UniSA pain science experts leading a Pain Revolution
Professor Lorimer Moseley
Professor of Clinical Neurosciences and Chair in Physiotherapy, University of South Australia
Most people would explain pain as beginning in the body due to some sort of damage, which sends a signal to the brain that pain is occurring. However there are a number of problems with this theory: why is pain sometimes delayed after a trauma? Why do people feel pain in phantom limbs after amputation? And, importantly, why do millions of people experience years of chronic pain without an identifiable injury?
“We now know that pain is truly not a measure of tissue damage, it’s a marker of all of the things that might be telling your brain to protect your body,” says Professor Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy at UniSA (pictured above with his research team).
While this idea sounds simple, it can be considerably difficult to grasp, particularly if you have the very real experience of chronic pain. Yet it is this concept that has caused a major re-think in the scientific and medical community.
“Pain is no longer thought to be a purely sensory function but one that also includes psychological and environmental input – particularly learning – that motivates our behaviour to protect ourselves.
"It is now understood that the body doesn’t have pain sensors, but it does have ‘danger’ sensors. These sensors are called nociceptors, nerve endings that respond to changes in their environment, such as something touching the skin or a contraction within the gut, by sending signals to the brain that there might be something important occurring that needs attention.
“The brain is able to produce this unpleasant feeling in just one location, so you know that you need to protect just that area. When you think about it in this way, pain is a gob-smackingly sophisticated development in evolution.”
The Imprecision Hypothesis is one project Moseley has undertaken to better understand how the pain system can go wrong. This hypothesis details how a normal protection response (pain activation) can become 'fuzzy', leading to generalised pain — a more over-protective pain response.
A normal pain response is usually elicited to an area of the body due to a specific event. However, Moseley’s work suggests that the brain learns to associate events or situations surrounding the initial pain causing stimulus, as being a cue for danger, thus leading it to trigger pain when pain is not in fact helpful.
But Moseley warns, “We need to be careful how we frame the idea that pain is all in your head, because someone in pain hears ‘you don’t have pain, it’s not real, you’re illegitimate’, when the reality is that their brain is eliciting a very real pain response – it feels exactly the same, there is nothing fake or unreal about it.
“What we now need to do is teach people about their pain, convince them that we know it hurts but that we also know that they are safe if no serious damage is found.
“We want people experiencing persistent pain to ask their health professionals if their pain system is being overprotective, how to retrain it to be less protective, and to also ask if they are safe to move because we also know that movement is usually the kickstarter to recovery.”
Now Moseley and his team are focusing much of their work on helping sufferers rethink their pain, in order to find new ways to recover. This is why each year they hold The Pain Revolution — a fundraising and community education cycling trip through remote and rural centres.
“The fundraiser supports the training and mentoring of rural based pain educators who will support their local community.
“Each of these pain champions will receive training in pain science and develop a curriculum for their community, and then pay it forward by training others to do the same – train the trainer; the gift that keeps on giving!
“These people will become pain champions for their neighbours, helping people in their area learn how we can promote recovery – little by little, how we can use evidence-based tools such as mindfulness, active coping skills, biopsychosocially based graded exposure, and new self-help tools like The Protectometer. Most importantly, we want entire communities to rethink how pain works.
“Our Pain Revolution ride gives us the opportunity to start to build awareness about the changes in pain science and get people engaged. Next year we will visit Wollongong, Nowra, Canberra, Cooma, Jindabyne and Albury/Wodonga — rural centres where we will have a pain champion ready to continue to educate people after we leave.
“Over the next few years we hope to see pain educators far and wide in rural and remote centres helping people better understand and manage their pain.”
To make a donation to support the Pain Revolution, please visit: https://donate.unisa.edu.au/pain-revolution
For more information about the Pain Revolution Rural Outreach Tour and Ride, visit: www.painrevolution.org