Therapy thoughts (7/7/25) How dry is the forest?

Helping people understand the complexity of pain can be tough. It’s something I think about a lot! Broader models of pain can often be quite abstract and go against the common understanding of pain as quite simple, mechanical, and linear. 

It can also be open to misinterpretation, what do you mean “stress is causing my pain?” or “is its all in my head?” 

So what does a dry forest have to do with all of this? 

This ties in with understanding causation in 3 ways: 

Risk factors – Things that predispose us to pain 

Initiating factors – Things that trigger pain 

Maintaining factors – Things that may maintain pain and make it sticky 

 My personal belief is many things can “make the forest dry” meaning that it might only take another small spark to trigger the fire (pain). This positions psychological, lifestyle and life factors as predisposing or risk related, rather than causative entirely on their own. There are lots of times we are stressed without pain erupting! 

So, if we are stressed out, under slept or burning the candle at both ends maybe that bit of gardening yesterday made me more sore, stiff or even painful than usual. It took a smaller spark (initiating factor) to trigger the fire, often innocuous. 

This could be that our systems are switched to a more pro inflammatory or pro nociceptive state. The stimulus required to trigger a big old response is much smaller when the system is primed to erupt. 

We often remember the triggers to our pain; this can often be movement or activity related. Adding other things into the mix in a linear causal way often creates more problems than it solves in my experience. 

This for me is important as the more abstract “anything can cause pain” may not always be helpful or reflect many situations. But a model that reflects wider psychosocial factors as increasing risk or predisposing us to pain maybe closer to both clinical situations and the literature!