Tuesday, 3 January 2017

Meet on the Same Stage (Stages of Change and Pain Management)

change and chronic pain
Imagine you are acting in a play. Your goal is to follow instructions from the director, in order to tell a story. The problem is that the director is in a different room, and can’t see the stage you’re acting on. The director calls out instructions, but they don’t seem to fit with the set or the props that you’re working with. You know the director is experienced, and has spent a lot of time studying this play, but his cues just don’t make any sense. He seems to become increasingly frustrated with you, as the play is not progressing in the way he intended. You are equally frustrated with him, because it feels like he does not understand your situation or respect the effort you are making. You are both trying to achieve the same goal, but it seems like you’re on two completely different pages. 

Now imagine that instead of being an actor, you are a person in pain. The “director” is someone trying to help you. It could be a health care provider, family member, or simply an acquaintance who read something on the internet. Whoever it is, they are well-meaning and have something they want to share with you. No matter how much they know about pain, you are the one who is living with it every day. Unless they understand your unique set of circumstances, their suggestions may not work for you. They may seem frustrated with you, because their attempts to be helpful are not resulting in an improvement of your situation. At the same time, you may feel frustrated with them because it seems like they simply do not understand.  

Now let’s look at the word “stage” a little differently. Instead of thinking of a stage as a platform for acting out a play, let’s think of the other kind of “stage,” a point in a process. Just like it is essential for a director to understand the set and available props, anyone who intends to help someone in pain needs to understand where the person is, and what their strengths and challenges are.

When it comes to managing chronic pain, self-management is often an essential component. But simply giving people a one-size-fits-all list of steps to take may not be effective.  This type of approach will likely result in a similar scenario to the one described above with the actor and the director. The clinician and person in pain will become increasingly frustrated with each other, and the intended goals will not be achieved. Clinicians can sometimes assume people will follow every single recommendation and it can be a source of tension for both parties. There can be a multitude of reasons for this disconnect, such as the information clients have previously been given about their pain, their stress level, their responsibilities (looking after children, keeping a job, etc), and their beliefs and values.

The clinician needs to start by understanding where the client is. One model that can be useful is the stages of change. Today we’ll make some suggestions about how we believe the stages of change apply to lifestyle changes that people want to make, such as pain self-management strategies. Please note, there is no right or wrong stage to be in. Telling someone they are in the wrong stage of change would be like telling someone they’re in the wrong stage of grief after a loss. Everyone deals with challenges in their own individual way, and it may change over time.

stages of change and chronic pain

Precontemplation: “I don’t have any control over this.”
In terms of coping with chronic pain, a person in this stage is looking for someone or something outside of themselves (a medication, a new doctor, a new treatment, etc.) to make their pain go away. This might mean they feel completely helpless and that their pain is out of their control. 
  • If you are in this stage
    • If you are reading this blog, you are probably not in this stage. Unless someone suggested you read the blog, in which case, thanks for checking it out.
  • If you want to help someone in this stage
    • Support them as they look for answers.
    • Express that you believe them and how pain is affecting their life.
    • Let them know you’ll be there for them along their journey.
    • Note: If you give a lot of suggestions about self-management to a person in this stage, it may not go over well. This is like the actor and director we described above. You may end up feeling frustrated that they are not taking your suggestions, and they may end up feeling like you don’t understand their situation. If you do give them suggestions, it may work best to frame it as something to keep in the back of their mind.
Contemplation: "Maybe I can have some control over this.”
In the world of pain, a person in this stage may be dissatisfied with the symptom relief they experience from their current treatment, and they may be looking for more options. They may begin to feel that there could be something they can do about their pain, but they are not yet confident that change will make a difference.
  • If you are in this stage
    • Look to reliable sources of information and support. This may include your health care providers, support groups, books, and other sources. (We like to think of ourselves as one of these reliable sources!)
    • It may be helpful to make notes or jot down ideas that seem interesting to you
    • Try not to get overwhelmed by all the different perspectives out there
  • If you want to help someone in this stage
    • Recognize that their interest in change may rise or fall, and that’s okay
    • Try not to overwhelm them with too many different suggestions
    • Try to encourage them without pushing
    • Remember that this is their journey.
Preparation: “This is how I’m going to try and take control.”
A person in this stage is formulating a specific plan.
  • If you are in this stage
    • Decide on one small, sustainable change that you want to start with
    • When deciding what change to make, consider what changes might take the least effort and/or have the most reward
    • Eliminate barriers that would stand in the way of achieving your goal
  • If you want to help someone in this stage
    • Identify the positive results that this change would bring about
    • Express that you believe in them, and their ability to carry out the change
Action: “I am taking control now.”
A person in this stage is carrying out their plan.
  • If you are in this stage
    • Don’t be afraid to start very small. Walking for two minutes more than you have been is a huge step in itself.
    • Don’t be too hard on yourself if it doesn’t work some days
  • If you want to help someone in this stage
    • Encourage them on rough days
    • Make the change along with them, if you’re a family member or friend
    • Help them celebrate their accomplishments - both the small successes and the big ones
Maintenance: “I have tools and resources that I can use to help manage my pain”
  • If you are in this stage
    • Recognize that there will be ups and downs
    • Keep learning and trying new strategies to add to your “tool belt”
    • Celebrate how far you’ve come

