TEDxAdelaide – Lorimer Moseley – Why Things Hurt

Translator: Dinah Challen
Reviewer: Peter van de Ven … just as everyone goes,
‘Great, quick nap.’ Don’t have a nap! Raise your hand – just squeeze
your left ear as hard as you can. Raise your hand if it hurt. Fantastic. Thanks for having me. (Laughter) No, no – it’s not true. Let me tell you a story. I just want to take that
off the screen for the moment. I want to tell you a story
that will explain to you the first three years
of the Neurobiology of Pain that you would study
at university. Eight years ago,
I was walking in the bush. I had a sarong on. (Laughter) Very cool. This is what happened. Did you see that? Hang on, this is what happened. Biologically, I’m going to tell you
what happened just then. Something touched the outside
of my left leg in the skin. That activates receptors on the end of big fat, myelinated,
fast-conducting nerve fibres, and they stream
straight up my leg – whizz – straight into my spinal cord –
whizz – up to this part of my brain, and they say, ‘You’ve just been touched on the outside
of your left leg in the skin.’ (Panting) (Laughter) Meanwhile, whatever it was is sufficiently intense
to activate free nerve endings; we call them ‘nociceptors’. They’re thin, unmyelinated,
slow-conducting Lada Niva – someone knows
what a Lada Niva is – (Laughter) nerve fibres. And that message travels
up to my spinal cord, and that’s as far as it goes. And it says to a fresh neuron
in my spinal cord, ‘Something dangerous has happened on
the outside of your left leg in the skin, mate.’ (Laughter) And the spinal nociceptor
takes that message up to the thalamus, which sits in there somewhere, and says, ‘There’s danger on the outside
of your left leg in the skin, mate.’ Now the brain has to evaluate
how dangerous this really is. So it looks at everything. And the way that I make sense of this,
of what happened to me, is the brain thought, ‘Frontal lobe,
have we been anywhere like this before?’ Hang on, I’ll just ask
the posterior parietal cortex. Have we been in this environment before? Yes, we have. Has it happened at this stage
of the gait cycle? Yes it has. Is it coming from the same location? Yes it is.
What is it? Well your whole life growing up,
you used to scratch your legs on twigs. This is not dangerous. I’m going to give you,
the organism, something so you can kick off the twig
and continue on your merry way. And that’s what happened for me. I can’t show you now,
but I took off my sarong, got in the river, got out of the river, and that’s the last thing I remember, having been bitten
by an eastern brown snake. (Mumbling) Survivor. (Laughter) Thank you very much. (Applause) Now, for some reason, the eastern brown snake
works by poisoning you – clearly – and one of the things it does is
activate nerve fibres. So actually my brain
would have got these messages saying, Danger! Danger! Danger! Danger! and, in its wisdom, it said, No. No. No. Six months later, I’m walking
in the bush with a boring talker. You know what a boring talker is? Those people, it doesn’t matter
what they say, it’s boring. (Laughter) It’s irrelevant, but we’ll call her Naomi because that is her name. (Laughter) Anyway, this is what happened, right? Ow! Wah! And I’m in agony. I have got a white-hot poke of pain
screaming up my leg. I’ll tell you, biologically,
what’s happened. Something touched the outside
of my left leg in the skin. That activates big, fat,
myelinated nerve fibres which send a message –
whizz – whizz – up to here. Just been touched on the outside
of your left leg in the skin. It’s sufficiently intense to activate
these free nerve endings. Danger receptors take
the message to my spinal cord: something dangerous has happened on
the outside of your left leg in the skin. (Audience) Mate. Yes! (Laughter) Well done, you weren’t planted. That goes to the thalamus
and says the same thing: something dangerous has just happened on the outside
of your left leg in the skin. (Audience) Mate! So the brain says, thanks very much,
Thalamus, kids alright? Good, anyway … (Laughter) Frontal cortex,
anything to tell me about this? Hang on, I’ll ask the posterior
parietal cortex: where are we? We’re walking in the bush. You’re a bit ‘mate’ happy. At this stage of the gait cycle? Where’s it coming from?
Have we been here before? Oh yes, we have. Last time we were here, you almost died. I’m going to make this hurt so much
