There are opportunities to learn more about pain everywhere we look: our experiences, books and research, our health practitioners, and as it turns out, possibly even the pub!
While drinking alcohol isn’t a useful coping strategy for pain and rehabilitation, it can give us a foundation upon which we can build many metaphors, talk about some neuroscience, and provide some insight into understanding pain.
On January 20, Pain Revolution 2018 rider Jack Behne hosted a fundraiser aiming to combine two of his passions - pain education and brewing. The result was Painful Pints, a collection of five beers, each relating to a facet of understanding and recovering from pain. The idea was to encourage donations to Jack’s fundraising efforts for the Pain Revolution, and use his home-brewed beer to share some of the stories behind his support of this event. It was an overwhelming success, raising over $2000, showing both the generosity of Jack’s friends and family, and his brewing and story-telling skills!
So what are some of the messages and metaphors we can glean from beer, and how can we relate these to pain? Jack has created a few key messages from years of both brewing beer and helping people with pain rehabilitation, linked to the curriculum we will be teaching on the Pain Revolution ride.
People are always changing (just like our tastebuds!)
Many of those people who really love beer can remember being absolutely repulsed by their first sip. The fizz, the bitterness, and the overall weird flavour. We wondered what the fuss was about, until we came to like it.
What is it that changes?
What makes us ‘get a taste for it’?
We socially practice drinking beer until our 'tastes change’. Without getting into the long and controversial discussion about why we put ourselves through a ritual of consuming something that doesn’t taste very good, mostly we can agree that tastes change.
To the same chemical input (which we can call beer) we will respond differently over time. Things will taste different - for better or worse - as we grow up. This is based on a culmination of experiences (and contexts; see below), and our neuroimmune system adapting as a result, which will also be somewhat guided by our genes and other bodily systems. It’s a fantastic malty and hoppy example of neuroplasticity.
Like new activities like exercise for persisting pain, changing tastes has to be gradual otherwise our protective systems will encourage a protective response. This may be a foul taste in the mouth, a guttural retch, or a proclamation to the rest of the bar: gee this tastes terrible! Brewers understand this, hence the many ‘gateway’ beers on the market, which give a stepping stone and pathway to tolerating traditionally repulsive flavours like assertive bitterness or sour/funky flavours.
There’s more to enjoying beer than just the brew
Neurophysiologically speaking, having a beer or two is a multisensory, emotional experience. It heavily relies on the environment, as well as our memories and past experiences. This sounds a little crazy, but just think about how it feels just plain weird to have a rich, black beer on a hot summer’s day. What about the fact that you rarely enjoy a beer in a coffee mug? How important do you think that frozen over font is at the front of your local pub? In Australia we almost need to see evidence of frostiness to enjoy a beer, and cringe at the possibility of room temperature beer such as the cask ale the Brits love.
Clearly, much like pain, it’s obvious how our other senses and cultural values affect the experience of beer. Appearance is a key variable when judging a beer, because we are so well aware of its influence on the overall taste. This context is put to the test in many styles, including Black IPA (the P stands for pale, making it essentially a black pale beer), and the current trendy style New England IPA which has to be so opaque that it resembles ‘fruit juice’ which it is vital to give the impression of.
Pain is no different from the experience of tasting beer, but it can often be harder to identify and understand the contexts that contribute to the experience - those hard to reach DIMs and SIMs! Different experiences can mean Danger in Me (DIM) or Safety in Me (SIM), and the meanings they have very much shape our experience. Like warm beer, changing the balance of DIMs and SIMs can drastically change the meaning and perception of pain.
In the course of the afternoon, we moved from beer to some similar discussions about pain and receptors and hot sauce (which the challenge winner received a particularly spicy lesson in how sensations are detected and understood!)
I’m sure there are many more ways to tie beer and pain together, but will stop there before it gets out of hand. I suggest practicing the same moderation with pints as I am with metaphors. It’s wonderful to be able to draw lessons across from hobbies and turn them into learning points and opportunities for education clinically. Pain can be a scary thing to talk about, and we know that people living with pain experience fear and worry, so finding a way we can talk about pain in a non-threatening way is a vital part of building a good clinical relationship. I’m looking forward to the Pain Revolution 2018 to hopefully share some these conversations around pain (and maybe beer), and I’m excited to hear some stories back along the way.
Also, there is this growing brewing scene in Canberra I’ve been meaning to check out for ages...
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