Useful Pain: Therapeutic Pain as a Tool for Healing and the Alternatives

Erik Dalton, a respected leader and educator in the massage therapy field, recently published an article in which he proposes massage therapists employ pain - in limited, controlled quantities - as a useful tool to the therapeutic process. This is known as Pain Exposure Therapy (PET) and is used in many rehabilitative settings and modalities.

The premise behind this method is that we can decrease pain by “normalizing sensitization by providing constant stimulus to the affected area for short periods of time.” Or more simply, we can show the brain that the body is not in danger by controlling the amount of pain felt in a given movement. Levels of pain felt are reduced as the nervous system registers that whatever threat caused the injury is no longer present.

Dalton’s main application for PET is with therapeutic stretching. He notes “traditional stretching routines produce an immediate increase in muscle extensibility,” but “more permanent extensibility” is seen when PET is utilized.

Two possible reasons are offered for why the results are longer lasting. The second proposed is because the feedback loop between the central nervous system (brain and spine) and the peripheral nervous system (all the other nerves; specifically the area of pain in this instance) is being reorganized. The first Dalton states is likely more important; “the client’s willingness to tolerate the discomfort associated with the stretch.” A client’s active involvement is allowing him or her push through barriers created in attempt to stave off pain, effectively illustrating in real time that fears can be calmed and avoided behaviors can be reintroduced into normal routines. Essentially, the therapist is helping the client to integrate the physiological and the psychological elements of the central nervous system to resolve pain more quickly.

While I see the benefit of utilizing controlled pain to speed the therapeutic process (and will initiate it depending on what the underlying cause of the pain is), there are, in my experience, better ways to reach the same goal. We can decrease central sensitization - the process by which the central nervous system goes on high alert in an effort to guard against injury - by engaging the nervous system and indicating safety through softer means. Myofascial work, Spontaneous Muscle Release Technique (SMRT) and muscle testing are the primary methods I use.

Part of the effectiveness of PET is that the therapist is introducing novel stimuli to an affected area. With SMRT, the novel stimulus comes through the subtle nature of the holds and the activating force of the compressions. The nervous system can be directly involved in the conversation in ways that are usually drowned by the “loud,” larger movements of everyday life. We then engage your psychological state by having you test your range of motion, creating visual and tactile evidence that your pain has decreased. What I find most amazing about this work is that even when the pain returns as is likely to happen after a few days after the first few sessions on an ongoing issue, it is often greatly diminished or has shifted to reveal another element of the compensation pattern that is ready to resolve. Muscle testing has similar benefits. Using this form of nervous system communication, we can ask your bodymind exactly what stimuli is most needed, and will therefore be most effective to create change. Safety within the body is front and center as we ensure that the locus of control remains squarely with you and your nervous system instead of barging in to make demands that may not make sense with all of the autonomic concerns and available resources your bodymind has.

Overall, there are some legitimate reasons why pain might be experienced during a massage session and therapeutic pain can be helpful in your healing. But, as I have asked so often, if you don’t have to experience pain, why should you? What has your experience been with pain during therapy? Let me know in the comments!

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