that you can do nothing else. And I was in absolute agony
for what seemed like minutes. Screaming pain – until one of my mates looked at my leg,
and there’s a little scratch from a twig. (Laughter) The pain in those situations
was totally different because of meaning. I want to convince you that pain
is an illusion 100% of the time. Here’s a visual illusion … So have a look at this picture, you’ve got a square that’s got A in it
and one that’s got B in it. Raise your hand if you think
that the square with A in it looks darker than the square with B in it. Thank goodness for that. None of you have a really socially
embarrassing neurological disorder. Except you. (Laughter) That’s not true. Watch what happens
if we have another look at this. These are those two squares
taken out of that picture. Hopefully you can see they’re identical,
and some of you may not believe me. I’ll just put A on top of that,
and I’ll put B on top of that. Some of you may still not believe me, so why don’t we
just move A over on top of B, or B over on top of A. No matter how long you look at this,
A will look darker than B because your brain’s doing
some really groovy stuff, really quickly, outside of your awareness. Have a look at this. Turn your head on the side
and have a look at the same picture. Nothing changes. (Laughter) Fantastic. 100% take! So what really happens here, exactly the same frequency
is hitting your retina, and that sends a message
to the back of the brain, and then all of this groovy stuff
happens very quickly to ask the question,
What does this really mean? What’s biologically advantageous for me? and then you get a visual image. This is a visual illusion,
and vision’s not about emotion, vision’s not necessarily about survival, but pain is. Now, some of you might not know,
if you’re not medically trained, but what’s happening
at this guy’s right leg, that’s not right, that’s … (Laughter) that’s a dangerous situation, and that danger message
arrives at the brain, and the brain has to ask
exactly the same question. What does this mean?
What should be done here? And hopefully, the orchestra in this
person’s brain will make your leg hurt. In the work that
I’ve been doing for a long time, we’re trying our best to work out
how do we convince people in pain that we understand they’re in pain, but it’s not just about
the tissues of their body. How do we convince them of that? And a key conceptual shift
that we think is really important is that you can understand
that pain is the end result. Pain’s an output of the brain
designed to protect you. It’s not something that comes
from the tissues of your body. There’s nothing there. We show patients a really sharp knife, and we say this knife is sharp, yeah? Yeah. And it might be a bit cold;
it’s hard; it’s got all those properties. This knife – painful as it sits out there. No, it’s not. That knife does not
have the properties of pain. And when you stick it into their belly –
we do this regularly, straight through – the belly doesn’t adopt
the property of pain. The brain has to do some
very rapid and groovy things to project this illusion
that pain exists there. 100% of the time,
pain is a construct of the brain. We can mess with pain easily
without touching the tissues. This is an experiment we did a while ago where we got supposedly ‘normal’
healthy volunteers. They’re not normal people, because they’re volunteering
for a pain experiment, (Laughter) but let’s say they are
reasonably normal, right, and we put a very cold piece of metal
on the back of their hand, and we just show them one of two lights. One light is red, and one light is blue. We don’t tell anything about the lights,
we just show them the light. I see that hand. We ask them, ‘How much does it hurt?’ And if they see the red light, it hurts
more than if they see the blue light. The stimulus is exactly the same, what’s different is
the meaning of the stimulus. Now there’s a cue that says,
‘This is really hot.’ Because red means hot. So the sensible brain,
the clever brain should say, ‘Well, I really don’t want you to do it,
so I’m going to make it really hurt.’ There’s people in the States that are
allowed to get their psychology students to participate in experiments
in exchange for credit points – or sex, or something – anyway, they put their head inside what
