Continued from previous post
… All is not lost, however. There is an emerging body of literature that suggests that we can change the way people understand their pain. We can reconceptualize pain in a way that makes clear the distinction between tissue damage, nociception and pain. The bulk of the work in this area is guided by a model that suggests three phases of intervention:
- Provide evidence against the current (and inaccurate) conceptualization;
- Provide evidence for a new (and accurate) conceptualization;
- Test, confirm and finally embed this new conceptualization, such that it can guide behavior.
Each phase has its challenges. For example, the first phase needs to avoid being retarded by the cognitive defenses we all possess in order to guard our own views. That is, key conceptual challenges need to be ‘snuck in under the radar’, as it were. We also need to exploit methods to make our interventions memorable – to maximize the likelihood that they will ‘stick’. For this, we need to engage emotional systems and use multiple media styles. Our group has recently tested the utility of using metaphors to induce a conceptual shift in the understanding of pain . Metaphors can be described as understanding and experiencing one kind of thing in terms of another and are thought to provoke contemplation and increase the potential for reorganization of previous meanings. In short, simply giving people a book of short stories that are used as metaphors for key concepts in pain biology  led to measurable shifts in the knowledge of pain biology and in pain-related catastrophizing .
Much of the research into reconceptualization of pain has focused on the second phase of the above list – the provision of evidence for a new conceptualization. These experiments and randomized controlled trials show that ‘explaining pain’ (see  for coverage of material) as a therapeutic strategy leads to rapid changes in pain-related beliefs and attitudes [16,17] and increased pain threshold during movement [18,19]. When integrated into a behavioral or functional upgrading approach, explaining pain is associated with better pain- and function-related gains than upgrading alone [19–22], and when intensive cognitive–behavioral pain management is preceded by explaining pain, the long-term outcomes seem substantially better .
Of course, the loftier goal here is to reconceptualize pain before people have chronic pain (i.e., when they have acute pain or, better still, before they have any pain at all). This will clearly require a team effort. I argue that we can start by truly taking notice of Patrick Wall’s advice from 25 years ago and stop calling nociceptors ‘pain receptors’, nociceptive pathways ‘pain pathways’ and noxious stimuli ‘pain stimuli’. These are erroneous terms. That is, let us not fool ourselves that the mislabeling of nociceptors as ‘pain fibers’ is an elegant simplification – we need only sit with a patient in chronic pain to see that this mislabeling is indeed a most unfortunate trivialization.
Previously published in: Moseley, G. (2012). Teaching people about pain: why do we keep beating around the bush? Pain Management, 2 (1), 1-3 DOI: 10.2217/pmt.11.73
About Lorimer Moseley
Lorimer is NHMRC Senior Research Fellow with twenty years clinical experience working with people in pain. After spending some time as a Nuffield Medical Research Fellow at Oxford University he returned to Australia in 2009 to take up an NHMRC Senior Research Fellowship at Neuroscience Research Australia (NeuRA). In 2011, he was appointed Professor of Clinical Neurosciences & the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide. He runs the Body in Mind research groups. He is the only Clinical Scientist to have knocked over a water tank tower in Outback Australia.
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