Explain Pain

[dannyg]

So, when I was a student I read the original 'Explain Pain' by David Butler and Lorimer Moseley - and while it was interesting as far as using it to explain some concepts and research to patients - I didn't enjoy it that much. (If anyone is suffering chronic pain I do Highly recommend 'Painful yarns' by Lorimer Moseley which is a funny and educational read. I steal stories from it all the time to put across the useful concepts, rather than the research)

Anyway - although this book was expensive, I bought it anyway: Explain Pain Supercharged: The Clinicians Handbook. It is FULL of wonderful gems and concepts that support everything we talk about here. 

If any of you in Australia can get hold of a copy (it ships from Australia) I really recommend it. It's excellent. I can write up a full review when I have finished it, if anyone is interested.

The reason I'm posting now is because early on in the book it has a lovely statement that has been buzzing around my head:

 

"The way our body feels to us relates closely to what we are able to make it do"

 

Which immediately made me think of @Kit_L

 

Lorimer Moseley's writing is great anyway though - as he is the first person I heard using the term 'bioplasticity'. Which I have shamelessly stolen, and use all the time. 

 

Hope you are all having a wonderful year so far. 

[Squin2]

Hi danyg

Greetings from Canada.

My wife has fibromyalgia and is constantly in pain. I assume that your comments regarding Explain Pain Supercharged comes from a Clinicians point of view but am wondering if it would be of value to her as a pain sufferer.

The book is expensive but if it could help with the pain it would be invaluable. 

Best regards 

Dale

 

[dannyg]

From page 2 of the book:

 

 

Definitely start with with painful yarns, it has some great stories and metaphors to help understand pain. BUt it depends on your ability to decipher 'Scientific Jargon' if you want to go for EPS or one of the others. Personally I think Explain Pain is more useful than the protectometer book. 

Here's some of the blog, if you want to have a read - and expose yourself to some of the research  - https://noijam.com/2017/12/21/hot-damn-our-top-jams-2017-edition/

 

 

[Squin2]

Thanks for that. 

Most helpful. 

Best regards

d

[Jim Pickles]

My recommended resource for anyone wanting to find out about pain that, like pain from fibromyalgia, is chronic and not necessarily related to any current site of injury in the body, is this video, which discusses central pain, and its treatment (inlcudes useful clinical information).

 

[Kit_L]

On 3/2/2018 at 4:26 PM, dannyg said:

"The way our body feels to us relates closely to what we are able to make it do"

Not precise enough, for me. Here's my perspective:

The way our body feels is identical to what we can make it do.

And (the key point) the feeling, and hence the experience in the moment, may not be accurate; often it is not. Re-acquiring lost movement, even if uncomfortable, is most often the way forward.

I can expand on this, but for beginners in particular (that is, anyone who lives more in their head than in their body, and who does not have a functioning movement vocabulary—in other words, people who do not 'use' their bodies in the way we understand most here do) getting to the end of whatever range of movement they have is experienced as pain, and not simply as a signal that the part has reached its familiar end of ROM as it is to people who do use their bodies and are familiar with them in this way.

I cannot stress the importance of this error, yet almost no one speaks of it.

[AlexanderEgebak]

I have read this book through twice and I can highly recommend it. A bible in terms of understanding pain and other protective mechanisms; as well it gives you a perspective on how to deliver this message to other people through metaphors. I always learn something new when start reading it again.

I can also recommend Therapeutic Neuroscience Education by Adrian Louw et al. Less banter, different structure but still and easy read. Perhaps more patient-friendly without losing value to clinicians. Different metaphors as well.

EDIT: I have to retract my opinions on Explain Pain. The authors imply that pain can exist without nociception, that pain is (all) about perceived threat, and chronic pain is about about threat sensitivity. I cant stand behind those claims

[Matt Chung]

> My recommended resource for anyone wanting to find out about pain that, like pain from fibromyalgia, is chronic and not necessarily related to any current site of injury in the body, is this video, which discusses central pain, and its treatment (inlcudes useful clinical information).

