What is the one thing that Lorimer Moseley wants people challenged by pain to know about? Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Prof Lorimer Moseley.
About Prof Lorimer Moseley
Prof Lorimer Moseley is a pain scientist and a science educator. He is Director of the Innovation, Implementation & Clinical Translation in Health (‘IIMPACT in Health’) at the University of South Australia, and he is Chair of PainAdelaide Stakeholders’ Consortium. He co-developed a consumer-facing resource called Tame the Beast (https://tamethebeast.org) and other resources for clinicians and the general public via the Pain Revolution website (https://www.painrevolution.org). Lorimer has also co-authored several books including ‘Explain Pain’ – https://noigroup.com/shop
Transcript
So Lorimer, what’s the one thing that you want people who are challenged by pain to know about?
One thing? It’s a very limiting question isn’t it? I would like people challenged by pain to know that that there is genuine hope being revealed by scientific discovery and that it’s an exciting time for pain scientists to be in the pain field because the field is actually moving again, and it feels like there’s a lot of opportunity… so the one thing that I would love people to know is that there is hope.
And the reason I think there is hope is that we have we have seen the field shift a great deal in what’s considered the best treatments and we’ve seen glimpses of outstanding outcomes for people challenged for years, decades, with persistent pain. And those outcomes seem to be associated with exploiting the resources that this individual has for the person who’s actually challenged by pain, has those resources inside them. And the reason that I see great hope in this, is that we are now on a journey of working out how do we find those things, and empower people and embolden people to find them themselves, train them, and take a journey that is actually moving towards recovery.
The reason I think that’s really exciting is that for much of the time I’ve been in the pain science space, which is 30 years, there’s been either ‘pain management’ – “live with it, deal with it, it’s not going to change” sort of approach, or “treat an injury” and we now know actually often (nearly all the time) an injury is not the problem. So, there is great hope that we’ve shifted our focus towards a new journey.
Could you expand a little bit on what those “things” are? It sounds like it’s an active process, but what are those things that give you hope?
Yeah, well I guess we’re on the front edge of that journey, to work out what exactly are those things. When we look at the things that characterize people that make this shift, and take on a different journey and do well, we’re trying to work out what’s different about them and what’s different about what they did and how they engaged with different approaches and things like that, and I guess the themes that are emerging (and we still don’t we still know the best way to deal with this, actually, we’re really looking for a lot of input from people challenged by pain to help us with these sorts of research inquiries), but the themes that seem to be emerging include people shifting their understanding of pain to be about ‘protection of the tissues of their body’ not ‘detection of pathology’ and that’s actually not a brand new concept, it’s a couple of decades old, but we seem to be seeing more and more evidence that when people get it – when they really get it – then they start making different choices because their pain is converted into a protective device, if you like.
Now the challenge that faces people like me where is: how do we get a better hit rate with this, how do we get a better impact? It’s not just about delivering knowledge or content or something. I mean the experts, really, in this field, are the people challenged by pain. We have a set of skills of scientific inquiry that we can utilize but we really rely on the information from the true experts.
And I feel like I’ve been learning so much about how to optimize the likelihood of getting a hit, getting a really compelling conviction, within the person challenged by pain, that their system is changeable. We have a phrase called ‘bioplastic’ – all their systems, we know, are adaptable – we have just got to work out how we can thread that line of working with a way over-protective pain system, but also working with a highly adaptable, highly clever system.
And you know what, what the key is, I don’t know what the key is. But I certainly feel like we are doing our side of that way better than we were two years ago. And actually, some discoveries in my group, and other groups, really brought home the reality to me: we’ve been doing it not very well for quite a long time. And even doing it not very well (doing our side of things not very well) we’ve even had exciting outcomes. So we’re getting hit rates of about 50% which is fantastic, but we’re seeing that elevate now.
And you mentioned, Josh, you said ‘it sounds like an active thing’, and I’ve really flipped my whole understanding of what education should be about. And I think we, the pain education community, had somehow slipped into this misunderstanding that ‘education was the goal’, whereas that’s not the case: education is the strategy to achieve the goal of fundamental embedded learning. I can only see that we will get better and better at working out what this individual needs to learn, and working that out collaboratively, and how to operationalize that, how to have the embedded knowledge, that you start making decisions differently, and you take a different course of action. It’s obviously very individual and highly complex, but yeah we’re definitely moving in a good direction.
So yeah, where to go, Josh? I would probably say: go somewhere with your eyes open, critically, but take on that journey yourself. Look for the things that – you know, you start on a level – so let’s say you start off with an animation on pain that seems to be reputable… Look deep inside your guts as you’re watching it to see: Are you surprised by something? Do you disagree with it? Do you feel angry about any of it? Do you feel frustrated? Anything you feel… well you might feel elated, or you’re surprised? They’re critical learning moments, so don’t let them go through. Stop the video and think: “Why am I feeling like this right now?” and if you listen to that and allow that to be a motivator, that will lead you towards the next resource presuming you’re comfortable online following links and those sorts of things.
But certainly, do not take on the myth that education is something that happens to you, remember that learning requires you to do the learning. And the more I learn about it, the more it feels just like training your body: you have intense periods of effort, evaluate your performance, monitor when you’re surprised, or angry, or excited, and ask yourself the question: why? Why did I feel like that? Because that will really drive your learning, and you will drive the direction of your learning. Now somehow that turned into some sort of weird “wisdom thing”, which I didn’t mean to do it all. I don’t have a sense of being that person.
That’s great, thank you so much for your time. I really appreciate it. We’ll let you get back to work.
Thanks Josh, have a great day!