they think is a stimulator for their head, and they make sure that
the subject can see the intensity knob. And as they turn up the intensity knob, this little figure there showing
the lines going up at a steady rate, that’s their reported head pain, and it matches the intensity knob. But the stimulator’s doing nothing. It’s just one of those
old-fashioned plastic hair dryers that doesn’t do anything. You know those things? You probably use one – yeah? The trick is that they
have to see the intensity knob. I always think it’d be fun
to do an experiment based on that Spinal Tap film
where the intensity knob goes up to 11. Remember that film? What’s really important
from a clinical perspective, and I’m a clinical neuroscientist,
and I see patients in pain, any piece of credible evidence
that they’re in danger should change their pain, and they’re all walking
into hospital departments with models like this on the desk. What does your brain say
when it sees a disc that’s slipped so far out
it’s sitting on its own? (Laughter) If you’ve ever seen a disc in a cadaver,
you can’t slip the suckers. They’re immobile, you can’t slip a disc. But that’s our language,
and it messes with your brain. It cannot not mess with your brain. We can even modulate the location of pain.
We can do some groovy things. It’s quite well established
that referred pain gives you pain in an area of your body
that might be physiologically normal. Most of you would have heard
of referred pain. (Sneezing) Bless you. We do experiments where we give you
pain in an artificial limb – it’s not even yours. This is Meng, who was a postdoc
in my lab in Oxford in the UK, and we stole a prosthetic limb, which is a whole other story
which is really funny – but I won’t tell it to you – so that you start to feel like
the plastic limb in front of you is yours. And we can make the rubber hand hurt. And we can bring in a knife,
and run the knife across the rubber hand, and you have your brain responses
to protect that rubber hand. You’re feeling pain
in a lump of plastic, effectively. Here’s a groovy experiment where
we take two Microsoft clipart people, and we put a webcam
on the forehead of one of them and a set of virtual reality glasses
on the other one. And then we get them to shake hands. And as they’re shaking hands, the person on your right,
who’s wearing the goggles, their visual field is coming
from the other person’s forehead. Have you got it? So they are effectively looking
at the other person, thinking it’s them because they’re shaking hands,
the motor command fits, everything’s good. And then we come in and put
a painful stimulus on that person’s arm, and they see it hit that arm
of the person over there, with whom they’re shaking hands,
and they say, ‘Ouch! It really hurts.’ And we say, ‘Where does it hurt?’ ‘On that man’s arm.’ (Laughter) They get it right every time,
pointing exactly where it is, but if you were on the outside,
taking a photo, they’re literally – we’ve got the painful stimulus here,
and they’re saying, ‘It hurts there.’ So the brain is not only producing pain, it’s projecting it
to this location in mid-air. We can mess with that. This all becomes really important
when pain persists because two things happen
when pain persists that make the life
of someone in pain really difficult, that costs our country
40 billion dollars a year. It costs Australia more than cancer, cardio-vascular disease
and diabetes combined. Thanks for that facial expression,
I wanted someone to go … This is the problem,
that if we keep running the neurons, the brain cells that produce pain,
they get better at producing pain. They become more and more sensitive, so we need a smaller
and smaller influence. The illusion, if you like,
in increasing sensitivity becomes very unhelpful. It’s trying to protect you from something
that’s not needing protection. It’s very real. The other thing that happens
is that all of these networks lose their capacity to be specific
and precise, so the pain spreads. The pain changes its quality.
Ultimately, it’s not even informative. It’s both unhelpful and uninformative. Maybe the next TED Talk ever
is the really important question, ‘What do we do about it?’ Who knows? No, we do know, that’s what we’re really researching,
but that’s the end of my 18 minutes. Thank you very much for having me. (Applause)

