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Explain Pain

Image entitled "Non-neurogenic contributions to inflammatory nociception" from EP2018 course, Cairns (and yes, this diagram still gives me a headache!!).

As a young physiotherapy student some 25+ years ago, I struggled my way through a subject called "Physiology and Histology". It involved complex diagrams on blackboards and overhead projection sheets (yes this was before white boards and Powerpoint presentations). Then on Friday afternoons we spent hours in the lab looking down microscopes at cells and dissecting cane toads then applying electrodes to their exposed muscles to make them twitch (fun times!).

I wouldn't say I excelled in this subject (far from it) but it was the start of my learning about pain.

Back then it was simple -

Painful Stimulus --> message to Spinal cord --> simultaneously pull body part away plus message to brain

--> OUCH!

We then learnt a gate theory, that meant that if we added a different stimulus (ie: rubbing the injured part) we "closed the gate" to pain, and ta-da....pain is gone!!

Ah, the good old days, when it was a simple on/off switch.

In 2003 two bright physios-come-pain-scientists from Adelaide released the book "Explain Pain", and life for this physio has not been the same. I bought the book, tried my best to read it, watched videos, listened to podcasts, even went to seminars and tried to get my head around it all. It was messy, difficult, made patients a little frustrated and I am sure at times I did more harm than good in my blundering attempts to explain pain.

Fast forward 15 years, and I finally attended my first "Explain Pain" (EP) course in sunny Cairns!

Yes, this is me attempting a selfie on the Cairns esplanade.

After 14 hours of delightfully entertaining and stimulating learning from the humorously humble Tim Cocks, I have taken a giant leap forward in my learning. The problem now is that there is no turning back - I can no longer give half-baked wishy-washy explanations to patients about why they have pain and what I am doing to "fix" it. I know that they deserve a better explanation and a better pathway to pain reduction. The ideas are simple, yet intricate, and whilst they were so thoroughly and adequately explained at the course, they haven't "stuck" in my head yet. My first week back at work and already I am feeling tongue-tied and blundering yet again.

What is clear is that we are complex, and so is our pain.

I have learnt that our ability to adapt, restore and recover is almost unlimited, but that the barriers (the DIMs.....more about that another day) are sneaky, complex, pervasive and tricky to recognise sometimes.

So to summarize - there is a new hope for persistent pain sufferers! The last 10 years of research has provided an improving understanding about pain which means we can treat it differently (and hopefully more effectively). Each person's pain experience is unique, and so each person holds the unique ability to modify pain. The course has provided a toolbox of info and ideas to help me help you to do this.

If you'd like to know more, give us a call.

Or head to our website here

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