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Pain, where art thou?

By Noigroup HQ Patient examples 29 Jul 2014

Although on holiday it was a pleasure to try and give some reassurance to a lovely fifteen-year-old girl suffering from persistent, multi level back pain who had been advised to give up all sporting activities except swimming- she is a fit, vibrant, outdoor girl who loves to be active! Her story included wearing a rigid spinal corset for three years before undergoing spinal surgery two years ago to correct part of her scoliosis – the thoracic component.

Whilst trying to “tell the pain story” in Italian I began to reflect on my own understanding and beliefs concerning the construction of the experience we usually refer to as pain.

Taking the Osteoarthritic hip as an example, following surgery to remove the offending “source of pain” the patient often, even after many years of suffering, awakens pain free.

So how is that possible?

Was the source of pain purely nociceptive with removal of the hip joint causing the “signals” to cease?

Was the pain spinal, and centrally driven by the “issues in the tissues” and turned off when the signals stopped?

Or, was it the expectation, on the part of the patient, that surgery would “remove the pain” with only central mechanisms then taking credit for the pain relief?

I wonder what the result would have been had the patient awoken with the incision, drains, drips etc but the surgeon had only performed a sham operation without replacement. Would the relief have been equal?

My point is, why did this young lady begin to experience pain in the first place? Was she suffering “simple physiological back pain” from too much texting? Did investigation then discover the scoliosis, and was the seed then planted that “That’s a bad one. That must be painful. That has to hurt forever“.

With her present belief systems, has surgery failed as far as pain relief is concerned because she has only had part of her scoliosis operated on?

If she believes the biomedicalists then her pain has to continue- particularly with the suggestion that further surgery is needed to correct other levels. Are we to blame that this poor girl is in pain. Had we not found her scoliosis would a “new boyfriend” have solved the problem? I really don’t mean to be cynical here.

I would be interested in people’s thoughts concerning peripheral versus central…

-David Bolton

(On Location, but not brain dead)

David Bolton, MCSP MMACP MSOM, has over 40 years of clinical experience in the field of neuromusculoskeletal medicine.  After qualifying in 1971 from the Royal Army Medical Corps School of Physiotherapy, David spent 24 years living and working in Switzerland, running a busy and very successful private practice as well as providing specialist physiotherapy services to the Swiss Alpine Downhill Ski and Ski Jumping Teams, the Swiss National Karate Squad and the Menuhin School of Music.

In 1997 David decided to down size and move his practice back to his roots in London. Setting up in Chelsea Harbour, David now specialises purely in acute and chronic, therapy-resistant pathologies, biopsychosocial thinking being the core of his treatment philosophy. Recently David has been invited onto the education committee of the Faculty of Musculoskeletal Medicine which is a sub group of the newly formed College of Medicine London. In his free time David loves to escape on his Bonneville or spend the day fishing.


Get your think on and get up to date at a noigroup course, or immerse yourself in some brainy books with Explain Pain 2nd Edand The Graded Motor Imagery Handbook


  1. Chelsea Harbour. That’s a nice part of town. I might come and do some locum work. 😉

    Regarding hip replacement, we will never know what causes the immediate relief because surgeons are terrified about the implications of performing placebo-controlled studies. On occasion, a brave surgeon (or one near retirement) decides to do a sham surgery study and finds the results are equal to the real thing. Why would hip replacement be any different?

    A new boyfriend for the girl, sure. There’s no more powerful drug than a new romance. It can ‘clean sweep’ all the negatives out of the mind in a second and the pain disappears with it. Of course after the initial flush, all those beliefs of being unlovable will probably reappear, and so will the pain.
    Acceptance is what she really needs. It’s what everyone needs. Deep level acceptance.

    Good post DB,


  2. Following on from my attempts, in a foreign language to help this young girl I did receive some feedback. A relative, one of many listening to my story at the time- we are in Italy – has been a sufferer of post “Shingles” neuropathic pain in the thoracic region for many years. She said she was fascinated by the lecture but, Quote” I’m different as my pain is in my chest not my brain”. She has a point as do all the sufferers who respond in this way ………….. so where does one go from here. I know where I go but I’d love to hear where you take this so some feedback on this too please……
    Enjoying a cappuccino ☕️😎

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