Author Since: Mar 11, 2019

  1. I wonder if this ties into the frequent headaches people get from stress. Perhaps some of that stress is just maintaining "pain" networks designed to guide social behavior.

  2. I was at the TEDx Adelaide conference and this was one of the best talks of the day. There's another TED talk by VS Ramachandran where he talks about pain in phantom limbs. Can't put links in youtube comments but his talk is at TED dot com /talks/vilayanur_ramachandran_on_your_mind.html

  3. Wonderful explanation – and very informative (as well as entertaining!) As a yoga teacher, I can really use this information to connect the dots. Thank you so much!

  4. Pain is an experience which is modulated at many levels. Pain can present without any peripheral stimulus (phantom pain). Similarly nociceptive input doesn't necessarily lead to the experience of pain (those wounded in war who have no pain at the time). This neuromatrix theory accounts for pain as a result of peripheral nociception (e.g. inflammatory cascade stimulating pain receptors) whilst also providing an explanation as to why someone can feel pain in the absence of peripheral input.

  5. Nitpicking here, but is it not dangerous to state that pain is an illusion? To clarify, I would say the shadow trick in this video is an illusion, however sight is not an illusion. Therefore I could agree that specific cases such as phantom limb pain and chronic pain could be described pain illusions but pain generally is not. My concern is jumping the gun and telling patients their pain is an illusion is not helpful.

  6. good point. I think what SMARTchiropractic was trying to say is that acute pain is still a perception, but then becomes an illusion to the nervous system once it becomes a chronic/persistent pain.

  7. I thought pain was the brain's recognition of a nerve signal that means some damage has or is about to occur. Just an automatic self preservation response. If we do not recognize the signal as being unpleasant, we will not respond to the stimulus appropriately and will become damaged, which may in turn affect our chances of survival and passing on our genetic code. Just as unicellular organisms respond to stimuli for self preservation. If you lack the adequate response mechanism, you might die.

  8. Another bad joke from the Cult of TED. You have to love these smug, self-important types that speak at TED, and their inane audience.

    Next up for TED, conferences on:

    – You're not really you.
    – Survival is not really necessary for survival.
    – Eating is not necessary, just an illusion.
    – How fiber optics will increase family cohesion.
    – Earthquakes and tornadoes are good for the economy.
    – Suicide is actually caused by excessive hope, not depression.

    It's all in a day for the cult of TED.

  9. It's not the speaker's fault that you are unable to decipher what he is saying. He's not saying pain isn't real inside your conscious mind. He's not saying that you don't actually experience pain. He's simple saying pain itself isn't real. There's no 'pain' molecule in the physical world, pain only exists because your brain takes a benign signal from a nerve and decides to tell your conscious mind that it's painful.

  10. Oooohhh — the TED cult members have given my comments enough thumbs down to hide it. That's what cult members do when exposed: they attack.

    The quantum woo spread at these TED cult gatherings are not questioned in any way. Until later of course, when peer review destroys the woo.

    But hey: TED tells you we can solve famine by dropping iPads into war-torn regions! It's all so simple, you just need some of that Silicon Valley enthusiasm! Problem solved!
    Just sprinkle some TED woo on it!

  11. I'll thumbs up if that helps? There is a questioning and removal process of TED videos in place; you can even Google "banned TED talks" and you'll find them. The removal process happens when content can be unmistakably refuted and discredited. Moseley is really saying what's what; thoughts that fire together wire together; tolerances build to all sensations and the brain creates more. Pain is, very, real – it just comes from our brains; and that really makes sense!

  12. You're also correct though in another assumption; many TEDers don't question what they see simply because TED said it. Which is really quite a shame. I've been an extremely proud TEDer for years… There is a lot of crap on that site, no doubt. E.g. check out Charles Fleischer's (yes, the voice of Roger Rabbit) "Everything is Moleeds." I'm still not certain if it's shtick or not.

  13. Pain can occur with or without actual trauma. We always receive signals through our 5 senses, pain is just one of the outputs, like hunger, sleepiness, etc. Pain is your brain's 'opinion' of what is happening, and your brain is not always necessarily correct, just like in optical illusions. Pain is an output, not an input.

  14. I'd really like to hear him talk about his research on what to do about it. If pain is all in your mind, how to convince the mind that there is no pain? Also, why do pain killers work? Placebo effect? I don't think so. This was a very interesting talk that brings so many questions to mind.

  15. A lot of people with chronic pain don't take Aspirin, rather they are on opiods which don't act on your body, but depress activation in the central nervous system. In essence dulling the brains perception of pain.

    If you want to convince the mind there is no pain, a lot of research has indicated that by slowly increasing exposure to a very slightly painful movement a lot of times every day will help the brain realize, hey, this actually doesn't hurt. Then you continually move on.