We purposely put these steps in a circle because although they are a logical progression, they are not necessarily linear. People may move backwards, forwards, or sideways depending on what’s going on in their lives. What may feel like a set-back may just be part of the journey. Remember that just like the actor and the director at the beginning of this post, the person in pain and someone who wants to help them will both find the experience more rewarding if they are on the same stage.

Wednesday, 17 August 2016

Pain Theory Applied

Knee Pain
This post will be a little different from our typical chronic pain post. This is a real-life story about a woman who was able to use strategies based on pain theories to minimize disability from her pain. This post will bring together points that have been made throughout our previous posts.

This woman, let’s call her Abigail, had a knee injury a couple of years ago. At that time, the knee pain got pretty bad. It definitely interfered with her function. She wanted to go jogging, but that caused the pain to flare up, so she stopped doing it. Sometimes she even had trouble walking. She had a really hard time getting up and down off the floor with her young children, and it interfered with her enjoyment of spending time with them. She went to her doctor, who diagnosed it and referred her to a physiotherapist (PT). The PT taught her how to strengthen her quadriceps to put less strain on her knee. She had custom shoe inserts made to support her flat feet (which can cause her knees to go inward, and was thought to be contributing to the pain). She iced her knee and took anti-inflammatories only when the pain got really bad, thinking that she should avoid taking too many meds. She wore a knee brace for a while, because she felt scared to do things without it on. All these things seemed to help, and she felt good that she had a few strategies, but it took months until the pain gradually went away.

Now fast forward a couple of years. Abigail is in better shape overall, and her knee hasn’t been bothering her, unless she does too many squats. She likes to go to a zumba class a couple of times per month. She wants to be able to go jogging, because she has enjoyed that in the past. She’s a little worried that her knee might bother her, but she wants to try it. She starts a running routine with some co-workers, taking it easy at first and gradually building up, with a goal of reaching 30 minutes. She registers for a 5km fun run, hoping she’ll actually be able to run it. The first few weeks of training, her knee feels fine. She’s pleasantly surprised, but still careful.

When she gets to a point where she’s running 20 minute intervals, the knee pain is suddenly back. It’s relatively mild at this point, but it’s got her attention. She knows she doesn’t want to go back to the moderate/severe pain that affected her so much two years ago.  

This time, she sees an occupational therapist and a physiotherapist who both specialize in pain.  Her health care team explains some theories and science around pain.

1. The “Pain Alarm” (see this post)
  • The pain alarm can be useful, so it is probably telling her something.
  • Since the pain clearly started when she began to run 20 minutes at a time, she thinks it’s probably telling her she’s pushing herself too hard, too fast.
  • But if she blindly listens to that alarm, or misinterprets what it’s telling her, and she stops moving completely, it will likely get worse.

2. Pain related fear and avoidance (see the diagram on this post)
  • If she stops doing activities that can hurt (like running, zumba, or playing with her kids), the decreased activity could actually make things more difficult and painful. This in turn could increase her avoidance of these tasks, creating a cycle that results in decreased functioning.  
  • If she completely ignores what her body is saying, and continues trying to increase her running endurance by trying harder and harder to push through the pain, well, that could potentially cause serious pain. Which would lead to avoiding activities because her knee truly can’t tolerate them. This in turn could lead to more fear, and more avoidance, and more pain.

3. “Safety in Me” vs “Danger in me” (see this website)
  • There is value in anything that helps build her confidence in her body’s ability to move without causing her pain to get worse.

