In this WOW Chat episode, Shelly sits down with Professor Lorimer Moseley, one of the world’s leading and most respected pain researchers and co-author of the ground breaking books “Explain Pain” + “Explain Pain Supercharged” with David Butler.
In this WOW Chat, Lorimer talks about the difference between ‘pain science education’ and understanding pain and how he is somewhat apprehensive about the way ‘pain science education’ is becoming a stand alone modality. So much wisdom to unpack in this chat!
He also shares his perspective on passion vs clarity for clinicians and all humanity and cautions Shelly and everyone to be open to challenging our own biases and not always surrounding ourselves with people who only agree with us.
Enjoy this delightfully light hearted, inspirational, informative and value-packed 13 minute WOW Chat video OR read the full transcript below:
Shelly: Welcome to my WOW Chats! Words Of Wisdom with people I admire and respect and whose work is in line with making this world a better place.
Lorimer: Thanks – well, was that a compliment to me just then?
Shelly: Yes, because you’re my Wowser.
Lorimer: I’m your Wowser
Shelly: Yes that was a term you came up with!
Lorimer: Actually no, I didn’t come up with that term. A Wowser, where I live, is someone who doesn’t drink or smoke or dance or something like that.
Shelly: Oh — So are you a Wowser?
Lorimer: So I’m not really a Wowser, no. I don’t smoke, I don’t dance very well (laughter).
Shelly: For those of you who don’t know – this is Professor Lorimer Moseley. Thank you, thank you so much.
Shelly: He is busy and highly sought after. We’re at the World Congress on Abdominal and Pelvic Pain.
You are so well respected in academia, in the clinical world — and you are a researcher. Some of you watching may not know who he is:
You’re really one of the world’s leading pain researchers!
Lorimer: That’s very generous and kind, thank you.
Shelly: Well you are though! I mean you have almost three hundred papers. I’ve read them all from start to finish (no just kidding)
Lorimer: Excellent. That’s probably more than I have read…
Shelly: And you have several books and your specialty is explaining pain. I mean, you wrote the book with Dave Butler, Explain Pain.
Lorimer: With Dave, Dave Butler. Now HE is truly the king.
Shelly: So that makes you a Prince, perhaps.
Lorimer: Of sorts, yes. But then that means I’m his offspring…. Anyway, that’s not what we are talking about (laughter).
Shelly: I have a question along the lines of explaining pain. How important or essential would you say pain science education is for the clinician and for the person living with persistent pain – and is it a continuum – like would you say it’s essential, moderate, or depends? And I really want your perspective for both clinicians (for them to understand it and be able to explain it) and also for the person living in pain – is it really that important and if so, how important?
Lorimer: Yah, cool. I think that if I could change the question slightly, it becomes a lot easier for me to answer. If the question was, “How important is it to understand and to be able to explain the biology of your pain for a person in pain?” I think it’s really important. Whether it’s essential? I’m not a ten guy, right? I am always reluctant to conclude “absolutely 100 percent, for all cases ever.”
But I would argue that it’s important for someone who has persistent pain, it will be beneficial for them to understand some of what we now know about why they have persistent pain. Not to say that we know everyone’s situation intimately, but we know many potential mechanisms by which people hurt and there’s level 1A evidence that when people understand that, their situation improves on a range of markers.
So, obviously, I’m biased because of the things you mentioned when we started. But even I think if you ask that question to somebody who just read the literature and said, “Well this systematic review and this meta analysis said it is good and important to do.” Guidelines for practice around the world now say, “It’s good and important to do”, so I would concur with that.
The next half of your question was for the clinician in dealing with people in persistent pain. My view there is that it’s critical. It’s essential, I think that might have been your word. Because we are the conduit by which people can understand what’s going on for them and if we don’t understand what might be going on and if we don’t have a theory of how we’re working that’s based on contemporary science, then we’re missing in treatment, I think we’re failing our patients. So I do think it’s important. But I think a very important shift I made in a question was shifting your question of pain science education into a state of pain science understanding.
