WARNING: you may have a low tolerance to the views within this blog! Read on at your own discretion!
We all have different tolerance to different things, such as how long we can concentrate, or exercise, or put up with some people, and this can vary for many reasons. I recognise I have a very low tolerance for many things in life, things such as idiots who wear those stupid toe/finger shoes, twats with man buns, or anything with avocado in it. I also have a low tolerance for those who slag others off behind their backs, and the many other wassocks in our profession who talk complete and utter bull shit.
Anyway, as I was saying our tolerance to things both physically and psychologically is based on many things such as our experience, previous exposure, and the environment. For example, some people can tolerate exercise more than others simply because they do more of it. Some people can tolerate certain stresses in life due to previous experiences with them. And some people can tolerate others views and opinions more due to being taught patience and respect by their parents and teachers from an early age.
However, it is becoming clear that, in general, human beings are becoming less tolerant to everything. Many are less tolerant of things like food, textiles, medications, and other environmental factors. Many are less tolerant of change, diversity and difference, and many are less tolerant of difficulty or discomfort.
Most of us who live in the developed world now live a life of convenience and comfort. A world where we have ample access to food, water, shelter, and wifi. A world where you have technology and gadgets to make your life easier and effortless. A world where you can buy a device to put your socks on in the morning, or a duvet that makes your bed, or a machine that opens your jars. We don’t even have to go to the supermarket anymore to get our jars or lift them off the shelves and carry them in a basket a few hundred yards.
We are living in a world where effort or exertion has mostly been removed, where any struggle or strain is considered unnecessary and often avoided. Now, this lack of hardship and difficulty clearly has many positives, I for one am not complaining about my wifi, my central heating, or even my online grocery deliveries that I enjoy. But I do think the sheer amount of convenience and ease we have in our lives today has many drawbacks that most are not aware of or appreciate.
To put this as bluntly as I can we have lost sight and recognition of what is tough, hard, or inconvenient. What many of us think as difficult these days simply is not. Being without wifi, missing a meal, having to walk around a supermarket, are simply not serious challenges yet our modern lifestyles and environments and lack of exposure to these tasks have made them appear so.
And this is no different for pain. Having a sore knee, an irritable shoulder, or some low back pain with no history of trauma or unusual symptoms is, in my opinion, not a medical emergency or even a condition that needs to be treated. Simply put things hurt from time to time due to many reasons, the key point is they are not serious and they have a favourable natural history getting better usually with nothing more than time, but we have lost sight of this.
If we were to look back just 100, 50 or even 20 years you will see that most people with a sore knee, an irritable shoulder, or some back pain wouldn’t immediately seek medical attention or treatment. Now this may be due to lack of access to medical services was different back then, but I often ask myself when I have some pain from time to time, what would my grandad do with this… and most of the time it would be to just crack on!
I see day in day out how our species and society has become less tolerant to things that hurt. I see day in day out many people with some pain, an ache, or a niggle that clearly is not serious, life-threatening, or disabling, that clearly has a favourable natural history of resolving on its own with time alone. It is these things that as a physio I don’t treat.
Well, when I say I don’t treat, I actually mean I do. When I have listened to the patient’s history and concerns about their pain, done my examination and excluded as best as I can any serious issues, I will give patients some simple clear advice and reassurance that they have nothing to be worried about, that this issue will resolve in time and doesn’t need any further treatment or investigations. I will answer any questions or concerns they may have and may give some further advice about modifying some of their activities for a little while to ease or help natural history along, but mostly I tend to advise most that they should continue on as normally as they can. However, in this world of low tolerance, many people don’t like to hear or accept this, both patients and healthcare professionals.
Many think that being in any pain or discomfort is not acceptable and that it should be reduced or eliminated immediately. I disagree. I think many things that hurt from time to time need to be tolerated and endured more. I believe that by reducing and removing pain too soon, too quickly, too unnecessarily it is contributing to us as a species becoming less tolerant and resilient to things that hurt.
Many think living pain-free is an automatic right. It’s not. It’s a privilege that has to be earned with hard work, self-control, and some discipline. If you want your body to look after you, you need to look after it. Many non-traumatic musculoskeletal conditions we see are often the consequence of our modern easy convenient lives. Other times its just due to things like backs, knees, shoulders hurt from time to time for no obvious reason. Regardless, of why things hurt from time to time the key point is often nothing needs to be done other than reassuring people there is nothing to worry about, they will not damage or harm themselves if they continue on, and they should try to carry on as normally as possible and things will improve.
However, as much as patients don’t like hearing this, healthcare professionals don’t like doing this. Many healthcare professionals simply don’t like or feel comfortable telling people in pain and discomfort that its normal and nothing to worry about, and many healthcare professionals do not like NOT treating people for either financial or egotistical reasons. Personally, I think many musculoskeletal conditions are way over treated with healthcare professionals pandering to patients while natural history gets them better and makes them look good.
Now, this is not just me being scathing, cold, uncaring, or discompassionate, this is me being open, honest, and frustrated at a system and society that I think is going the wrong way and screwing things up royally when it comes to non-traumatic musculoskeletal pains. Healthcare has undoubtedly helped humanity hugely by reducing disease and pathology and increasing our lifespans, but healthcare also has and continues to have, a huge role in making our society less resilient and less tolerant to pain due to over-diagnosis and over-treatment of it.
This needs to change. Quickly.
If you look at the global burden of disease studies you can see that low back pain now consistently causes more disability and costs more than any other medical condition across the world, and this is despite advances in so-called pain management. Simply put what healthcare is doing for musculoskeletal pains just isn’t working and something needs to change. Personally, I think this needs to start with more healthcare professionals recognising that they over treat pain and many patients recognising that pain is inevitable, suffering it is optional.
In summary, non-traumatic musculoskeletal pains need to be tolerated and endured more and to do this healthcare professionals need to be better at confidently and compassionately reassuring patients that no treatment is often the best treatment.
As always thanks for reading