Coming in to this weekend, I was expecting to hear a similar pain education talk that I have received multiple times throughout PT school and lectures at CSM and boy was I wrong. I was not expecting to delve so deeply into the “bottom of the iceberg” but figured it would be focused on the visible portion of the iceberg or the area of pain science focusing on teaching us how to portray this plethora of information to our patients. I was struggling with this throughout the weekend until I changed my mindset.

Looking back, it was naive of me to think that this course would just hand me a few sentences or phrases to explain the pain phenomenon to my patients. Even if we did receive those sentences or phrases, would those sentences or phrases even resonate with our patients without a better and more in depth knowledge of what pain truly is? Lorimer Moseley gave the example about dry needling and I paraphrase (poorly), even without the needle as long as the PT believed that they were in the correct spot and that they were affecting change in the tissue then it had an effect on the patient. Can this apply to the topic of pain science and education? For example, if we were to have been given a few sentences and phrases to tell our patients (top of iceberg) but didn’t know or believe how the bio, psycho, and social aspects of the human and pain interacted (bottom of icebergurg) would that therapeutic pain science discussion be beneficial to the patient?

Lastly, I came into this conference thinking that I was pretty decent at giving a therapeutic neuroscience pain talk to my patients. I would always use the kitchen smoke detector as an analogy, for example:
Me: “Pain is the alarm system in the body, it does not always mean that there is damage in the area but is more so telling you that there is a potential for damage. Have you ever been cooking on the stove top and you put some olive oil on the pan and it starts to smoke a little bit and then all of the sudden the smoke detector starts to go off?
Pt: Nods head
Me: “Imagine the smoke detector as pain alerting you that there is a potential for danger. In this case, the smoke detector is telling you that there is a potential for a fire so go check it out. The same way the body tells you there may be something wrong, check it out (go to a doctor, they run scans, perform different tests, etc.)
Me: So you hear the smoke detector and the first thing you do after yelling at it, is to check the sources for danger. You realize that the oil in the pan is smoking but there is no actual fire but just a potential for it. So in your case, you have gone to a doctor and/or me and we have checked for the “fire” (red flags, fractures, etc). Now that we have made sure there was no fire, lets turn down the stove and get rid of the smoke, aka lets start some gentle movements in order to get back to what you want to do.”

While I still like my analogy and I have been given good feedback from my patients, after this course I believe I will need to go back and change some things up. I really like the visual and idea of how pain creates a larger buffer and alters the threshold of when it is experienced. I’ll keep you all updated if I think I have something that works well.