Queen Mary's University of London evening on why tendons get better. A panel of speakers looking at the different reasons why tendon pain may or may not get better hosted by Dr Dylan Morrissey -- Prof Bill Vincenzo, Prof Hazel Screen, Trevor Prior, Dr Paulina Kloskowska, Dr Robert-Jand de Vos, Dr Michael Skovdal Rathleff and myself. I was asked to comment on the brain and pain (see blog on website for a full comment).

1. Richmond M. Stace
MCSP MSc (Pain) BSc (Hons)
Specialist Pain Physiotherapist

2.  Moving on……
 Pain is NOT in the brain
 Pain is whole person
 We are more than a brain
 Emerges in the person

3.  As with any pain….
 …it’s the person who is in pain, not the ______
 Emerges in a space
 Cross hands or feet
 A space predicted in need of protection
 Part of a bigger picture; e.g./
 Functional pain syndromes
 Previous persisting pains – ‘vulnerabilities’

4.  To feel pain needs the brain….
 ….which is different to central sensitisation
 These are not the same
 Some will have CS
 Some will not but…
 If they are in pain, it must involve the brain

5.  What do we need?
 Perceived threat
 Forms of threat
 Inflammation
 Thoughts
 Expectations
 It’s the perception that is key….like stress

6.  The brain’s best guess, a prediction
 What does all this sensory information mean?
 Based on prior experience
 Pain
 Prediction that this sensory information means
‘threat’

7.  Reduce the perceived threat
 Take action
 How?
 Pain compels action
 Understand pain
 Normalise body sense & movement
 Improve tissue health

8.  Well it’s only gettin’
better, and a change is
gonna come my way

9.  The person knows
 I can get better – what do I tell myself?
 I am better
 I feel myself again
 Pain affects us in so many ways
 Thinking
 Planning
 Moving
 Sense of self – who I think I am

10.  The person who understands their pain
 Working knowledge
 The person who perseveres with the training
 The person who learns and moves on from the
challenges
 The person who uses their strengths
 The person who expects to get better
 The person gets better, not the tendon
 How would a tendon know it is better?

11.  Importance of ‘the person as much as the
condition’ – Oliver Sacks
 Person => brain-body-context
 More complex than tissue focus….
 ….but more opportunity for change in the
desired direction

12.  Person has working knowledge
 What do I think? What do I do?
 Pain = a lived experience
 Programme = a lived experience
 At any given moment, make a choice
 What to think, what to do
 The person creates the conditions, expecting
change
 Learn to become their own coach

13.  The person feels pain
 Pain emerges in the person in the face of
perceived threat
 Pain changes because we change
 Address the person
 Body-brain-context

15.  painphysiolondon@gmail.com
 www.specialistpainphysio.com
 @painphysio
 @upandsing