-based professions.

See you at the discussion!

The Reading List

October 2022 Readings: Pain & Touch

Humanities Piece: Fly in the Ointment

Reading 1: Pain & Touch: Kearney, R., 2020. Philosophies of touch: from Aristotle to phenomenology. Research in Phenomenology, 50(3), pp.300-316.

Reading 2: Bialosky, J.E., Bishop, M.D., Price, D.D., Robinson, M.E. and George, S.Z., 2009. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual therapy, 14(5), pp.531-538.