Understanding Pain & Pain Management Techniques
"An enactive approach to pain: beyond the biopsychosocial model"
Peter Stilwell and Katherine Harman's paper "An enactive approach to pain: beyond the biopsychosocial model" proposes a new way of conceptualising pain that moves past the traditional biopsychosocial model. The authors argue that the existing model, while an improvement over purely biomedical approaches, still falls short due to its fragmented application and insufficient theoretical foundation.
They introduce the "5E" framework to better understand pain, describing it as Embodied, Embedded, Enacted, Emotive, and Extended. This approach suggests that pain is not merely a result of biological, psychological, or social factors in isolation but a complex, relational, and emergent process of sense-making through a lived body that is inseparable from its environment. Scroll on for a deep dive into pain and the chronic pain management techniques that help manage it effectively.
Embodied
Definition: Pain is experienced through the lived body, emphasising that our bodily experiences are integral to how we perceive and react to pain.
This perspective highlights that pain cannot be fully understood without considering the physical sensations and the body's role in the perception of pain. It acknowledges that the body and its movements, postures, and physiological states are central to the pain experience.
Embedded
Definition: Pain is situated within a specific physical, social, and cultural context.
Pain experiences are influenced by the environment and social interactions. For example, cultural beliefs about pain, the support system available, and the physical environment (such as workplace ergonomics) all play significant roles in shaping how pain is experienced and managed.
Enacted
Definition: Pain is an active process that involves the person's interactions with the world.
This concept suggests that pain is not a passive experience but involves active engagement and behaviours. How individuals respond to pain, such as avoiding certain activities or seeking out specific forms of help, constitutes an essential part of the pain experience. The actions taken in response to pain influence its perception and management.
Emotive
Definition: Pain is inherently tied to emotional experiences and affects.
The emotional dimension of pain is crucial, as pain often comes with feelings of fear, anxiety, and distress. These emotions can exacerbate the pain experience, creating a feedback loop that can intensify the suffering. Addressing the emotional aspects of pain is, therefore, critical for implementing effective pain management techniques.
Extended
Definition: Pain extends beyond the individual's body and mind to include tools, technologies, and social networks.
This concept acknowledges that pain management often involves external aids and support systems, such as medical devices, medications, and social relationships. The use of these external resources becomes part of the pain experience and influences how pain is perceived and managed. The support from family, friends, and healthcare professionals plays a vital role in the pain experience and recovery process.
By integrating these five dimensions, the enactive approach offers a holistic understanding of pain that recognises the complexity and multifaceted nature of pain experiences. This perspective encourages a more personalised and context-sensitive approach to chronic pain management, moving beyond traditional models that may overlook the dynamic and interconnected aspects of pain.
Expert Chronic Pain Management with Our Exercise Physiologists
The paper emphasises that pain should be viewed as a dynamic interaction within an individual's lived experience, rather than something located in specific parts of the body or mind. This perspective aligns with recent advancements in phenomenology and cognitive science, suggesting that understanding and treating pain effectively requires a holistic, integrative approach.
If you are struggling with chronic pain you can book an appointment with one of our Exercise Physiologists for expert management and support.
We might like to add how the below is an example of how our Exercise Physiologist’s would put the 5E framework into practise using an example of general lower back pain:
For a client with chronic lower back pain:
Embodied: Begin with core-stabilising exercises and teach neutral spine alignment.
Embedded: Adapt their workout for a home setup if they lack gym access, and recommend breaks to stretch during long work hours.
Enacted: Create a progressive plan that builds their confidence in lifting light weights safely.
Emotive: Use positive reinforcement and relaxation exercises to manage fear of reinjury.
Extended: Suggest a supportive walking group and guide them on using lumbar supports or ergonomic tools.
By addressing all five E’s, an exercise physiologist can craft a tailored, integrative approach that respects the complexity of the client’s pain experience, enhancing both outcomes and client satisfaction.
FAQ:
How does exercise help with chronic pain management?
Exercise works wonders for pain management. It builds strength, boosts flexibility, and improves mobility while reducing inflammation and releasing feel-good endorphins. Plus, it tackles those underlying imbalances to help prevent future injuries and keep you moving with confidence.
How often should I see an Exercise Physiologist for pain management?
The frequency depends on how you’re feeling! We typically recommend weekly or twice a week to start.
What type of chronic pain do you treat?
We’ve got you covered for everything from back pain, joint pain, sports injuries, post-surgery recovery and chronic conditions. Whatever your body’s been through, we’re here to help you move, heal and feel your best.