Thanks for bringing the topic back to earth. I have recently been reading a little on what Lorimer Moseley (aussie PT) has been going about preaching - i.e. pain and what causes it - tissue damage or the brain.

This is an interesting topic in the light of the placebo effect as in some cases it has now been shown that the tissue damage causes the afferent stimulus to the brain that something has happened and the brain decides what to do with that informatiion. In some cases what it decides is PAIN, at other times it ignores it or decides it is worth ache sensation etc. This variance between patients in the brains decision might be what we see as differences in an individuals pain threshold. Mind you it always seems to be those with what they seem to think is a "High Pain Threshold" that come in complaining about pain!

The interesting thing here is that this concept might help explain the placebo effect. e.g. by taking a form of action (swallowing a pill, even seeing a therapist for assessment and advice only) this might make the brain content that someting positive has been done and therefore it can remove the PAIN stimulus.

His work also suggests that the education of patients about pain and whether to promote a tissue damage explanation or a brain response scenario. Thus far some repeatable studies have shown that explaining the situtation from a brain perspective (not tissue damage) in low back pain has been followed by positive results. In the same studies the tissue damage explanation groups were in fact worse off. No actual treatment as such was given in these studies so the effects we limited to the explanation and advice given.

This new insight alone can help us as clinicians to improve on whatever we are currently doing as a treatment approach. It might also help seperate those individuals with more of ann inflammatory issue from those more mechanical. Maybe I will start a new post on this line of thinking.