The following are some key points from The Thinking Practitioner Podcast with Til Luchau and Whitney Lowe on February 7th 2024, Episode 111. How Bodyworkers Can Explain Pain (with Lorimer Moseley).

Twelve years ago, Lorimer Moseley’s TEDx talk “Why Things Hurt” helped to catalyze profound changes in how pain is conceptualized, in the massage and bodywork field and in many others. If we think about pain as protection, rather than as damage, it changes how we explain the improvements we see in hands-on work.

Moseley outlined three historical phases of pain education: Ancient, Old school and Current pain science. I’ve outlined them below.

Ancient pain education: Been around until turn of the century. Sometimes called Back school. Uses Anatomy and physiology, lifting and posture to explain pain along with some rudimentary advice on relaxation, structure and behavior. Moseley refers to this phase of pain education mostly useless and says it might do more harm than good, using the example of the concept of “slipped disc” as an example. He finishes this phase by suggesting it may be worse than useless.

Old school pain education: Currently the dominant concept. It’s often referred to as Pain neuroscience education. It started in the early 2000’s, probably along with the rise of fMRI. It involves Intensive education on the neurophysiology of pain. It’s good, not very good or excellent, but it’s better than useless, referring to it as didactic.

Current pain science education: Petal (pain education team of absolute legends), not sure if there was a joke I missed in here somewhere, but….Ha? Current pain science differentiates current strategies from neuroscience. Pain science education incorporates content and integrates strategies. Asking how to integrate with other models of care. What are the principles of content delivery? How do we evaluate if our delivery was useful? What are the easy wins? What are the mistakes that most people make that are making things harder? If this isn’t clear, he goes on to identify 4 essential pain facts.

4 essential pain facts: I’ve been looking for something like this for years and was excited write this out.

In a nutshell: Pain protects us and promotes healing. Persistent pain is also a protective function, many factors can influence pain, and therefore, there are many ways to reduce pain and recover.

1) Pain protects us and promotes healing – most people think pain detects pathology or danger. That’s not how it works. The evidence that pain detects damage is very poor. The evidence that pain occurs in order to prevent damage is very compelling. Decoupling pain from damage opens up all kinds of possibilities and raises all kinds of questions, presenting a lot of opportunities for intervention when we embrace this concept.

Concepts involved: Peripheral sensitization in the presence of injury and inflammation. Interpretation of a flare-up for example.

2) Persistent pain over protects us and prevents recovery – Persistent pain winds our system up. Through repeated protection, the protective systems are getting better at doing what they are doing. It’s bioplasticity or neuroplasticity across systems. Ongoing pain is also protective. The way synapses work at a cellular level (neuron to neuron and neuron to immune cell synapses), the more often we produce pain, the lower the threshold to produce it will become because our system learns how to do it better. We call this Allodynia and hyperalgesia. Neurophysiologically we call is a reduction in postsynaptic membrane excitablility. In consumer words, we call is pain system hypersensitivity. It’s not necessarily the pain system going wrong, this is how it works. It’s a normal response to an abnormal set of circumstances. Some may say it’s the pain system going wrong, which is a Moot point anyway because the threshold for what is dangerous has reduced so much.

Concepts involved: Central sensitization, Nociplastic pain.

3) Many factors influence pain – Pain, fatigue, muscle activation (stiffness or tightness). They didn’t cover it, but I am curious of now our personal narrative influences pain (I’m working on a separate blog for that).

4) Therefore, there are many ways to reduce pain and to slowly recover or to slowly retrain the pain system back to normal protective settings.

To summarize, Lorimer interated that teaching clients about pain is challenging. If you find it difficult, you are not alone. The concepts involved are complex and require patience and practice. In his experience, when the concepts of pain science education are received in a meaningful way, it can help create a profound shift and decrease in how pain is experienced in the body.

To view Lorimer Moseley’s TEDx talk: https://www.youtube.com/watch?v=gwd-wLdIHjs

To listen to the entire podcast: https://podcasts.apple.com/us/podcast/111-how-bodyworkers-can-explain-pain-with-lorimer-moseley/id1492004207?i=1000644465445