A Recap of Lorimer Moseley Pain Lecture

Professor Lorimer Moseley is one of the leading researchers in pain science. He recently gave a lecture at the University of Washington on 7 Amazing Pain Facts That Could Change Your Life. Below are the main points of the lecture and a few takeaways. Video: University of Washington Anesthesiology & Pain Medicine

1. Pain is always real, no matter what is causing it.

The verbiage used to describe pain matters. For example:“I know this pain seems real to you” implies that the pain is not real.“I know this pain is real for you” meaning the pain is real for you but not me.“Pain is always real.” 

2. Your brain is like a jungle.

Neurotags are a network of neurons that are collaborating and competing for influence. The activation of a neurotag, or multiple neurotags, will lead to an output such as pain.An example of these neurotags competing for influence is demonstrated by research published by Daniel Harvie. The participants with neck pain had on a headset and would rotate their head. When the headset would overstate the amount of head rotation, the participants would experience pain. This demonstrates the competition of proprioceptive data and visual data, with visual data being more influential. 

3. Your brain is looking out for you in sneaky ways.

In a 2013 study published in Pain, participants were asked to estimate how far away a switch was from them. When the participants were in pain and the switch would stop the pain, participants would underestimate the distance compared to the other conditions.In a similar study by Abby Tabor in preparation, participants with osteoarthritis were asked to estimate how many stairs were nearby. When participants were told they were going to walk up the stairs, they would overestimate how many stairs there were.Together this demonstrates that the brain will modify your perception of the world to better protect your body.

"Priority #1 is protection" 

4. The brain uses all incoming data.

In regards to pain, it is commonly thought that pain is generated as a direct message from the tissues. However, several studies demonstrate how the brain uses all incoming data to determine pain.A 2018 study found that altering the visual input changed reported pain. Delayed onset muscle soreness (DOMS) was induced in the quad muscles of participants. The participants were randomized into different groups and asked to perform a series of painful contractions. Viewing the injured leg, un-injured leg, or a neutral object had no effect on the rated pain level. However, viewing the injured leg through a magnifying glass resulted in an increased pain level.Smell has also been reported to alter nociceptive reflexes. A study in Pain found that exposing participants to an unpleasant odor caused a greater withdrawal reflex than when compared to a neutral or pleasant odor. In these examples, the brain modifies the amount of pain based on over information gathered.

5. And all data already stored.

Pain is also influenced by data already stored in the brain. Knowledge, beliefs, expectations, and attitudes can all influence the pain experienced. 

6. Our nervous system learns pain.

Pain is a protector of the tissues in the body. The longer the pain persists, the better protected your tissues are from things that are dangerous as well as things that are not dangerous.The immune system is also involved in the transmission of danger signals to the brain. In the tripartite synapse, the immune cell can influence how the message is transmitted. These have termed:

• DAMPS - Damaged Associated Molecular Patterns
• PAMPS - Pathogen Associated Molecular Patterns
• XAMPS - Xenobiotic Associated Molecular Patterns

The point is that general threats can increase the influence of nociceptive neurotags.

“Pain is not just a sensory signal. Pain is a protective feeling that is modulated by any credible evidence that you are in danger. Then there are other pathways to seek pain relief.” 

7. Understanding contemporary pain biology may be the missing link.

If people learn why they hurt, they hurt less and will be less afraid to move. This was based on data from a study published in the Journal of Pain. The suggestion to include education as part of treatment is reflected in many of the practice guidelines, including the recent Lancet articles on low back pain.