Reconceptualising Pain

Maleny Physio - hip painPhysiotherapists deal daily with the issue of chronic, or long-standing pain, it is usually the main complaint when clients present to the clinic. Pain is a critical protective device.

“Pain depends on how much danger your brain thinks you are in, often not how much danger you are actually in.

Pain is designed to get you out of trouble. However, pain and the amount of tissue damage occurring often do not relate. An example of this would be a person feeling neck pain/headache driving past the spot where they sustained a whiplash injury in a motor vehicle accident years before. It is not so much tissue/cellular injury causing the pain response. The person essentially feels threatened. Here, many other output systems such as the motor, memory, emotion, visual, sensory, autonomic and immune system to name a few are working together, allowing us to escape danger, cope or heal.

The Neuro Orthopaedic Institute (NOI Group) based in Adelaide is an independent international group of Physiotherapists dedicated to research and education in pain. Current research encompasses a biological (neuroscience) and psychosocial paradigm to help ‘Explain Pain’.

Over the past years, many Medical and Allied Health Professionals, including our Physiotherapists at Maleny Physiotherapy have attended their courses in an effort to improve clinical outcomes – for patients, therapists and the clinical team.

As we continue to learn more about pain, some of our physiotherapy treatment strategies and techniques have developed and changed and new language or dialogue to educate our clients has emerged.

“It’s my L5 disc, it is slipped!” The language we use builds very strong images in our minds of pain and dysfunction. This sounds like the back is unstable, unreliable and dangerous. As clinicians we often examine spines that have radiological evidence of disc disease, but the spinal level named is not the structure/level causing pain! Metaphors are commonly used to express how we feel about pain and its effect. This too, gives us clues as clinicians as to how to help our patients.

For more reading, visit or come in and see Tim or Mary Bagshaw at Maleny Physiotherapy and discuss and learn something about ‘Explain Pain’.  We will add more articles in this column from time to time to expand on this topic.