  16. Get the book "Explain pain", by Moseley and Butler, it gives you tips as above and explains the physiology of pain; it's interesting and also empowering. You own your pain and you have the power to get rid of it. As the authors point out: "knowledge and movement are the stress and pain liberators". I remind myself of that every time I experience pain.

  17. I so need to do that….but embarrassed to admit I am so scared of re hurting my back I'm not making much progress. This is the hardest thing I've ever had to deal with

  18. tell me how! I injured my back 9.5 years ago and still I can't bend like a normal person despite xrays being normal. I've had countless other injuries and broken bones, but they were childs play compared to my back trouble

  19. I broke my leg years ago clean through. I didn't know it was broken and walked around all day til I got xrays. It was painful, but no where near as bad as my back pain which shows no abnormalities on xrays and mri's. How can this be??

  20. Find a physiotherapist that specializes in working with people who suffer from chronic pain. They will help you a lot with your fear of re-injury so you can sustain your progress.

  21. xrays and mri's are only pictures at a moment in time and are best to show bigger structural abnormalities. They don't show the nervous system lighting up every time a movement irritates soft tissue or in chronic pain, lighting up because that movement used to hurt and the body has sensitized itself to make you think it will hurt as a protective mechanism. By protecting a part of your body and not moving it for long periods of time has been shown to be very counter productive for healing.

  22. thanks Lionhardt15…..what you said about slowly increasing exposure to a painful movement is what I've been trying to do

  23. when he said "wearing a sarong" and then mimed the bite, I thought he was miming the sarong catching on something.
    But fascinating talk.  I love his challenge, and I would love to hear more on this topic.  

  24. I just had hip surgery and to imagine the sensations of pain I did feel before and now. My brain sensed it and helped me deal with it, but to say I didn't hurt is an understatement. I feel having undue stress in one's life will make pain feel worse. So meditation has been helpful. I have back issues but continue to workout and relax. Pain is real, it's how you deal with it in everyday life.

  25. The central principle has not changed – pain is a signal that something is wrong and those who medicate the pain first without investigation lose out on the opportunity to understand it.

  26. One thing about this is it's a TED conference speech. These have to be the most innovative and "out there" ideas possible. And while he is absolutely correct about acute pain, that process doesn't apply to chronic pain. He's speaking as if there is only one type of pain and that is untrue. There's helpful pain, which is acute pain (the pain he is talking about), and it is the kind that tells you that something is wrong somewhere and it needs to be fixed. This can absolutely be blown out of proportion of the brain associates it with a dangerous prior experience. However, the second kind of pain is chronic pain. It serves no purpose and is not occurring to alert us to a problem. It is from DAMAGE. Damage that, typically, is not fixable. There is also centralized pain, which is pain that has actually entered the central nervous system. When you are in pain 24/7 and it NEVER goes away, accompanied by significant fatigue, chances are your pain has centralized. This causes significant hormone imbalances which exacerbate the situation.
    People like me with connective tissue disorders like my Ehlers Danlos suffer from extreme pain that is very real. Our pain has been described by one of the U.S.'s top pain specialists as worse than cancer pain. We EDSers typically suffer from all 3 of the hove described types of pain. I say that because each time we have a new subluxation or dislocation, we experience acute pain again. However, we pretty much all defy all of the logic set forth in this video, as our pain tolerances tend to be much higher. So, whereas a normal person may sublux or dislocate a joint and feel so much pain that they feel like they are going to die. We often just suck in a quick deep breath, do what we can to reduce it and just breathe through it. There is no doctor on the face of this planet that can honestly state that a joint subluxation or dislocation is not truly painful, but an illusion of pain.

  27. Perception has a massive influence on pain. I read in "Your Body, Only Better" that the same injury but in different situation can result in different pain sensations. This is a really interesting subject and shows just how much the brain can influence how much discomfort we feel.

  28. This guy should be an actor, but he's in a more honest field, as a researcher/scientist. Bless him.

  29. I wonder if this guy has ever experienced chronic pain. I highly doubt it. Ive read some of his work and he has a suggestion that you can adjust your attitude and chronic pain will go away. I dont care how many research grants and masters degrees this guy has, unles you have lived with chronic pain, day after day after day after day for years and tried everything you can think of including diet and exercise and correct pain meds then how can you truly understand what it is to have chronic pain. The thing that pisses me off the most about that statement is that someone close to me has read it and because this guy is world renowned he believes him, that all i have to do is adjust my attitude and i will get better. Thats a dangerous statement for all those who suffer chronic pain.