So basically, Abigail knows she has to pay attention to the acute pain “alarm.” She needs to find the balance where she continues to do activities, but doesn’t overdo it. Understanding these concepts, she works with her health care team to explore how her new knowledge applies to her situation, and develops some strategies:
  • She knows that she needs to keep moving, but aims to “fly under the radar” (see last post) of pain, meaning that she will do movements that bring her just to the point of discomfort, but not past it into pain. Basically, she wants to stay in the pushing-herself-but-safe zone.
  • With that in mind, she scales back on running, but doesn’t stop. She knows that when she was running for 16 minutes, her knee pain didn’t flare up. So she decides to go back down from 20 minutes to 16, and stay there for a couple of weeks. She plans to increase her time only if she feels the pain is well under control.
  • She decides to replace Zumba classes with water aerobics for a while, to give her the chance to focus on running. She realizes that both running and Zumba involve impact on her joints, and decides she needs to choose one to focus on. She wants to increase her running endurance, so that's the one she chooses.
  • She learns different exercises from her physiotherapist. This time the exercises are more personalized to the specific reason for her knee pain.
  • She ices her knee and takes anti-inflammatories any time she feels the pain and swelling coming, instead of trying to be “tough” and taking meds only when she can’t take the pain anymore. She knows she wants to keep the inflammation at bay so she can keep moving.

Abigail finds great success in this plan. She’s absolutely thrilled that she was able to do it, and is so glad that she didn’t stop running when the pain first started. She’s also glad she took the pain seriously and came up with a plan. She’s grateful for all of the pain theory that she was able to build into her plan. The best part - in another month, she’s able to run the 5 km fun run without experiencing knee pain! 


Diagram by Reclaiming Life. Graphics from freepik.com

Saturday, 30 July 2016

How Can Pain be Changed? Brain Based Treatment Ideas

"If we’re in pain, it's changes in our total body that have lead to chronic pain, but it is changeable." - David Butler (2015)

At the end of our last post we talked about how pain treatment is evolving and growing as knowledge of pain increases. We described some neurophysiology concepts in that post, and how they relate to pain. Now let’s go one step deeper and look at an overall approach and some specific treatments that apply these concepts to clinical practice.

The neuromatrix approach described by Moseley (2003) leads to a clinical framework that involves using this knowledge of brain mechanisms to change the experience of pain.  Research into neuroplasticity has opened the door to the idea that our brains can, and do, change throughout our entire lives. The great thing about this is it creates new possibilities in the treatment of pain.

All of these ideas are based on some common themes:
  • Many areas of our brain work together as part of the pain response. The network that makes up this response is unique to each individual.
  • Pain is an alarm telling us that something is wrong - but the alarm can malfunction. It can respond to the wrong type of information, or require less activation of the network to produce a pain response.“Smaller and seemingly less relevant inputs are sufficient to...produce pain” (Moseley, 2003, p. 4).
  • If we can decrease the threat value of the signals our brain receives, or allow more of the network to be activated before the pain response is triggered, we can decrease the pain (Moseley, 2003).

Moseley (2003)  explained three steps to treatment based on these concepts. Today, we’ll examine each step and how a variety of treatment ideas could be incorporated into the process he described.

1. An initial step in treatment involves reducing the threatening input and/or the threat value the brain assigns to these signals. The idea is that if the signals coming from the body are decreased or  interpreted as less of a threat, then the alarm doesn’t need to sound as loud. There are several ways to achieve this. One way is by fixing physical issues in order to reduce the actual input. This can be done through manual therapy, exercises, heat/ice as appropriate, pain medications, etc. Another approach is to reduce the threat value of the inputs. This can be done by things like education about pain, and techniques that calm your nervous system like relaxation, deep breathing, and even laughter yoga.

2. The next step is to figure out how to activate components of the “neuromatrix” without triggering pain. Like we talked about last time, the neuromatrix is a network comprised of different areas and processes within the brain. When enough of the network is activated the pain response is triggered. The goal with this step is to activate some components of this network without activating the pain response.   Some examples of ways to do this include:

  • visualization (imagining pain free movement)
  • breaking activities down into simple movements
  • reducing the physical demand of a task
  • changing the way tasks are done
  • changing the context surrounding tasks
  • changing the language we use to decrease  the  “threat” associated with a particular movement

3. Then, the next step is to gradually increase how much of the neuromatrix is activated, so that more and more of it can be activated without resulting in pain.  The key to achieving this without causing flare ups is to be aware of the threshold (how much of the neuromatrix can be activated without pain), and very gradually increase that threshold. One way to conceptualize this is the idea of  flying under the radar, as described in the graphic below. The idea is to avoid triggering enough of the neuromatrix to cause a flare-up, and gradually push the limits. This will increase how much of the neuromatrix can be activated before a flare up is triggered.

