“Where is Your Pain?”

 

My late teacher, the Japanese Shiatsu Master, Mitsuki Kikkawa, C.S.T., R.M.T., used to torture us repeatedly with brain puzzles like that. Master Kikkawa was a Zen Buddhist, and in keeping with his tradition, he used these seemingly nonsensical or paradoxical statements (called “koans”) as a teaching device to trigger a sudden realization in his students. Zen prizes direct experience over the imperfections of mere words, a strategy that carries a distinct advantage: if the student can be brought to the point where they suddenly comprehend something on their own, nothing more needs to be said. When it works, it’s a very efficient method, but for Western students, who are used to being taught in terms of protocols, procedures and step-by-step instructions, it can be a very frustrating experience!

Master Kikkawa would often begin a class by uttering such statements, and then just stand there, smiling, refusing to say another word until someone had correctly answered the riddle. The point was he wanted us to think for ourselves and come to our own understanding, not simply parrot back what we’d been told.

So, where is your pain?

On the surface, the question, “Where is your pain?” seems quite innocent: Well, if I have back pain, then the pain is in my back (obviously!) Where else would it be? When we hurt our knee, we instinctively rub our knee, not our elbow … so what’s the puzzle here?

Consider another well-known example: phantom-limb pain, the kind of pain experienced by better than 90% of amputees; that is: pain in the part they no longer have. What should we tell them? That their foot pain resides in their non-existent foot, or that they’re just imagining/faking the pain? If you said such a thing, they might slap you, and rightfully so – their pain is real, they’d forcefully assert, and they need some help with it. So the question is not as simple as it first appears.

Indeed, where is your pain?

Let me hint at the answer by asking another question: What part of your body controls the tone of all your muscles, the position and orientation of your bones and joints, and the function of all your organs? Hint: it’s the same part that registers and controls all of your other sensations, including pain.

The answer, of course, is your brain. Am I saying that pain is all in your head? Well, yes and no. Yes, in that pain is an entirely subjective, psychological phenomenon, and no, in that it is certainly not imaginary. As Master Kikkawa used to say, “No brain, no pain.” However, since pain is entirely mental, this partly explains why so many people in pain can have X-rays, etc., taken and yet have nothing show up. That doesn’t mean they’re not in pain – after all, there is no scan for pain – we just assume we will always find a direct, physical correlate to explain it. And if we can’t find one, we often tell people there’s nothing wrong with them, or that they’re just stressed, and then we might prescribe them antidepressants or even accuse them of looking for drugs. Try telling that to an amputee suffering phantom-limb pain (then I’d suggest you duck).

Knowing this, you’d think that everyone in physical medicine would take steps to “treat your brain”, as well as your knee, back, etc. Unfortunately, this just isn’t the case. When you come in with knee pain, we mainly treat your knee. If we’re “integrative”, we might also treat your hip and ankle, and maybe your lower back to help your knee, but your brain? Sorry, no.

Your Pain and Your Brain

Addressing the brain and central nervous system – “the master controller”, in my late teacher’s words – is the missing link in physical medicine. “Missing” in the sense that no one seems to do anything about it. And yet, in the words of Dr. Hance Clarke, Director of the Pain Research Unit at Toronto General Hospital, who I heard interviewed on CBC Radio earlier this year, the best treatments for pain that they’ve found at TGH are “the ones that, first, calm the nervous system”.

If this seems like news, don’t feel bad; taking seriously the central role of the brain in pain management is rare, but now appears to be the cutting edge of pain therapy. The words Dr. Clarke uttered were truly revolutionary. However, we now know that inducing relaxation is the prerequisite to causing neuroplastic change in the brain and nervous system (Dr. Norman Doidge’s books are highly readable primers in these concepts), and when the brain changes, the body changes, too.

The type of work I do (my teacher named the technique he developed, “Suikodo™”, pronounced ‘Swee-KOH-doh’) primarily addresses the brain and central nervous system.

The point is, first, to relax your brain.

Relaxation of the body is a secondary effect, but the one patients notice the most. Master Kikkawa was prompted to develop an alternative to the typically painful Shiatsu (deep pressure) treatments when some of his patients, particularly the most sensitive, weakened or debilitated ones, failed to improve or even got worse. He did something very unusual then: he went back to the proverbial drawing board. Instead, he found that the more gently he worked, the more easily patients could relax. Then, profound physical changes would often ensue, far beyond what he could accomplish using painful deep pressure techniques. This was a huge departure for my teacher, the person who the inventor of Shiatsu (Master Tokojiru Namikoshi) had declared the most talented instructor in the history of the Tokyo Shiatsu Institute, and whom he had sent to “bring Shiatsu to the West” in 1972.

I was prompted to write this article by an encounter I had recently while up North visiting a friend. We went to his parents’ house for dinner, and his sister and brother-in-law were there. His brother-in-law is a paramedic, who had sustained a significant lower back injury many years ago, on which I’d worked at the time. As another paramedic once told me, “No one ever seems to collapse in a convenient position”; first responders often destroy themselves trying to save us.

He’d had eight nerve blocks and two epidurals just in this year alone to try and quell his pain, sadly unsuccessful in the main. Then he asked me, “So when are you opening your own clinic again? You’re the only one who ever made a difference in my pain.” Though I was a bit surprised, after 21 years of treating with Suikodo™, I needn’t have been; I’ve heard similar statements countless times.

What he was saying in effect was that this treatment, designed to relax the brain and nervous system – and thereby all the physical parts they control, including those governing pain perception – was more effective overall than nerve blocks intended to merely numb the pain. That’s a rather striking statement especially coming from a medically trained professional.

What is needed then, I feel, in physical medicine today is a paradigm shift: to move beyond merely hammering away at people’s bodies with increasing amounts of force, or numbing them, and instead toward changing their bodies and their pain, as both Dr. Clarke and my late teacher have said, by first relaxing their brains.

The “Nuts and Bolts”

Treatment involves a thorough assessment and diagnosis, then the use of gentle, relaxing motions of the muscles, joints and points on the skin (nerve-rich areas) to trigger relaxation, first in the brain and central nervous system, and then in the body.

One of the virtues of this approach is that, since your brain controls your body, results can often be seen very rapidly. We almost always see changes in the first visit, so it doesn’t take much time to know if Suikodo™ can help you or not.

It works well on its own, or in conjunction with other traditional therapies, e.g., massage, chiropractic, etc. If you’re in chronic pain, or have some kind of physical dysfunction, particularly the kind that seems resistant to treatment, like back or neck problems, headaches or sciatica, I encourage you to give Suikodo™ a try: you have nothing to lose but your pain.

John MacIntosh, ND, RMT

Posted: 2017 Nov 1

 

 

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