  30. Thank you so much for the clip. Got informed about it by somebody i just met. Just had surgery 1 month ago and in extreme pain, not from surgery, but the inflammation which caused the swelling. I always assumed the injured body part sends the pain signal to your brain, and must admit only recently started to wonder how painkillers works. This was a HUGE eye opener and gives me something to work with to manage the pain I experience. I now have to figure out how to over-rule my brain and inform it, that I do not experience as extreme pain as it makes me believe currently. Must say this does not cover why people with amputations feel itch or pain in missing limbs. But at least I now know, I can learn to control my mind to associate the correct amount of pain to my situation.

  31. Wow, this dude is so FOS.Inflammation causes pain. Pain is not a neutral stimulus to the brain. If it was, why would it be experienced across all cultures , ethnicities, and even across all species? This guy is a nut.

  32. This is fantastic!! Dr Lorimer Moseley – your research and delivery of this topic is at the top of its game. Definitely worth sharing for people who still have residual nerve pain after surgery. My husband went through a study at Prince of Wales Private Hospital this year (2016) called Resolve. This video was part of week 1 of training! If anyone is still having back pain after surgery and structurally everything is fine in the back – get enrolled into this clinical trial! My husband after 3 years of pain after his back surgery – is now pain free, skiing, running and throwing our daughter on his shoulders. I hope you guys get the same results. Thanks again Dr Moseley – really important work!!

  33. I think this area of "Pain Science" is so amazing, however its so sad that so many dismiss it because they think it is cause for attacking those with chronic pain. I do agree he should preface it with a large bolded "This Pain is Real for those Experiencing it", because he did mention it, just very lightly. It becomes especially apparent in his story about himself, and how he experienced excruciating pain from an experience his brain recalled as traumatic, that was only a cut. This science can really help us add another means of helping those with pain, and help redesign some of our education to the general public, as he mentions on topics such as "slipped discs".

  34. As someone who has lived with a headache for five years now, I want to believe this SO much. There is truly nothing physiologically wrong with me, but my pain receptors are just having one big party in there shooting off like it's the fourth of July in Texas and they are on a weekend bender! No medication touches it, and it has impacted my life quite a bit (although not to the point where I let it stop me from doing what I want to do). I hate it and I want it gone.

    I have to look up more of his stuff because F this pain. I am SO over it. I found him because I am participating in a chronic pain study and this was a suggested video.

  35. Yeah ok then so this is all really good in terms of explaining why we feel pain and why/how it is produced but how do you combat the pain, just tell yourself "oh this is all in my head, go away pain, you're not real'?
    I'm a longterm sufferer of midcarpal instability, CRPS, thoracic outlet syndrome so subsequently suffer from incredible pain on a daily basis. Surgery hasn't worked and I have had over 7 operations and medication doesn't work either so just do something to stop the fucking pain!!

  36. I find it interesting that those who have experienced chronic pain commenting on here completely get what I'm saying and those that haven't are suggesting I rethink my attitude. Until you have lived with chronic pain for years shut the hell up. Most health care professionals, scientists, experts,…. whatever " A" haven't suffered chronic pain, albeit they have a desire to understand it, and "B" are all just flailing around in the dark guessing where conditions like fibromyalgia come from, caused by etc… there is a myriad of different proposed ideas about this disease but currently they can only measure by the symptoms. I recently read a book called "medical medium" and it's the first real sense I've ever heard on these chronic pain conditions, including an author who explains that it's not your fault, it's not in your head, here is what's really going on….. for those on this thread who suffer with chronic pain and have searched for years, find this book by Anthony Williams, it has helped me more than any attitude adjustment I've tried. He's compassionate and sympathetic to chronic pain sufferers and has some real answers. My pain has diminished 80% in just over a week since following his advice(it's now been a month and still no return of the pain), I look forward to completely healing. All those who haven't suffered chronic pain, don't bother commenting, it falls on deaf ears, just like our (chronic pain sufferers) complaints fall on unsympathetic ears telling us re-adjust our thinking. pftt.

