Body awareness as a therapeutic dimension in complex or difficult pain. Why fascial bodywork can be an important phenomenological and interoceptive pathway

Abstract

Introduction Chronic pain is as a multi-dimensional phenomena which includes a dimension that more recently receives a fair amount of attention, namely body awareness (BA). The most fundamental aspect of BA is the ability to experience the body ‘from within’. Traditionally, BA-therapies have been more focussed and applied in a ‘hands-of’ context of psychiatric or psychological problems. But being a significant element of overall health, BA should also be included as a therapeutic dimension of osteopathic-manual treatment or ‘hands-on’ bodywork in general. But on a more conceptual level a lot remains unclear and not operationalised for therapeutic application, although a fascial-oriented osteopatic treatment focussing on BA could be a promissing alternative for psychotherapeutic interventions. Not only from a scientific point of view a thorough differentiation of BA-concepts, their clinical assumptions and relationships between fascial touch and BA as an interoceptive pathway is needed. Also from a clinical perspective this research is preferable because more then ever osteopaths and manual therapists are consulted by patiënts with complex, chronic or medically undefined symptoms of pain to whom a strictly biomedical approach clearly fails.

• Methods We conducted a extensive search of literature on Medline, Cochrane Central, PsycINFO, Web of knowledge, PEDro and Cinahl and explored different BA-concepts in several therapy-related domains (i.e. philosophical, psychological, neuro-biological and therapy, including osteopathy and body-oriented psychotherapy), followed by a conceptual analysis.

• Results At first, we synthesized BA as a concept different from embodiment. The experience of simultaneously having and being a body is called embodiment. It’s a pre-reflexive process of experiencing our being-in-the-world and constitutes the basis of our self-awareness. Here, the body is conceptualized as a dynamic, organic site of meaningful experience rather than a physical object. BA is seen as the subjective, phenomenological aspect of proprioception and interoception that enters conscious awareness and is modifiable by mental processes including attention, interpretation, beliefs and memory. Secondly, research and clinical evidence was explored for a neurobiological approach of BA as a bodily process which helps the individual in organizing and experiencing its identity. Here, especially the ‘interoceptive’ pathway ands it’s link with fascia seems promising as a basis for physiological and psychological processes of BA and pain.

Conclusion Their seems to be a significant difference among several concepts of BA as well as it’s philosophical roots in the concept of embodiment. Traditionally, BA-therapies have been more focussed and applied in a ‘hands-of’ context of psychiatric or psychological problems. More recently there is a shift toward a broader therapeutic interest on more somatic dysfunction also. So gaining insight in the psychological (i.e. phenomenological) and neurobiological (i.e. interoceptive) dimensions of BA may be important for a correct application of ‘hands-on’ fascial treatment aiming at the therapeutic influence on BA. This conceptual study helps in offering a differentiated and trans-disciplinary overview and points at several existing explanations why hands-on ‘fascial’ therapy could have a more prominent role in the treatment of complex or difficult pain.