This week I am reflecting the interview with David Butler who is a physiotherapist and educator on pain science. I learned two new terms DIMS (danger in me) and SIMS (safety in me). DIMs and SIMs are used to describe experiences that either increase pain (DIMs) or decrease pain (SIMs). This has implications for our immune/inflammation systems, our nervous system and brain network.
Pain science tells us that pain occurs when the brain perceives danger in the world. The brain perceives safety when we have less pain. Often times in yoga we experience a stopping point. Such as, we gain a certain amount of strength and stop or we are unable to relax beyond a certain point. At some point in our lives we have learned not to advocate for ourselves or we feel too unsafe to be able to let go. From a movement perspective, we can break movements down even more in order to “trick” our nervous system to strengthen more or to relax. From a psychological perspective we can explore beliefs of why we feel unworthy of getting stronger or letting go.
The language we use in how we express our story of pain also plays a role in how we perceive pain. For example, instead of focusing on the negative (the swollen knee), focus on the positive (you are healing already) because you came in for therapy. This is an example of turning a danger in me (DIM) into a safety in me (SIM). Another example of a DIM is blaming your health care practitioner. Change it to a SIM by thinking that your health care provider is trying to help you. Not sure how your use of language frames your pain? Have your partner or friend report on the language you use. Expressions such as “my back is out…” or “it feels like a knife,” are a DIM. The story we tell ourselves over and over again impacts our brain by becoming ingrained. Even the expectation of pain can increase our pain experience.
David described the Protectometer which is a metaphorical device to demonstrate the ups and downs of DIMs and SIMs. The balance shifts up and down. Education and exposure to movement are powerful SIMs. So are taking care of our emotions, well-being, and safety. For example, going for walk (movement) and enjoying the weather (happy emotions) increases your SIMs. Our immune system is impacted by SIMs.
A DIM at one level may not be a DIM at another level. For example, at work your neck hurts but it doesn’t hurt at home. Explore what aspect of work is making your neck hurt.
A SIM or a DIM can be something as simple as a thought. In fact a thought can change a DIM to a SIM. For someone in chronic pain going to the movies for the first time in 6 years could be a SIM. We need conscious awareness to go through this process of recognizing DIMs and SIMs. They tend to hide in hard places to find. A loved one who knows you well, a yoga teacher or a therapist might be able to help you with this process. There could be 30-40 DIMs in someone with chronic pain.
For people in pain, David Butler recommends
1) looking for a health care practitioner who is scientifically aware and believes recovery is possible (very few doctors are well versed in pain science). The biomedical model doesn’t work because it operates on the causal. A biopsychosocial model requires discussion, explaining and curiosity.
2) Look online and familiarize yourself with SIMs/DIMs/Protectometer.
3) Seek out Level A evidence from studies that are a trusted resource.
4) Start a journal of your SIMs and DIMs. There are apps for symptom tracker than can help, if a journal is a DIM.
4) Adopt a sense of curiosity and discuss what you find. Awareness follows and then clarity arises.
5) Be aware of your frame of reference – we may not notice what changes when pain goes away.
Here are 10 Target Concepts to get into this new way of thinking.
- Pain is normal, personal, real
- Danger sensors, not pain sensors. It is the brain that weighs whether or not it will hurt. We don’t have pain neurons.
- Pain and tissue damage are rarely related. It’s all about context.
- Pain depends on Danger and Safety. More danger = more pain.
- Pain involves distributed brain activity. Different areas of the brain are affects such as memory, fear, future, vision and smell.
- Pain relies on context. What we see, hear, smell, taste, touch, say, think, believe, places, people, what we do.
- Pain is a protected output. This mean other things change our immune system and nervous system. For example, someone with back pain likely has gut (digestive) issues.
- We are bioplastic in that we can change. At any age our brains can change.
- Learning about pain can change you. Understand why you hurt.
- Active treatment fixes pain. Doing, learning, dealing. Can’t be passive (pill popping).