Understanding Chronic Pain

Dave Moen – Bachelor of Physiotherapy, University of South Australia and Master of Musculoskeletal & Sports Physiotherapy, University of South Australia

Dave is a physiotherapist at Form Physiotherapy and the director of Form Health and Permission to Move. He previously worked at UniSA teaching masters and undergraduate physiotherapy students, and worked in research at Body In Mind with Prof Lorimer Moseley. Out of this pot came Tame the Beast - a collaboration between Lorimer and Dave that helps to explain pain and give people useful tips toward recovery. The Tame the Beast animation is played in public hospitals and pain programs all over the world, and has gained international recognition as a leader in pain education.

Dave has a particular interest in treating chronic pain, educating clinicians in pain science informed treatment, and using education and exercise to inspire and enable people to pursue lofty goals.

 

My first extraordinary experience of pain didn’t strike me as interesting until years later. 

I crushed the end of my finger at work – caught in the cooling tray of a coffee roaster and I was asked to go to the Emergency Department to have it looked at. The hospital was very busy, and before taking a good look at my finger a doctor injected the contents of a memorably large needle into the back of my hand, causing a lump about the size of a quail egg. 

At the exact moment I registered the new (and concerning) shape of my hand, the doctor left and so commenced the worst pain I have had - before, or since. This was before I studied physiotherapy and I concluded that the liquid was injected too fast and must have torn the skin’s connection to my body, and also injured a nerve. 

The most concerning thing was that when I touched the area I couldn’t feel it. The area was numb and there was no way I could clarify that things were ok. 

When the doctor returned five minutes later I was clearly distressed and holding the painful hand, looking urgently around for help. The doctor, unfased, told me it was normal for the skin to balloon up and then asked me if I could feel him touching the skin. I looked at the hand - I couldn’t feel his touch. At the exact moment I realised the area was normally and safely anaesthetised, the pain disappeared and the cold burning pain changed to a pleasant numbness. 

It’s fascinating to look back and see how I neglected to pause and reflect on my pain. Why did it stop so quickly after I was reassured it was ok? Why did it hurt when it was meant to be under anaesthetic?

This story speaks directly to the idea that ‘nociception is not sufficient nor necessary for pain’. This simple idea challenges so many assumptions. 

Since that day, I have learned a lot about pain and pain treatment. I’ve worked with a few thousand patients who have had long-term pain, and trained more than 200 physiotherapists in the model of care outlined in this book. 

The most important thing I have learned is that our own understanding of pain is important - it underlines our response to pain in our own lives, and also our response to pain in others. For clinicians looking to integrate principles of pain science into practice, my recommendation is to reflect on your own ideas about pain and your threshold for Safe to Move. If particular movements make you uneasy - for example, lifting bodyweight from the floor, pressing weight overhead, or going for a run - then you might decide to undertake some mastery experience of your own. 

It’s very difficult to ask others to do things that you would not do yourself.

Dave Moen is a founder of Tame the Beast and the author of Permission to Move. Permission to Move is a book about pain science with a refreshingly simple approach to treating chronic pain. Get a copy of the book today.

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