@Jim Pickles thanks for sharing this video. I recognize that the comment was from 7 years ago but the video was phenomenal and I believe that I stumbled on it at just the perfect time since I'm currently recovering from multiple (self-induced, apparently) injuries. So many gold nuggets to take away but to enumerate just a few that I find worthwhile:

• Three underlying mechanisms of pain (i.e. nociceptive, neuropathic, centralized) and how one can/should approach to treating each mechanism
• The concept of "fibromyalgia" - appreciate his non binary approach and that there's a spectrum and he would not want to reserve the tools that are used to treat fibromyalgia for those who don't fall into the exact definition of fibromyalgia
• Felt compassion and sadness for my younger self (around 20 years old, 16 years ago) when I was seeing so many different doctors to treat irritable bowel syndrome (IBS), interstitial cystitis, TMJ ... not realizing that these comorbidities were stemming from my brain
• "30% of people with osteoarthritis of the knee that have their knee replaced don’t get any better. No improvement of their pain"
• "Tender points counts are totally stupid. those whole person is tender. it doesn’t matter where you push on someoen with Fibromyalgia. if you push on the thumbnail, they are more tender than with someone without Fibromyalgia."

The video is quite long (about 2 hours) and for the latter 45 minutes or so, he was going over the various pharmaceutical drugs and I was sitting on the edge of my seat, waiting for him to go over non-drug based solutions.

Ultimately, I'm glad I hung around to listen to the final 10-15 minutes because I felt so much self-compassion and learned a lot. More specifically, he talks about what typically happens is when someone with chronic flare ups gets a "good day", they end up going all out and re-injuring themselves, what he calls a "maladaptive behavior." This is me in a nutshell. When I've reported injuries over the last couple months, Kit has kindly mentioned in my thread that it's likely a "too much volume" problem and I think I am guilty of ramping up too quickly; I had created a viscous cycle.

I'll elaborate more in my own work log but just wanted to say that watching this video was the perfect timing because I was quite literally about to go work out for 1.5 hours since today my plantar fasciitis has not been acting up so much but realized that I would just likely injure myself.

Thanks again

[Matt Chung]

Also, although the video covers some tools in the final 10-15 minutes, I thought I drop the website that was shared (and created) by the presenter: https://fibroguide.med.umich.edu/pain-care/self-care/pacing/

Again, you don't need to be officially diagnosed with Fibromyalgia to benefit from the pain care protocols. Of the modules that the (free) resource offers, I think that (for me), the one I can see benefiting me the most is "Activity Pacing", since I can relate to the

"People with pain often 'over do' resulting in pain flares up. Pacing can allow activities to get accomplished safely, without flare-ups, and in a manner that conserves energy"

[Gareth O Connor]

Is fibromyalgia psychosomatic?

[Jim Pickles]

Psychosomatic?

Definitely not. Fibromyalgia is not properly understood, but there are changes in biochemical signalling in the brain - for instance, continuing inflammatory signals from the microglia (support cells) in the brain, and many other changes. It may result - in some cases at least - from a past virus infection such as Epstein-Barr virus (which gives mononucleosis/glandular fever) that remains in the body, and for unknown reasons is not cleared by the immune system, and keeps flaring up.

[Gareth O Connor]

Not nice for those that have it

[Gareth O Connor]

It was probably insensitive of me to ask whether it was psychosomatic

[Jim Pickles]

Not at all. It gives me the chance to correct a common misconception.

[Pat (pogo69)]

On 1/5/2025 at 11:31 AM, Gareth O Connor said:

It was probably insensitive of me to ask whether it was psychosomatic

It is also important to understand that "psychosomatic" is not necessarily a slur.  It can be used with that intent, but is not fundamentally so.

Just because an illness is caused or worsened by harmful thought processes, does NOT imply that it is simply made up.  The brain is part of the body, and they bidirectionally affect each other in more ways than we will probably ever understand.

[Gareth O Connor]

What about the mind?