Clinical Reasoning // Education //

‘Expanding Our Understanding of Pain Physiology into Patient Care’

Loz1SO….. day one at #IFOMPT2016 kicked off and I was lucky enough to be blogging on Lorimer Moseley’s session on ‘Expanding Our Understanding of Pain Physiology into Patient Care’. Now, I am sure we have all watched Lorimer online and a variety of YouTube clips and you hope he will live up to expectations…! Well….. guess what ‘HE DID..!’ The guy delivers a message that is both clinical and person centric, in a way that is clinically relevant and realistic in its application to practice and the person that we have in front of us.

Abstract link to Lorimers session here [Abstract]

The main premise of the session seemed to be around our understanding of pain biology and our ability to understand the context of research and deliver the take home massage to the people we assess and treat.

There was some interesting discussion around some of the emerging research from clinicians and academics that are challenging the finite detail in pain science. Daniel Harive is one to look out for that works with Lorimer and one of the papers discussed was ‘When touch predicts pain…’ where they looked at predictive associated learning and whether pain-associated tactile cues [Conditioned Stimuli:CS] could alter the perceived intensity of painful stimulation, and whether this depends on duration of the Cs, seeing that CS duration might allow or prevent conscious expectation. Check out the paper here Touch Predicts Pain


The other researcher to check out is Tasha Stanton on ‘Stiffness, creaky doors and swosshy sounds…’ Check out this paper: Reliability of assisted indentation in measuring Lsx stiffness Where they suggest ‘The reliability of manual methods to assess spinal stiffness is modest at best..’

Lorimer also talked about Placebo and its notion that placebo responses are responses that are evoked by nothing is not strictly true and that responses observed are in fact responses to things other than the thing to which we hypothesise a response. So, could placebo responses reflect the limitations of our experimental design (Kaptchuk et 2008; Waber et al , 2008) Worth reading this paper Placebo Reconceptulised

There was some interesting discussion around perceived intelligence of clinicians and if you are a good looking clinician that you may get a better outcome so I do worry for Jack Chew on the latter, however there was some lovely analogies to paly with. When your patient walks into the consultation room and sees your Mercedes car keys on the table or in contrast your push scooter at the back of the consultation room….. what do they think, perceive, feel and how does that affect their outcome? Better hide my Aston Martin keys then..!

Take home messages were respectful of the people we treat and the progression and development of the profession.

As with all of the speakers and topics, I have to extrapolate how do I put that into practice tomorrow. In an ESP clinic with 30mins for a patient to assess, diagnose, advise on rehab, order investigations, refer to appropriate service and dictate a letter time is precious so the message has to be clear. Setting context for the person we are treating, decreasing fear and some nice little nuggets of information that can be played into the patients court for them to think is challenging, but Lorimer does that well. Most of us might not have the luxury of time with patients so research has to deliver succinct message that can be modified and applied to suit the healthcare economy and communities we serve.

Two things to leave you with ~

‘The biopsychosocial model rejects the biomedical model because the biomedical model is not concerned with the person. But it does not reject the role of structural, biomechanical and functional disturbance of body tissue as potentially powerful drivers of protection…’

   [Moesley and Butler, in press Explain Pain Supercharged]

and secondly ……I have to leave you with the highlight of Lorimers talk for me, which was the ‘Martha and the Pelvic Tilt..’




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