Modern science and knowledge about the brain and nervous system has opened up a variety of treatment options. Treatment can be done in several different ways, depending on the individual’s needs, and the approach can change over time as needed. Note, we have to be careful attributing everything to the brain. The brain clearly plays a huge role in pain, but human beings are vastly complex, and so is pain. In order to understand pain, clinicians need to understand “several domains...neuroscience, immunology, endocrinology, psychology, sociology, and philosophy”. (First-person neuroscience and the understanding of pain. Thacker and Moseley. 2012). We would like to suggest that because so many factors contribute to pain, there is hope that all of these factors can be used to change pain.  Even though we don’t have a cure for chronic pain yet, we do have solutions; methods to reduce and manage it, and learn to function better.


Diagrams by Ashley and Colleen. Graphics are from freepik.com

Butler, D. via  Arthritis Victoria. (2015, August 3). Treating Pain Using the Brain - David Butler [Video File]. Retrieved from https://youtu.be/4ABAS3tkkuE on April 22,  2016.

Moseley, G.L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130-140.

Thacker, M.A., & Moseley, G.L. (2012). First-person neuroscience and the understanding of pain. The Medical Journal of Australia, 196(6), 410-411.

Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65(12), 1378-1382.

Friday, 13 May 2016

The Brain and Pain: Is Chronic Pain Changeable?

Brain and Pain
A while ago, I (Colleen) was having a discussion about pain with a friend who has fibromyalgia. One of her comments was that she believes it’s “all in her head.” (I cringed as she said that, but then listened to her reasoning.) She feels like there isn’t anything wrong with her tissue and body. It seems like her brain is hypersensitive to “pain signals,” just like it is to many other things (stress, sound, etc). I stopped cringing, and commented how cool it is that our brain’s perception of those signals can be changed.

Her reply was “Do you really think that can change?”

I responded: “Absolutely”

Why that answer? Back when we were in OT school we didn’t learn a lot about chronic pain other than, it was chronic. But since then, we’ve learned enough to convince us that it isn’t as static as we once thought. Yes, it is persistent, and yes, it is real. And no, there aren’t any magic wands to make it completely go away. But the research suggests that it is definitely possible to change our nervous system and our experience of pain.

So let’s take a peek at this idea. How did it become a part of the pain picture? And what is the evidence?

Some (Very) Basic Neurophysiology 

This idea of looking at the brain’s connection to pain is relatively new. A lot of it has come into play in the last few decades as new technologies have become available. We are now able to see what is going on in the brain during different activities (fMRI). Researchers and clinicians have begun to understand just how much the brain can, and does, play a role in pain. For the sake of this post, we are only touching on a few ideas. 

  • Neuroplasticity: One of the key points that has come out of this research is the idea of neuroplasticity - that is, our brains are changing every day and will continue to change for our entire lives (Butler, 2014).
  • Neurotags: Our brain is made up of tons of neurons that are interconnected in a complex way. A neurotag is a network of neurons from different areas of the brain. When this network is activated, it “generates a particular experience” (Cundiff & Schellinck, 2015; Moseley, Butler, Beames, & Giles, 2012). We have all kinds of neurotags, for a variety of different experiences, and the components that make up these neurotags are individual. For example, if you have experienced food poisoning after consuming a chicken burger, you could have a “food poisoning neurotag.” This neurotag would include neurons that are related to the smell of chicken, the appearance of a burger, the type of bun used, the restaurant you were at, etc. When enough of these neurons are activated, the whole neurotag gets activated, and you experience nausea (Cundiff & Schellinck, 2015)
  • Activation threshold: The activation threshold is the amount of input that is needed to cause a nerve cell to fire. Just like nerve cells have an activation threshold, neurotags need a certain amount of stimulation to be triggered. The activation threshold is the amount of the neurotag that has to be activated before it produces an output (Moseley, Butler, Beames, & Giles, 2012). In the above example, maybe just seeing a similar burger wouldn’t be enough to activate that whole network, but seeing the burger at the same food truck in the summer would activate the nauseous sensation.  

neurotag, activation threshold, brain, pain

So How Does This all Relate to Pain? 

There is a prominent approach called the neuromatrix theory of pain that takes all the concepts we explained above, and turns them into a way to explain and address pain.

