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  • Jean Jordan

Could I Learn Chronic Pain From Mum Or Dad?


Family of tall straight trees close together


If you learnt how to have chronic pain - is it time to get retrained?


There are many reasons why people have chronic pain. One reason I want to discuss with you today is: can chronic pain be learnt by living with and watching parents with chronic pain?


To put forward my argument about learnt pain behaviour I'll discuss the way that we learn more practical skills, that involve movement.


Because parents with chronic pain may move in a guarded way, have limited movement or use language to express their painful movements.

In the same way we learn physical skills such as, how to ride a bicycle, how to dance, like Zumba (my favourite exercise) or learn how to decorate a celebration cake.


Steps in how we learn to do things:

o first you watch;

o you observe what is happening;

o think about how something is done.


Lier et. al (2014) has shown that if a parent, mother or father has chronic pain, this increased the odds for musculoskeletal pain in adult sons or daughters from 20% to 40%. This figure can increase as children grow older or if both parents have chronic musculoskeletal pain.



Your Environment May Prompt Learnt Pain Behaviour.


It is well recognised by health professionals that the environment in which we live and in which we grow up, has a major impact on our health. Any doctor or specialist we visit wants to know our familial - typical for a family - health conditions, such as diabetes or cardiovascular disease so they can track our health or probability we'll develop an illness, especially chronic illness when we'll need constant medication.


Research (Zadro, 2018) that says it might be worth, not learning to do the wrong things to help prevent chronic musculoskeletal pain being passed from parent to child?


Are family Influences included on pain induction forms?


I'm not aware of questions about mother or father's pain history being regularly used on induction forms even when visiting a pain specialist? It's worth clarifying; here I am referring to lifestyle choices and influences, not to diseases such as rheumatoid arthritis and genetic components of diseases.


Importance of learnt behaviour for health


My interest is learnt behaviour such as eating the wrong food and sitting around all day that isn't the best thing to do if we don't want to get diabetes. I think you'd agree with that statement? Such as, if we know diabetes affects a family member we have the opportunity to make changes, so you're not the next family member to get diabetes. Can we also learn pain behaviour from a family member - such as poor movement, groaning or painful facial expressions, or disability due to pain?





If Pain Runs In Families - Have Children Learnt Pain?


Before I return to talk about chronic pain, in its many forms from back pain, knee pain, or post-surgery pain; I'd like you to show you some examples of how we learn in an instinctive way.


Not learning information, but learning how to move, how to act and how to do things. I have chosen three different examples of how we learn and how we practice to become proficient.


Learning to ride a bicycle like we can also learn pain

First Example: Riding A Bicycle


Learning begins by observation:


o see people riding bicycles;

o see the pedals going around under somebody's feet;

o watch the handlebars being turned;

o (but rarely noticing the brake being put into action the gears being changed)


Those last two actions are learnt when we start to do! That is when we actually get on the bicycle and bring movement and action to the learning process.



Learning Zumba - My Recovery From Post-Surgical Pain


When you first walk into an exercise class it certainly looks like everyone knows how to move. How do you learn to do the movements?


o watch and watch and watch, as the steps look so complicated;

o music and rhythm, more instinct here, start to move;

o steps are broken down, demonstrated, and talked through by the instructor.


We start to do, observing, following steps, usually watching our feet move, watching the instructor's feet move and trying to do the same. And for me, I'm always going in the opposite direction!







Learning To Copy Complicated Movements


My last learning example is learning how to decorate a celebration cake. This is a very complex process for a cake to look amazing and often left to the professionals. We just admire the beautifully decorated cake.


Before people begin to learn and have ingrained, automatic methods and movements, even professional cake decorators had to start somewhere.


o They watched demonstrations;

o They followed spoken instructions, practiced how to move hands evenly and smoothly;

o They drew diagrams, photos, then created designs and I haven't even got to the cake yet;

o Then they practiced, practiced and practiced.


Perhaps there are some of you readers who can do your own celebration cake usually because you've learnt, had a bit of trial and error and practiced.



Now Back To Thinking Of Chronic Pain


Let's reflect on the examples above of learning physical skills that become automatic and without thought. Can we really learn pain behaviour?


Let's use back pain as an example; chronic back pain, middle or lower back. Whichever, it's pain that goes on for months, for years and without many real solutions to your back pain.


Growing Up With a Parent living with Constant Pain


What do you think happens to a child who grows up with a mother or father that has chronic back pain?


o They watched the painful way mum gets up from the sofa.

o They see their father's expression when his pain hurts as he moves.

o They experience a grumpy day with a tired parent in pain after coming home from work.

o For some children they'll be their parent's carer, or helper when the pain is too difficult or causes disability.



