A First Person Perspective on Neuroscience and Pain | Modern Manual Therapy Blog

A First Person Perspective on Neuroscience and Pain

Thanks to @snippetphysther for providing this link on twitter!

Drs. Thacker and Moseley propose a new way of looking at pain, using a first person perspective and taking into account all the patient's experiences and feelings. They also refreshingly state pain is emergent from many systems. They are even suggesting giving up educating patients on "all pain is in the brain" saying. Kudos to that, as I was getting tired of hearing it. Most patients were not buying it either, making the pain science/education approach very difficult to implement. How often do we really actively listen to the patient, other than just writing down what makes them better, worse, and what they can and cannot do?


  1. Erson, perhaps it would help if we as therapists whom accept and practice a modern pain neuroscience education stop calling it exactly that. I think this entire issue extends beyond that as it reconceptualizes how the pt. and therapist understand the therapy experience.

    Maybe it is being to much of a reductionist to label it as solely pain education. Yes, pts visit often with a primary complaint of pain or discomfort, and therefore this sort of modern understanding of the pain science is paramount and the backbone of the relationship. However, it can not solely be reduced to the pain experience.

    Therefore perhaps there is something larger and more encompassing than solely pain education that we can call it. Redefining the treatment experience is what I might call it. I think it allows us to move past the banality of only talking about the pain experience.

    Eric Kruger DPT @kintegrate

  2. Thanks for your comment Kyle. If I hadn't discussed this ad nauseum before I would definitely retort with my take. I almost feel like cutting and pasting all my previous posts on this topic as literally there is nothing new here, just the same old... In terms of liking to see some "data" for "Most patients were not buying it either, making the pain science/education approach very difficult to implement." I would like to see some data or logic for that statement."

    I only have my considerable experience... I took one of the first Sensitive Nervous Systems in America, most likely before you started DPT school. I've been at this for a long time, almost 10 years trying to implement that education. When I say patients do not buy it, THEY DON'T. And trust me, I am very effective at educating, I can break it down so anyone can understand, it's why I can blog 6 times/week. Or maybe they understand, but it does not make them feel any better. Thus, it remains only a tool in my bag. It is by far not the panacea. Yes it effects the way I look at patients in pain. NOT all patients need that type of educational experience. Many require a more mechanistic approach. It still gets them better, in very few visits according to my average, and keeps them better. Also, using that approach with athletes? They would just laugh and go somewhere else.

    Here's the problem... I don't put all my eggs in one basket, I use what works because everyone is an individual. That's it, it's all about the experience, and trust me, my patients are no worse for the wear if I choose not to implement an approach I understand completely. The people you SS guys normally argue with, I'm not one of them. I am educated, informed, and well read. Here's some #solvePT, leave every other well meaning, mechanistic practitioner who isn't a brainhead, alone, there is no evolution in arguing ALL THE TIME. Don't you get tired of it?

  3. Eric, thanks! Of course there is something larger, it is all about the experience, and although you would disagree, what works for one patient may not work for another. Perhaps all the education fMRI studies showing pain education changes the brain immediately are just from the interaction? Even the act of observing changes the outcome according to meta-physics.

  4. Thanks for the shout out Kyle! Erson, you know my feelings so I agree that we don't need to be redundant.

    I believe we can all agree that every individual requires an individual POC, because we all have an individual neuromatrix, personality and ability to conceptualize.