Back in an earlier post we talked about how pain is not simply a representation of what is happening in our tissues, but rather a judgement about the signals from our body. Our brain makes decisions about what these signals mean. Basically, “pain is produced whenever the brain concludes that body tissue is in danger and action is required” (Moseley, 2003). 

Now combine this definition of pain with the neurophysiology described above. All the concepts like neurotags and neuroplasticity can be applied to pain. The brain is always receiving signals, or messages, from the body. These signals have the potential to trigger a “danger” or “pain” response in the brain (neurotag). If enough of the neurotag is triggered (activation threshold), then the whole network is triggered. Many areas of the brain become activated at the same time and they work together to produce pain as a way to bring your attention to the threat. Because of neuroplasticity, this whole process can change over time (Moseley, 2003; Moseley, Butler, Beames, & Giles, 2012). These concepts can guide treatment planning.

The idea that pain involves many areas of the brain interacting with each other can also be helpful when considering treatment options. It means there are many more mechanisms involved in pain than previously thought. As David Butler (2015) said, this is exciting because it “underpins the ENORMOUS power of context. Say 500 areas of the brain are in action when we’re in pain - it means that there is kind of a formula for your pain.  We’re all different, and it can be changeable.” 

So back to our initial question “is chronic pain changeable?”  As our knowledge of the brain changes, so does our view on pain. Chronic pain is not as static as once thought. Current research on the brain’s role in pain has led to new ideas and theories about treatment. This post has been all about the idea that pain can change, and why we believe this is important. In future posts, we will discuss techniques and strategies that are built on these concepts.


Diagrams by Ashley and Colleen. Graphics are from freepik.com


Butler, D. (2014). noijam blog: Explain Brain. Retrived from https://noijam.com/2014/12/09/explain-brain/ on April 16, 2016. 
Butler, D. via  Arthritis Victoria. (2015, August 3). Treating Pain Using the Brain - David Butler [Video File]. Retrieved from https://youtu.be/4ABAS3tkkuE on April 22,  2016. 
Cundiff, L. & Schellinck, S. (2015). The Physiology of Pain. In Occupational Therapy Best Practice: Chronic Pain Management [Course Manual]. 
Moseley, G.L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130-140. 
Moseley, G.L., Butler, D., Beames, T.B., & Giles, T, J. (2012). The Graded Motor Imagery Handbook. Adelaide, Australia: Noigroup Publications.

Saturday, 23 April 2016

Neuroscience and Pain

Brain and Pain, Neurotags


Diagram by Ashley and Colleen. Graphics from freepik.com with the exception of the mosquito and the tent. They are by Julia Makotinsky from JMDesigns.


Arthritis Victoria. (2015, August 3). Treating Pain Using the Brain - David Butler [Video File]. Retrieved from https://youtu.be/4ABAS3tkkuE on April 22,  2016.

Moseley, G.L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, Volume 12, 169-178.

Moseley, G.L., Butler, D., Beames, T.B., & Giles, T, J,. (2012). The Graded Motor Imagery Handbook. Adelaide, Australia: Noigroup Publications.

Monday, 14 March 2016

Strategize: A Mini-Post

Strategize: “to make a plan for achieving a goal” (Merriam Webster, 2016).

Goal-setting is essential in providing effective health care (and most other areas of life where you want to achieve something), but it needs to go beyond having a vague idea of what you want to achieve. Goal-setting needs to go a bit deeper, into how you will achieve it.

Imagine this: There was a woman who wanted to start ice skating again. She happened to mention this to a health care provider one day. This health care provider, trying to help her regain some of the activities she lost, told her that her homework for the week was to go skating. However, the client just didn't feel comfortable or safe going skating - so she didn't. Every week the health care provider asked if she had gone yet, and expressed disappointment that she hadn’t. This left the woman feeling disappointed in herself, and never led to her going skating.

Fast forward a bit. The client had moved on to a new health care provider This one listened and acknowledged her concerns about balance and the risk of falling while skating. He also recognized that she was worried that a fall on the ice could lead to being in pain for a long time. The woman and her health care provider discussed which movements were likely safe (even if they hurt), and which movements were still best to avoid. He gave her simple strategies for improving balance, activities where she could succeed and see improvement. Though time, experience,and support, she learned skills that could help her achieve her goal. She also became more confident that she could deal with the effects of a potential fall. And finally, the health care provider shared in the excitement when the client did go skating on her own...and didn't fall!