What The Research Says Causes Familial Chronic Pain?


Genetic research to find genes that either cause illness or can make us prone to health conditions has increased in recent years. Therefore an area of research into the causes of chronic pain is looking for genetic reasons why some of us develop chronic pain. Perhaps there could be a genetic weaknesses or susceptibility of a person's spine to injury or disability?


Perhaps there is something else to consider, the possibility of unconscious "pain training" within families that could be more informative than a genetic test? Campbell (2018) says that in certain pain conditions "family members are more likely to have similar symptoms" p.41.



Another Way To Look At Family Pain Culture


"For example, two households one is a "rugby household", watching rugby, children play with an oval shaped ball, they play for their school rugby team etc."

"Then perhaps the house next door is a "football household", kicking a round football around the garden, making goalposts, and enthusiastic fans of Manchester United."

These above easy to understand examples of family culture can be very strong having an influence on the children in the family, living with parent who follow a particular type of sport.


A Case Study - A Daughter's Chronic Pain


It was a discussion with a woman who had chronic back pain that prompted me to write this article. A chronic pain client in her 60s, she had suffered back pain for over 20 years but what drove her to find me for treatment was recently added painful hands, hands becoming so painful work was becoming too difficult and now pain was a risk to her financial future.


When we discussed family history she described how she could only remember her mother being in chronic pain and its disabling effects. She had one sibling, a sister who although younger, was already suffering disability from chronic pain, already using a walking stick and had reduced her lifestyle.


The example above draws attention to the "complex interactions between an individual with chronic pain and their family environment" Campbell et al (2018). I’d like to suggest on the induction forms of pain specialists or history taking interviews, questions or some emphasis needs to be whether a parent, grandparent or even perhaps an uncle or aunt had suffered chronic pain for an extensive period. If this turns out to be the case, is it time for re-training pain?


Re-Training Or Updating The Pain You Learnt


Let's return to my cake decorator. Could there be an opportunity when getting bored with professional cake decorating they want to change their career to a carpenter making wooden cabinets, or growing trees because they want to work outdoors. Yes there certainly is this opportunity, with re-training. In happens every day.


I Re-trained From:

o A high school teacher,

o To a naturopath,

o Now a chronic pain therapist specialising in natural and self-help therapy.


In much the same way, once you have the awareness of what you watched growing up, other members of your family who unwittingly gave you instruction by demonstrating pain signals. Could there be an opportunity to retrain your pain?



Awareness is a good place to start.



Final Thought For Pain Suffers Or Pain Practitioners


If you are a person with pain reading this article there may or may not be some relevance to you. If there is perhaps, as Zadro (2018) says a familial predisposition to have pain because another family suffered with chronic pain, or if you are the parent struggling yourself with pain, ask some questions of your pain therapist, awareness and information is powerful medicine.


To health professionals who work with, and treat chronic pain, do have a look at what questions are on your intake form, relating to a possible family culture of pain. It may open amazing doors of discussion and an option to re-train your patients thoughts and intentions for self-help.




This article is the personal opinion of the author, Jean Jordan who is a natural therapist who works online with people who have chronic pain and related stress and anxiety.

Learn more about Jean and discover her philosophy and holistic approach.






References


Campbell, P. , Jordan, K. , Smith, B. , Scotland, G. & Dunn, K. (2018). Chronic pain in families: a cross-sectional study of shared social, behavioural, and environmental influences. PAIN, 159 (1), 41-47.


Goubert, L., Vlaeyen, J. W., Crombez, G., & Craig, K. D. (2011). Learning about pain from others: an observational learning account. The journal of pain, 12(2), 167–174.


Lier, R., Mork, P.J., Holtermann, A., & Lund Nilsen, T.I. (2016). Familial Risk of Chronic Musculoskeletal Pain and the Importance of Physical Activity and Body Mass Index: Prospective Data from the HUNT Study, Norway. Plos One; 11(4)


Lier, R., Nilsen, T.I.L., & Mork, P.J. (2014). Parental chronic pain in relation to chronic pain in their adult offspring: family-linkage within the HUNT Study, Norway. BMC Public Health,14,797


Zadro, J.R., Neilsen, T.I.L, Shirley, D.,Amorim, A.B., Ferreira, P.H. & Mork, P.J. (2018). Parental chronic widespread pain and the association with chronic widespread pain in adult offspring: Family-linkage data from the Norwegian HUNT Study. European Journal of Pain, 22(8), 1485-1493



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