It’s the beginning of a new year, and what better time to remind ourselves of the reason Noigroup exists – to provide quality, modern, science-backed, pain science resources to support clinicians in navigating the complexity of pain with clarity and purpose. By integrating contemporary pain science into practice, clinicians can enhance their reasoning, unify diverse therapeutic approaches, and cultivate deeper, more meaningful patient connections. Please enjoy the extended commentary on this topic by Noigroup CEO, Brendan Mouatt.
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Quite often, pain science is discussed in the context of explicit education – that is, explaining contemporary understandings of pain to patients to foster sense-making, self-efficacy, hope, engagement, and a less burdened neuro-endocrine-immune system. But understanding pain as a clinician can do far more than lay the groundwork for effective patient education – it can provide a lens through which clinicians can refine their clinical reasoning, reshape their therapeutic narratives with biologically grounded, evidence-based approaches, see a person as whole, and provide an opportunity to reimagine their professional roles. By anchoring everyday practice in pain science-informed theory, clinicians can reduce burnout, cultivate meaningful patient relationships, and find greater fulfilment in their careers. I imagine many of you who have started or are deep in the pain science rabbit hole may resonate with the sense of possibility that pain science brings – not just for improving patient care but for redefining what it means to practice with purpose and connection.
Many of us have attended professional development courses, building our proverbial ‘toolbox’ of interventions/strategies like McKenzie, Mulligan, dry needling, or corrective exercises. Anecdotally, we’ve often seen impressive outcomes (me included). Yet, if you’re anything like me, their explanations and rationales were frequently at odds with one another, and my clinical reasoning, in hindsight, felt fragmented. Patient experiences just seemed too complex for such simple rationales.
For instance, my McKenzie training highlighted how repeated spinal movements (often into extension) could reduce symptoms in patients with back pain, described as a strategy to mechanically influence disc properties. Yet, learnings from Stuart McGill suggested this approach might increase the risk of facet joint degeneration – a concept also seemingly at odds with tissue adaptation principles (ref: Mechanical Care Forum). The cognitive dissonance deepened when I encountered the debate between the McKenzie Institute and the late Louis Gifford (one of Noigroup’s original educators!). It was this debate that exposed the gaps in my knowledge and motivated me to begin to reconcile these conflicting approaches (read the full debate here: The Full McKenzie Debate).
I was particularly struck by Louis’ account of how doubting the value of McKenzie MDT patterns altered his own clinical effectiveness, an experience I also experienced. As Louis said:
“I don’t know if this is helpful, but as soon as I started doubting the value of centralisation – it never happened again in a way that was helpful! All I found was that patients became worse because I was doing movements repeatedly that hurt!”
I want to highlight that this is not an attack on specific interventions, but these debates and inconsistencies highlighted a fundamental truth to me: what I needed wasn’t another technique but a unifying scientific understanding to integrate and make sense of the biological, psychological, and social interactions underpinning pain and human behaviour. Pain science provides exactly that. Pain science didn’t remove the “bio” from the biopsychosocial model – it brought it back in, illustrating the intricate interplay between our thoughts and beliefs, the environment in which we exist, and the tissues and physiology of our body. It unified them into a beautiful, complex whole.
Why does one person with anterior knee pain improve by including VMO activation exercises while the next sees no benefit? Why doesn’t the biomechanical literature support many of the corrective exercise constructs I relied on, yet I still observed clinical improvements? Why did a patient with a decade of unrelenting shoulder pain leave my clinic pain-free – and remain so – after no more than a comprehensive assessment and a discussion addressing his worries? Or why do patients experience significantly less pain after molar removal when their dentist believes they are administering a real analgesic – even when all they actually receive is a placebo? (Gracely, 1985)
Pain science doesn’t have all the answers – and that’s part of why it’s called science. But it underpins a framework for making sense of complexity. It enables us to realise that we don’t need all the answers and that we likely aren’t “fixing” anyone. Instead, it enables us to facilitate environments, contexts, and understanding to afford someone new opportunities to adapt positively and gain control. Such understanding enables us to clinically reason through complex, long-standing problems, offering hope to individuals experiencing ongoing pain and empowering clinicians to approach their practice with new strategies while embracing the inherent uncertainty in what we do.
If you’ve experienced the same doubts or complexities I’ve described, regardless of your clinical background, pain science offers a way forward. Our courses are continually updated with the latest science. You can find a course near you HERE or start one from home, in your own time, HERE.
– Brendan Mouatt
MSc, AEP, PhD candidate
Always good to be kept thinking. Thank you.
I have been inspired by Lorimer’s understanding of neuroplasticity and Neil Pearson’s compassionate and holistic pain management skills. I continue to search for improved ways to educate patients and providers with tools aimed to improve well being, my most recent article now published in January, https://thischangedmypractice.com/trauma-informed-hicp-care/ I look forward to expanding my knowledge on this forum.
The Echenberg Institute has used pain science approaches with a biopsychosocial structure for over 2 decades. We care for complex chronic pelvic, genital, and sexual pain in an office-based setting to significantly reduce further surgeries, ER visits, and unnecessary invasive diagnostic procedures – validating that these symptoms are “not in their heads” – except for the obvious presence of the brain being there. I have met, heard, and corresponded with Dr. Lorimer Moseley and his group and read all of their books. I have also learned a great deal from Dr.Daniel Clauw at the University of Michigan where I did my OB/GYN training. I recently completed an e-book documenting the development of our program: https://www.theechenberginstitute.com/product/handbook-on-treating-chronic-pelvic-genital-and-sexual-pain-disorders/