  37. I have what might be called CHRONIC BLADDER PAIN MYSTERY SYNDROME. It is chronic as no-one knows how to diagnose it and therefore there is no sure treatment for it, however, somehow I do not feel that this guy has the answers for me, rather I do myself though I need to keep working on it and my pelvic floor therapist hopefully can help, moreover, some of this chronic pain may slip into pleasure with the X factor. Naturally I want more of the latter rather than the former and I am working on it! Needless to say this guy does not delve into a pleasure aspect which to me is the same side of the coin so to speak!

  38. I have chronic pain and I totally agree that the way I perceive my pain might be worse than the situation is actually worth. In that retrospect I remember having to get injections on a weekly basis and with every time the pain from the injection spreading through my body increased until I had to stop. What I want to know now ofc is how can I not feel the pain so much, especially when I know I shouldn't have pain right now and the pain comes more from my body trying to protect me from further damage to my joints? (ie: no visible signs of damage or swelling but still lingering pain due to having it experienced for too long in that spot)

  39. I would really like to hit this guy in the back with a large hammer. Then maybe we could have an intelligent conversation about pain.

  40. In my treatment of back pain–some 10,000+ patients spanning three decades, I can say that most chronic back pain has both a physical and psychological cause. Let me explain:

    I am speaking here of back pain as a condition, not a disease. This means it is ultimately caused by some biomechanical dysfunction (keeping the psychological aspect aside forthe moment).The vast majority of people with chronic back pain have spinal joint dysfunction and muscular tension. These are the kinds of conditions most often seen by chiropractors, osteopaths, physical therapists, and massage therapists. I would add that medical doctors are generally not trained to evaluate spinal joint dysfunction. They may not know, for example, that the sacrum may be in pain because the atlas (first cervical vertebra) is misaligned and not moving properly at the other end of the spine. They would not know that treating the atlas can often remove all of the pain and even sciatica going on in the lumbar and pelvic regions. My point is that medical evaluation is not sufficient. There needs to be examination by other qualified professionals in the case of chronic back pain. My other point is that adjusting the spinal joints and releasing accompanying muscular hypertonicity (tension) often gets rid of the pain. Except when….

    There is a patient like this one I had. Complaining of low-back pain, unable to bend forward more than about 45 degrees, result of a work-related injury. Treated with spinal joint and sacroiliac mobilization and massage, straightening his spine considerably. Arises from the table. Asked to bend forward and can now touch his toes. Asked the pain is now, his eyes glaze slightly and he says, "The same, no different." I say, "But you can touch your toes now." I press on his sacroiliac which had been painful on pressure half an hour earlier. He says there is no pain there anymore–and looks confused. What happened?

    Function was restored. Pain on palpation was gone. Where was this patient's pain? Was he lying? Malingering?

    I learned in that moment of his eyes glazing over that he was reporting on pain from THE PAST, not the present!

    He actually believed that he still hurt, even though pressing the previously painful places did not hurt, according to him. Pain in THE PRESENT did not exist. Pain from THE PAST was being perceived–mis-perceived–as taking place in the present. It was "recorded pain," not pain "live and direct." The memory of pain.

    This does not make past pain that seems to be present pain any less real. But it does have to be clearly distinguished from present, palpable pain. And it does have to be treated differently. However–and this is my point too–the biomechanical causes of pain–the misaligned spinal joints and excess muscle tension–have to be removed in order to 1) find out whether there is any other source of pain than purely physical/biomechanical, and 2) when there is, to treat past pain in the brain with other therapies than the purely physical. And all this requires making a full physical biomechanical assessment, and that is best done by professionals with that kind of training.

  41. My dependence on methadone is a chemical based need. A unknown substation with a inert sustance might kill me. His absubtion is incorrect.

  42. What I would like to know is how our consciouses is involved while we are experiencing pain. What is it doing our souls our essence?

