The Threat Bucket Model: A New Approach to Understanding and Treating Chronic Pain

The "Threat Bucket Model" is a concept in pain science that explains how the perception of pain is influenced by a variety of factors, including physical, psychological, and social factors. The model shows that pain is not simply a reflection of tissue damage, but rather a complex and subjective experience that is influenced by a variety of factors.

Our brain’s job is to keep us alive and constantly evaluate the information received. Integrating and interpreting this input to determine if there is a threat from the outside world or from within our body. The Threat Bucket Model highlights that our experience of pain is influenced by two main factors: the amount of perceived threat and the amount of perceived safety. When the perceived threat is high - which can be the result of a lack of quality and/or quantity of information - and the perceived safety is low, the "threat bucket" is full, and we may experience more pain. Conversely, when the perceived threat is low and the perceived safety is high, the "threat bucket" is empty, and we may experience less pain.

Perceived threats can come from a variety of sources, including physical sensations, emotional stressors, and environmental cues. Examples of physical sensations that can contribute to the perception of threat include muscle tension, joint stiffness, and inflammation. In addition, the compromised function of the brain and body systems such as the visual system, vestibular system, and lymphatic system – to name just a few – can be perceived as a threat. Emotional stressors such as anxiety, depression, and fear can also increase the perception of threat.

On the other hand, perceived safety can come from a variety of sources, including optimally functioning brain and body systems, social support, positive emotions, and a sense of control over the pain experience. Examples of social support that can increase the perception of safety include a supportive family and friends, access to healthcare professionals, and participation in support groups.

The Threat Bucket Model emphasizes the importance of addressing the aspects of pain management with a holistic approach in order to reduce the perception of threat and increase the perception of safety. This can involve a variety of strategies, including exercise, brain-based drills, relaxation techniques, cognitive-behavioral therapy, coaching, and social support. Ideally, an assessment of the quality and quantity of exteroceptive and interoceptive input to the brain is performed first before implementing strategies.