Recently, NCCP were lucky enough to receive an invitation to attend a unique presentation at the NeuRA Research Centre in Randwick. The presentation topic addressed some of the latest developments in chronic pain theory and management, and was given by Lorimer Moseley and Michael Nicholas. Given the calibre of these two presenters, Mike and myself knew the opportunity really was too special to miss and would benefit our patients immensely. A little about the presenters:
Lorimer is a physio based in Adelaide who has pioneered major breakthrough research helping us to understand, explain and treat pain. He is the author of a couple of books, and a researcher who has changed the way that we see chronic pain. Without a doubt his best skill is making you, the listener, think that he is on your level, when in fact his thinking is miles outside of the ordinary. See a TED talk he presented where this skill is on full display.
Professor Nicholas is based at the pain research centre at Royal North Shore Hospital and director of the ADAPT pain treatment clinic at Royal North Shore. He has also authored successful books, and has had many peer-reviewed scientific articles published in the field of pain research.
Lorimer talked about some of the current theories in how chronic pain manifests itself. It is now well accepted that there is a disconnect between the physical “input” coming from a pain sufferer’s body and the perceived “output” their brain is providing. Our traditional, simplistic view explaining pain is wrong. This view states that the feeling of pain is the result of something happening physically to our body, which then sends a signal along a nerve that travels to our brain, and we feel pain.
The most stark example of why we know it is a little more complicated than that simple “Damage In = Pain Out” concept is in “phantom limb” pain.
An amputee can feel pain in a part of their body that no longer exists. Once we better understand how this faulty (painful output is generated, we will be able to tailor our treatment around the best evidence and progress a patient out of their chronically painful state more effectively. The theories and research are mind-bending and super exciting. This stuff could reduce a huge burden that individuals and society have to bear.
Professor Nicholas was much more practical, and squarely put the onus back on health care providers as to why people suffer from chronic pain. We know through Lorimer (and other researchers) that the experience of pain can be reinforced by catastrophisation, which is a term describing a massive overreaction to a setback. Catastrophisation as a reaction can be “primed” by things that healthcare providers say or do that can subconsciously tell a patient that they are at very high risk of very dangerous outcomes actually leads to more of those dangerous outcomes. A grand example of this is when comparing patients with back pain who were randomly assigned to receive and MRI vs x-ray, the patients who had the MRI had worse results a year down the track. They had higher self-rated pain, more disability, and more had had back surgery. And the only difference was that one group had a fancy new scan.
So Dr Nicholas challenged us to question whether the way we go about explaining our treatments, and our patients’ pain are is in fact reinforcing the beliefs that tend to make the pain more chronic in those patients. The goal for physiotherapists now is to think about not only what we say to clients, but what our clients hear, and by choosing our words with more care we will better ensure that we can keep our clients off the chronic pain train! And now....
Something from the You Tube pain archives.....