Pain: Danger vs Safety! (DIM SIM!) 9 Dec 2017

Pain is complex! Yet simple!

Complex because pain involves many areas of the brain. Simple because: "We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body." (Moseley and Butler 2015, pp14). (Equally we won't have pain when our credible evidence of safety is greater than our credible evidence of danger)

DIMs and SIMs

The NOI Group are considered world experts in the realm of long term pain. They have been working on the making understanding of long term pain as simple as possible! They use this helpful concept to explain pain.

DIMs stand for 'danger-in-me'

SIMs stand for 'safety-in-me'

Put simply we can experience a lot of perceived danger and it comes in many guises.... xray or MRI results, what you hear in the media, what your doctor or physio might say, why you believe you have pain. The safety part comes from being correctly informed about your condition, having reassuring health professions, feeling in control, having hope or goals and even using different vocabulary about your pain.

Here are some examples of DIMs and SIMs. Can you guess which is which? Some could be either depending on your personal interpretation!

  • A holiday
  • Someone telling you you have to learn to live with it
  • A nagging partner
  • Supportive parents
  • Using the words "I have a strong back"
  • Going to a PIP assessment
  • Being prescribed stronger painkillers
  • A doctor telling you that you have a degenerative spine
  • A flare up
  • Walking in the woods
  • using the words "it's killing me"

The NOI group suggest that there are 7 categories of DIMs and SIMs. Have a look below at some examples of each.

The Protectometer

Now this is where it gets clever... but stays simple!

We all experience danger and safety signals individually and uniquely! They are made out of past experiences, social interactions, learning, medial, advertising, mood, expected roles and responsibilities to name a few!

What we believe is if we can reduce the number of DIMs or brains experience and increase our SIMs then we can influence our pain experience!

So the more SIMs you can find the better... right? They can be hard to spot but the more you spot the lower the threat and danger becomes. Turning a DIM into a SIM is fun... so if walking in the woods sounds ominous how about changing the context to make it feel safe and inviting (plan a shorter walk, turn it into an excuse for a picnic with loved ones)

A great story of someone using this in her journey with long term pain

At the core of the Protectometer is a subtle, yet profound treatment – leading to the possibility of a better understanding of why our brain can get "hot" and sensitised and how a reconceptualisation of pain can emerge with potential for life long benefit!

With grateful thanks to the NOI group for this revolutionary work on understanding long term pain.