  43. Hi, could you open communautary contributions ? I'd like to add french translation of this amazing story 🙂

  44. The epitomy of irony. Pain is supposed to be a protection. And yet it becomes the thing that makes life unbearable at times. I say this as a Fibromyalgia sufferer.

  45. The Pain Antidote: The Proven Program to Help You Stop Suffering from Chronic Pain, Avoid Addiction to Painkillers–and Reclaim Your Life Paperback – May 26, 2015
    by Mel Pohl and Katherine Ketcham. This book also covers what Moseley tells us about pain and I guess how to trick or retrain the brain… I have not actually read it, but I was helping a fellow student with the referencing side of a psychology assignment and came across it.

  46. Funny and informative about the neuro biology of pain, but I agree with others it's mainly useful for understanding acute pain. I have been attending pain management and education classes for the last 8 weeks and it's done little to improve my perception of my chronic pelvic pain / prostatitis

  47. I love the way this is explained, so accurate. I specialise in helping those suffering with Chronic Pain through Hypnotherapy it's fantastic to hear the medical community explaining it's all in your head. Cheers Tas Lombardo Langwarrin Hypnotherapy

  48. Why, if all pain comes from the brain, can we not learn hypnosis techniques or meditations that alter our brains and prevent them creating pain?

  49. Bah! Humbug!
    I have experience of Dr. Moseley's theories as a patient & all I am willing to say publicly is it is obvious he has never experienced chronic pain first hand…

  50. All of these "think your pain away" gurus seem to me just opportunists. There will always be people in pain, many of them desperate for relief, desperate for a cure.

    I agree that for certain types of pain, your mind can ease it to varying degrees, but something like a toothache will continue to hurt no matter what you think. And chronic pain with no APPARENT cause can only be coped with, at best, because there's something either undetectably wrong with the tissues or something wrong with the body's overall mechanism.

  51. He is 100% correct, however, as others have pointed out, this evidence – that pain is only in your head – can have a negative effect in the mindset of those not suffering with pain. Non-sufferers tend to dismiss the agony of the sufferer with statements and notions such as, 'Just change your way of thinking' 'think it away' etc. We can see examples of this in the comments right here, below, let alone in one's daily life.

    True, pain is in the head. But so is the pain of hunger— not your stomach, but in your head. So is the pain of fatigue, exhaustion, sleep deprivation. All these are 'in the head'.

    Yet, can any of us 'think these away'? Even if we could, would it be a good idea for our well being and survival for us to do so? I think not.

    Cheers from Tokyo.

  52. It's funny to make jokes and trick people in severe chronic pain, cheers mate! I do buy into what he says that the brain is in charge of pain and re-thinking your pain can help but try doing that when you are living in 9/10 pain 24hrs a day screaming and shaking in pain with nothing that relieves the pain except a few moments when the medication is working at full effect. Just try to imagine someone in that situation changing their attitude to their thoughts about their pain, it is all but impossible. I wish it were as easy as all the doctors and therapists say it is, no matter how hard I try these thought techniques my pain is too severe to complete the exercises. I am always brought back into the here and now moment, which is severe pain and nothing else. There is pain and then there is the pain I am suffering, if I had normal pain like a sore knee or arthritis then I'm sure these techniques would work a treat

  53. The brain is the master organ that processes pain signals from the body. The brain processes pain signals as sensations, emotions, and thoughts (not just a pure sensation). Thoughts and emotions can make the experience of pain much worse, or much more manageable. Thoughts and emotions directly influence the pain signals coming into the body. Now, does it work for everyone, of course not? People are weak when it comes to change. The brain becomes more sensitive to pain signals with chronic pain. This is why you might be more sensitive to pain signals than other people after living with pain for a long time. But you can learn ways to help lower the “pain thermostat” of the brain. Chronic pain is a chronic illness. Like diabetes, high blood pressure, or asthma, chronic pain needs long-term management, including lifestyle changes as well as medical treatment. IMHO…

  54. I don't know if u ever will read this but i was the guy at the hostel from Ica, Peru, who you teached about this. Thanks…. i took too long to watch it but i'm doing it. Vibes!

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