What Is Pain?


An interview with Othon Molina, Ph.D.

Othon Molina is a massage therapist and sports medicine body worker with over forty years of experience.

You have spent a career doing hands-on work with the human body. What perspective does that give you on the experience of pain and its treatment?

In order to talk about pain, we need to define it. There are many types of pain, many variations. Broadly, there is dull aching pain, sharp stabbing pain, cold pain, referred pain, pain from injury, pain from overuse. To treat pain properly, you have to really get to the source of the pain, and that may not be so easy. Is it a torn muscle, say, or a sprained ligament? Are your feet numb from a disk? Does this mean you have a problem with an intra-vertebral disk? Sometimes pain in the shoulder, in the rhomboid muscle, say, is not relieved by bodywork or physical therapy to that area because it is in fact may be originating in a cervical vertebra.

Each type of pain requires different treatment and assessment, which is why medications, which may be shotguns, often won’t work. It’s important to get a complete history, and before touching a patient, to make an intellectual assessment with questions about what they were doing just before, and at the time of, the onset of pain, even if the injury seems occult. Slowly, you narrow down the root of the pain, and then you do a physical assessment. If you think it’s a soft tissue injury, you do a contraction test and then a resistance test and palpation to test range of motion.

When you take a history, what role does your take on the person’s “buzz” have on your conclusion about their pain?

Some doctors believe that pain is all in the mind. My own training tells me that structure governs function. If your structure is out of alignment, your function is going to be affected. That concept applies to the mind as well as to other organs and structures.

You mean to emotions?

Sure. If the patient is in fear, if the person is angry, if the person is under heavy mental stress, the pain is going to be greater. I’ve seen plenty of examples of the correlation between state of mind and perceived pain.

You use massage and manipulation. Do you use medications as well?

Not at this time, although when I worked with a medical doctor, we did. I’ve had a chance to use both drugs and alternatives, and been able to gauge the effectiveness of drugs with an open mind. Frankly throughout the sixties and seventies I saw drugs as the last and least desirable alternative. Now, of course, so-called alternative medicine has morphed into integrative medicine and I’m glad to see that traditional practitioners are more open to massage, acupuncture and other bodywork.

Did your reluctance to use medication stem from a fear that the medication might do harm, or did it stem from the belief that a certain amount of suffering was part of healing?

Quite the contrary. I feel that suffering is not part of healing. But I feel that drugs mask the true cause of the pain. I feel that doctors sometimes take a shortcut so as to fix the problem quickly, that does have great value at times, if they then work with the other parts of healing the body. Many can’t take the time to assess the whole person they are so busy and it takes enough years to do what general practitioners have to do. We all have specialized for that reason, there is a lot to know about the body and working as a team seems to be one solution. That led me to my own take on pain, which is a sign that something is out of balance, pain is an alarm. Turning it off without looking for what is really going on is just the beginning. You can eradicate the pain, but miss the underlying conditions.

Do you think that this masking gets in the way of healing as well as assessment?

Of course, because if you can’t tell where the pain is coming from you can’t help heal it. More recently, though, I’ve seen steroids and numbing drugs actually used to do some assessment, so my mind is now open to the proper use of the proper drug. I’ve seen chronic pain patients medicated with steroids and pain killers for years so as to keep the pain at bay rather than figuring out what was really causing the pain, which was a combination of poor posture, weak muscles, and perhaps an injury that caused the body to guard itself and start a vicious cycle.

Do you think that pain is valuable then, from a biomechanical point of view?

Sure. Pain is a wake-up call. You can have pain as light as the press of a toothpick. If you don’t listen to it, it may reach the level of a ruler slapping you. If you continue to ignore it or mask it with drugs, it becomes a two-by-four wailing on you. In our society we typically wait until the two-by-four stage before we do anything about pain.

Do you suppose that’s because we live so quickly that we don’t have the time to properly engage and respond to our pain?

