Pain Perception Continuum: More Complex Than “High Tolerance” and “Low Tolerance”
The science and fitness worlds have greatly increased their interest in pain science in recent years. There’s been an increased awareness of the complexity of pain, and how we can utilize a more advanced understanding of how pain works, or doesn’t work, in order to help clients. This is something that Physical Therapists at MOTIVNY are taught to be constantly aware of, and has allowed us to raise our level of impact on our clients’ lives. While that general understanding has been crucial, I believe it’s also important to understand that there are multiple sides of the metaphorical dice when considering how people treat their pain.
We are used to seeing pain as a continuum, or a rating scale, or a happy-sad face scale, or any number of other visual and constructed representations of pain (See images below).
Patients/clients hate these scales. They can never quite put their finger on where they stand in terms of rating their pain, and don’t particularly want to closely analyze it. Frankly, most people, I believe, take a pretty simplistic view of it. If you take your car to a mechanic, you don’t want them to ask for a rating scale of just how broken the vehicle is, you want them to analyze it based on your complaints, and make the problem go away. People just want the pain to go away, and are not going to be enthusiastic about the minutiae of rating it.
In my mind, clients’ pain is better understood in a psychological response continuum rather than a rating scale. We are taking a constant assessment of our pain situation, and measuring that vs. the activity we want to do. It’s a risk assessment; a cost-benefit analysis, a willingness to suffer for what I tell myself that I want.
While it’s not so simple as classifying people into absolute buckets, I believe that drawing ourselves into a psychological response curve may be more useful in changing outcomes for individuals. We know this psychological approach is essential, as the cult favorite book by Sarno has explained, and that many cases of pain can be vastly changed, or even eliminated by changing of mentality.
That information is incredibly important, and while I do agree that many of our high-perceiving pain clients can improve with a shift in mentality, I’m here to say we also need to be careful with it.
In the chart below, we have three main categories, which are blended between one another. There are risks and benefits to each area on the continuum, and a client should be treated accordingly. “High Tolerance” for pain is not always a good thing, nor is it always a bad thing. The key is having appropriate psychologically adapted responses to pain tolerance, and guiding our behavior based on that assessment. How one deals with their personal pain situation determines if the pain tolerance is a positive or negative indicator.
I believe that athletes and the stigma of pain tolerance is a topic which should be discussed more. We revere and idolize individuals for pushing the limits of pain to achieve gold medals, championships, and all-star games. Unfortunately, often that justification comes with a lot of psychological problems that make long-term happiness hard to sustain. Shouldn’t that be just as important as short-term personal career success?
As the fitness boom in America has taken off, we have more and more people trying to take a professional athlete mentality in their sports, careers, or fitness. We should be cautious of applying this mindset without also creating a nurturing environment of long-term happiness and success. As therapists, we see people frequently who start as this “High Tolerance” archetype, and shift over years to more of a “Low Tolerance” archetype, and also have an unfortunate shift in mental state.
We want to achieve performance, and we want to be the best in activity, but I believe that the timeline of progress has to be respected. Too often do we want short-term gain and improvement so badly that we justify behaviors. Longevity is a principle that MOTIVNY holds of high importance. When crafting your goals, attempt to balance your current wants and needs with a thoughtful expectation of progress. Balance it with a lifestyle that will sustain your happiness and fulfillment for decades; not months. The poorly chosen behaviors of “Low Tolerance” as well as “High Tolerance” pain perspectives can lead to equally troublesome consequences.
The silver lining is that with thoughtful reflection, planning for longevity, and accepting timelines...You can have it all.