There are a few different ideas that could be pulled out of these examples. Perhaps the biggest lesson in this story is the value of health care providers who listen to their client’s concerns. In the second example, the provider created plans with his client, rather than for her. He helped the woman achieve her goal by strategizing. The process of strategizing involved finding out what the woman’s goal was, digging deeper to find out what factors were interfering with that goal, and addressing those factors. In this way, the health care provider was able to make a true difference in the woman’s life.

Skates from freepik.com (Modified by Colleen and Ashley.)

Strategize. 2016. In Merriam-Webster.com.
Retrieved March 14, 2016, from http://www.merriam-webster.com/dictionary/strategize

Saturday, 20 February 2016

The Pain Management Prism

Let’s take a look at the goal of pain management. It’s a pretty good goal. We’re betting that this goal would resonate with a lot of readers, either for yourself, for a loved one or for a client. But how is it achieved? The more we learn, the more we see that pain management really can be divided into a few inter-wound, but different paths.

Text straight .jpg

Let’s use the image of a prism to explain how the different aspects of pain management work together. As you see in the image above, when a beam of light hits a prism, the light is separated into a rainbow of colours. For the purposes of this post, let’s think of pain management as that beam of light. Then we can divide it into several components to examine how they connect with each other to achieve one cohesive goal. 

To begin with, let’s take a brief look at what components go into our experience of pain and how we can impact those components. To greatly oversimplify the process, first your body senses something (pressure, temperature, etc) and creates a message about it. Your nerves then transmit this message up to your brain. Your brain then combines this message with other information to come up with an interpretation of what is happening in the body. If your brain decides this is something you need to be aware of immediately, it lets you know through pain.

Pain Components draft 7 final .jpg

How This Relates to Pain Management

The message creation: One aspect of pain management is to look at what is happening in the tissue. That is, focus on what is causing the sensory neurons to fire. For example, is there a broken bone, too much pressure, or damaged cartilage? Are the muscles tense or stiff? This may be the most common approach to pain management and is particularly beneficial in acute pain situations where there is an immediate problem in the tissue. Treatment involves techniques such as stretching, strengthening, realigning, using ice or heat, massage, and electrical stimulation.

The message transmission: Another aspect of pain management is to look at quieting or blocking the signals that your brain receives from the nerve cells in your body. The theory behind this is that if you can quiet the message, you can reduce or eliminate the pain. The nervous system is more complex than a simple messaging system. It modifies the messages sent to the brain, sometimes amplifying the message. This is problematic for us when it results in chronic pain, so some treatments try to dampen the message or cut it off completely. These treatment methods include nerve blocks and some pharmaceuticals.

When most people think of pain management, they focus on treatments that address these two mechanisms. However, there is a third mechanism that is also essential in addressing the complexity of chronic pain.

The message interpretation: The final aspect of pain management we’ll discuss in this post is how the brain interprets these signals. When your brain gets a signal that something is going on in the body it gathers all the information it can to make a decision about this signal. It looks at past experiences, what you know about that area, and other sensory information. Things like mood, fatigue, and a multitude of other factors impact how these sensations are interpreted.  The brain then makes a decision about the significance of the information. It decides whether an alarm is needed, and how loud the alarm will sound. We then experience this “alarm” as pain. 

Researchers have turned this concept around and speculated that if the threat value of these incoming signals could be lowered, then the volume on the alarm could be decreased. Therefore the pain could also be reduced (Moseley, 2007).  Some examples of treatments based on this concept include relaxation techniques (telling the brain that things are okay), visualization (telling your brain that you can complete the movement pain free), and graded exposure (learning that awful pain doesn’t happen with every movement). This is the aspect of pain management that we’ve focused on the most in our blog so far, because it’s an area that we find really exciting. It’s an area that’s relatively new and full of possibilities.

The entire spectrum works together

Just like white light is made up of a spectrum of colours, we believe that effective pain management is made up of a combination of treatment techniques. There is benefit to looking at tissue based mechanisms as well as brain based mechanisms, and everything in-between. All three components discussed in this post (creation, transmission, and interpretation) have an impact on the pain message and open up possibilities for intervention. This generates a whole range of tools that can be explored and new ways to potentially change and reduce pain. But more than simply reducing pain, this opens the door to improving functioning and quality of life for individuals with chronic pain. For us, this means there is always hope.


Diagrams by Ashley and Colleen. Nervous system graphic and brain drawing from freepik.com


Moseley, G.L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, Volume 12, 169-178.