Beautiful. Absolutely. Totally right on. We move too fast, we don’t have time to deal with pain? Got a headache, take a pill. Got a backache, take a different pill. It’s the easy way out. I don’t blame physicians for this. They are overburdened. The truth is that our educational system is weak. We are not taught how our bodies work, and we’re not taught how to take proper care of them. We’re not taught biomechanics, we’re not taught function, we’re not taught what pain signifies, nor how to interpret the message it gives us. You have to be hungry for that knowledge to find it—which often means you are in intractable pain—because it isn’t easily available. Consequently, we want the quick fix.

You imply that the quick fix has a price.

The price of the quick fix is not getting to the source of the problem. Masking pain, ignoring the wake-up call, can actually cause further deterioration. If you don’t listen to the first call, you’ll have to listen to the next call. I’ve seen patients go from a manageable low back injury treatable with massage and exercise to a severe disk problem because they didn’t listen to the problem, didn’t stay off their feet, and covered up the symptoms with pain pills.

So Stoicism is a self-destructive philosophy?

Absolutely, although there are certain patients who have a very strong will. They may not be Stoic, so much as determined to get better. They’re easy to work with. They’re great. Then you have the patients who are co-dependent, who have been through years of doctor visits. They are accustomed in some cases to be being pampered, to hearing “Poor Baby.” Their favorite line is “Woe is me.” They haven’t really been helped correctly, they haven’t really been put in touch with their own healing process. When I worked in a clinic, I lost patience quickly with individuals who didn’t do the exercises I gave them. I figured that if they weren’t willing to contribute to their own wellness, they weren’t doing their part. Healing in a healthcare setting requires the practitioner and patient to work together against pain.

What would you say to the person who tells you “Your philosophy of healing is all well and good, but I’ve got a job to do, children to care for,” and so on?

I had that response every day, and my reply was simply to say that if you don’t take two weeks off now, you may be taking ten years off later. Either heal a minor thing now, or contend with disaster later. It’s very nuts and bolts. It’s not just philosophy at all.

What do you suppose are the social and cultural forces underpinning our attitudes toward pain, our desire to ignore it as a signal, to be rid of it as soon as possible?

The social implication of pain is quite simple really. If you feel pain, you’re weak. Nobody wants to feel that they are weak. Nobody wants to feel that they are not worthy somehow, that they are being deprived of health, even that they are being punished. Chronic pain is an unimaginably destructive experience, destructive to our sense of self. It demoralizes people. It breaks their spirit.

Thus the title of this book–Thief in the Temple.

Just so. Something has been robbed from the temple of the body, the temple of the spirit. People feel that they are less than they were when they suffer this way—less than other people too. At the very worst it can lead to suicide. I have patients who have suffered ten or fifteen years with chronic pain and they are shadows of their former selves. They have definitely been robbed of something.

You see, ever since prehistoric times, physical survival has been of paramount importance. We had to face the tiger. The name of the game was to beat the tiger or outrun the tiger. We had to be strong or smarter than the tiger. Our competitiveness with each other comes from our deep-seated instinct to be the fittest, and to survive. This is a primal and instinctive drive, and pain is antithetical to it. We see it as a failure, a weakness, an enemy we can’t beat. A tiger that eats us.

So we don’t want to face it. It’s like sex in school in the 1960s. Nobody wants to talk about it. It’s one of those nebulous diseases of our society, something we want to put in the back room. We want to take it out of the social light. You don’t share your pain with just anyone. It’s personal. Intimate. Yet you have to embrace it to heal it.

To me, the word embrace connotes acceptance. But acceptance connotes living with it, when living with it is not the goal. The goal is living without it.

The old saying “No pain, no gain,” has caused a lot of problems in the athletic community. I don’t know who invented it, but he did people a great disservice. Of course there is a certain level of discomfort that we feel when building our body, when exercising, it’s called irritation and adaptability. It’s the stress you put on the body to make it respond constructively. I’m talking about pain beyond this level. What I mean by “embrace” is to understand pain, get close to it, know that it’s only a symptom of something else. When you have pain in the knee while running, and you say “I’m going to run through this pain,” you are probably going to hurt yourself. The pain is going to get worse and worse, and you had better listen to it right away. The start of the listening process is what I mean by embracing pain. It’s the opposite of denying it.

