Pain Science Gems

Taken from Lars Avemarie – PT and pain aficianado:

What we have learned about what “pain” is, (from pain research):

“Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences”

Melzack R., Katz J. (2013), Pain. WIREs Cogn Sci, 4: 1–15.

“There is not an isomorphic relationship between pain and nociception, nor between pain and tissue damage“

“The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain [11], neck pain [12] and knee osteoarthritis [13]). Yet we continue to avoid the truth that tissue damage, nociception and pain are distinct. I would go so far as to suggest that even the use of these erroneous terms – pain receptors, pain fibers and pain pathways – leaves the patient with chronic pain feeling illegitimate and betrayed, and leaves the rehabilitation team lacking credibility when they look beyond the tissues for a way to change pain.”

G Lorimer Moseley. Teaching people about pain: why do we keep beating around the bush? Pain Manage. (2012) 2(1), 1–3.

“The biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a reconceptualisation of what pain actually is, and how it serves our livelihood. There are four key points:

(i) that pain does not provide a measure of the state of the tissues;
(ii) that pain is modulated by many factors from across somatic, psychological and social domains;
(iii) that the relationship between pain and the state of the tissues becomes less predictable as pain
persists; and
(iv) that pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger.”

Moseley, G. Lorimer. Reconceptualising pain according to modern pain science. Physical Therapy Reviews 2007; 12: 169–178.

“Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6].”

Sullivan M L. What is the clinical value of assessing pain-related psychosocial risk factors?. Pain Manage. (2013) 3(6), 413–416

“Psychosocial factors are important in the development of low back pain and disability.7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally.11 Patients’ beliefs need to be better understood to improve management of low back pain.”

Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.

“Clinicians should not utilize patient education and counseling strategies that either directly or indirectly increase the perceived threat or fear associated with low back pain, such as education and counseling strategies that

(1) promote extended bed-rest or
(2) provide in-depth, pathoanatomical explanations for the specific cause of the patient’s low back pain. ”

Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57. Epub 2012 Mar 30.