Pain is an extremely complex beast. Lets tame it by understanding pain perception. Here is my opening 10 minutes from The BCA 2014 Spring Conference (March 15th 2014). To find out more, visit www.knowpain.co.uk or find me on Twitter @knowpainmike

1. The Metaphoric language of persistent pain
by Mike Stewart
Clinical Specialist Physiotherapist
www.knowpain.co.uk
michaeladrianstewart@hotmail.com

2. What is pain?
“Pain is that sensory experience
evoked by stimuli that injure or
threaten to destroy tissue”
(Mountcastle, 1980).
“A multiple system output
activated by the brain based on
perceived threat”
(Moseley, 2003).

3. Historical assumptions
about pain
 Latin „poena’ meaning
punishment.
 The Cartesian model of pain
(Descartes, 1664) is
responsible for many
misconceptions about pain.
 Assumes all pain is caused by
injury & direct relationship
between damage & harm.
 Results in incorrect & overly
simplistic treatment options.
Descarte’s model continues to be
the driving force in the delivery of
Medicine today. (Goldberg, 2008;
Linton, 2005; Wade, 2006).

4. The present day reality
Remove foot from
the fire & avoid any
fires from now on.
Sensible in acute
situations but
massive
repercussions in
persistent pain (fear
avoidance).
Douse the fire with
water.
USA in last 5 years
has seen a 629%^ in
epidural injections &
a 423%^ in overall
LBP expenditure, yet
pain rates keep
escalating.
Cut the wire to remove the pain.
20% lumbar discectomy patients have the
same or worse outcome. Lumbar fusions
only reduce pain in 50% of cases.
Louw & Puentedura (2013)

5. Explaining pain as a perception
 Which part of your body is
enabling you to hear my
voice?
 The ear contains „vibration‟
& „sound receptors‟.
Messages from these
receptors are turned into
„hearing‟ by the brain.
 „Hearing‟ is a perceptual
brain construct.
 Consider this…Do you hear
things differently following
a horror movie?
So what happens when you
sprain your ankle?
PAIN…“A multiple system output
activated by the brain based on
perceived threat”(Moseley,
2003).
Nociceptors = „danger‟ receptors
that are interpreted by the
brain.
Communication & education
reduces the threat output
VAS: 0-10?