When people ask “why does it hurt?” I’ll get around to stating that “… also, context of [your pain] is a factor in how it feels.”
Now this may make sense to you, the PTBT audience, but this is often not an idea that people have thought of. Most people only remember a politician saying his/her words were “taken out of context” so it may be important to explain context.
Here are two quick context stories I tell. Please use them, please make them your own…
1.) Context example… “So now let’s say you are walking in a spooky forest, it’s dark out, you’re by yourself, a bit creeped out and you feel this on your shoulder (lightly tickle the skin), what would your reaction be?” Often a patient will exaggerate looking back quickly or state “I would jump, think it was a spider or something”, etc.
“Perfect. Now, pretend you are just getting in bed, warm covers on a cold night, and your lover reaches over and you feel this on your shoulder (lightly tickle the skin), what would your reaction be? Now most patients get it, some answer this question and it can be worth a chuckle, but the point is, (in my experience) an example along these lines seems to drive home the idea that Context has a role in how we feel our bodies.
I typically finish with a statement: “Notice, the exact same thing happened at the skin, the skin knows no difference between those two things, and yet, can you see how context can change what you feel or how you react to a sensation?”
2.) A second context example. (*bonus: involves sleep deprivation topic as well!)
“You’ve seen a little kid or baby playing with his friends in the sandbox, right. He bumps his knee…. keeps on playing, having fun, it’s all good.
Now, imagine that kiddo has not had a nap and is hungry, and bumps his knee. What happens then? Most patients will know this answer. Yep, the kid breaks down, cries, throws a fit, etc. The knee actually hurt and we’ll hear about it!
So was it about the knee-bump? The same thing happened to the knee both times, but in one case the kiddo didn’t have the capacity to handle it, was not distracted, was easily set off because of the context of his mental state. So it’s not all about the knee. And since we are are just big babies (I’ll say, pointing to myself) we behave under similar rules.”
The second one can really drive home the impact of sleep deprivation on pain tolerance and capacity to function while in pain. It’s my “go-to” for analogy on that topic.
Now, I may tweak these stories, and you should tweak yours too. Some patients can handle more or less technical terms, more or less elaboration, longer or shorter stories, smaller or bigger build-ups to the punch-line, etc. Stories like these, to explain context, often help shape the conversation, and help open up the idea that it’s not all about the tissues. It’s not going straight for “pain is an output of the brain” but more like massaging the idea that things can feel different at different times for different reasons. So let’s start there, with context.