So we might substitute the word acknowledge for embrace. We need to understand and respond to pain as an important signal?

If you want to conquer something, you must understand it. Ignoring it just makes it stronger. It’s just like fear. If you want to beat it, you have to face it, see where it comes from, grasp it. It’s a basic strategy issue. The understanding is just the first step, though. If you go to a doctor who is too busy to give you a proper work up, who just gives you a pill to make the pain go away, then you are not really ever understanding it. You’re ignoring it, and you don’t really conquer it that way. This takes time, of course, and knowledge.

The analogy I use is one of a car that is out of alignment. If you give it a tune-up, it will run a lot nicer. That’s acupuncture. If you go to a general practitioner who has not seen thousands of patients, you might get a pill, the equivalent of new paint or new leather—makes you feel better, but doesn’t fix that bum wheel. The only real way to fix it is to go to an alignment shop, have the thing measured, identify the problem, and true the wheel or replace it. But it’s not always easy in the complex human body.

Now sometimes, though, drugs can be helpful. They can actually allow the body to heal itself, can facilitate the process. The most common structural problem in our society is low back pain. One type is called sciatica, which may come from a disk pressing on a nerve, and it can manifest as cold or sharp or dull or numb, but the underlying cause is all the same. If I had a dollar for every patient who has ever told me “All I did was bend over to pick up the newspaper and I threw my back out,” I would be a millionaire. That’s how often it happens. It’s a plague on our society. There are myriad events that can trigger back pain, but the fact is that anti-inflammatory pain killers, in combination with a week of bed rest, can cure sixty percent of people completely. Another twenty percent may have some lingering problem, and need physical therapy. The last twenty percent may need other intervention.

But spending a week in bed on anti-inflammatory drugs just brings you back to the baseline, back to where you were before you bent over and picked up the newspaper. A person ought to be able to bend without harming themselves. Something must have been amiss before the precipitating event. My guess is that this is a broad statement that we can make about many different kinds of pain, even the pain of chronic disease. Perhaps there is a predisposing condition that exists before the disease sets in—a deficiency of the immune system or some structural problem that makes you vulnerable, prone to problems. That makes sense, doesn’t it?

Absolutely positively true. I would love to prevent injuries that happen to athletes and other people and we could do that through education, by teaching them proper body mechanics. Prevention is the key. But when you are a therapist in a clinic, you get the people who are injured. In that sense, all therapy is a band-aid. Drugs work best when you get the injury in the first day or two. If you wait a few weeks, the rate of recovery drops. The more you wait, the worse the irritation gets and the harder it is to turn it around.

The reason we injure ourselves so often, the reason we feel so much structurally based pain, is that we have gone from being an agricultural society to being an industrial society, to being a technological society. We sit in chairs all day long, see? We don’t exercise. We use some muscle groups too much, and others not enough. Consequently the body is out of balance.

Do you think that the principles of preparing, girding, training and educating against injury might apply to all the different senses in which we have pain; emotional pain and spiritual pain as well as the chronic pain of disease and the acute pain of injury?

I have to say yes, I believe that. As a student of the body and a student of spiritualism, I believe that all pain comes from some kind of imbalance. Our society doesn’t prepare us on all these levels though, the way some aboriginal societies did and do. We’re not taught meditation, or proper communication with each other. We’re not taught body mechanics, we’re not taught to understand emotions. We have lost our overall balanced worldview. If we worked toward balance on all these levels, we would feel much, much less pain.

I would like to see a world learning though joy and love.

–Othon Molina interview with author Arthur Rosenfeld

 

For any questions please call:
Othon Molina Ph.D. c LMT
(909) 730-5733

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