Shelly: And I wanted to go there with that next, so we can speak about that.
Shelly: Because a lot of people hear pain science education and think it’s this thing and it’s just another modality and something you do. But you know, it’s a state, it’s a way of living, it’s a way of being and it comes out in your language and comes out in all different ways.
Lorimer: Ya, I think there is definitely evidence, in fact there is very strong evidence, that effectively reconceptualizing the biology of pain with someone or in someone, is a good thing to do. I’m slightly apprehensive with what seems to be the current situation that explain pain, in its various brands, has become a stand-alone thing that you do to someone and like you, I think it’s actually an understanding of the human.
I just love the idea of that if we come from a place that’s defendable, scientifically, and we make our decisions and we construct hypotheses off that . . . whether that be me in the laboratory doing experiments or you treating someone who is in trouble in front of you – or I was talking to my kids or whatever – if it’s coming out of a place that is accurate as far as we know things to be, that would be better than if it’s coming out of place based on models that we know to be wrong now.
So my apprehension of the idea of explain pain becoming a thing is that we then pass it on ‘over here’. And one of my slides in my talk yesterday at this conference had that idea of: it feels that we’re getting sucked in to explain pain being another tool to put in our toolbox and the toolbox is sitting on a Rene Descartes structural-pathology understanding of pain, which is so outdated. And what I think we need to do is make the platform, the foundation on which we think and do, as accurate as we can.
Shelly: Ugh! So well said!
Shelly: I’m just so happy that you had time to do this. That’s how I feel and I knew that, and it’s just great to have you here, especially someone of your caliber, we can say, “Look!” You know it helps though – to have someone like you that’s a leading researcher and really respected to say those words. So thank you for your “Words Of Wisdom!” That’s great.
Lorimer: No worries.
Shelly: And I have another question. Do you have time for one question?
Shelly: Yesterday, when we were chatting, you said something to me that just really resonated with me and it made me really reflect even more after, and I was hoping you could do elaborate on it a little bit – not just as it applies to me but maybe even Words Of Wisdom to educate everyone listening (and Dustienne Miller who is holding our camera)!
So I made a mention of how I just feel so urgent about a lot of these messages that I have to share and I’m so passionate about messages in my work and I don’t know if you are just intuitive or maybe it was just my body language and you said, “Yah I can tell you are passionate” and you said, “That’s great” and you told me to “keep your passion” and then you said, “but be careful that you don’t let that cloud the clarity or the reality” or something like that. And I think I understand where you’re going with that but can you elaborate on that a little bit?
Lorimer: (laughter) Sure
Shelly: and even as it relates to just humans in general or clinicians or researchers.
Lorimer: Yah cool. Well ya, I think about these things a lot, and I think it’s also relevant to the way you introduced this today – that you like to sit down with people who you resonate who share your view or your values. And that’s really nice, but we need to be careful because if we just hang around with everyone who agrees with us, then we might all be missing out. I think that’s actually happening on a worldwide level at the moment. That the strategies of communication, all this social media, etc, and news dissemination; the algorithms send you what you want to hear.
Shelly: Yah it’s perpetuating it.
Lorimer: I think that’s a real problem. In science, we have a range of systems and techniques to minimize the effect of bias. So there’s threats to validity. I love passion. I feel like I’m quite a passionate person, and I sometimes feel that magnificence of the human to an extent where I will become overwhelmed by that. And I have a physiological response, and I have tears in my eyes, and I get goose bumps on my hands. And I value that side of me, and I love it. Like I love being in that space. But, what I also know is that that’s a rewarding space, and my brain will do what it can to create that space. Right?
And we’re predictive, and we’re always trying to fill stuff in, and we’re only really alert to learn when something doesn’t match our predictions. So if we spend our whole time making the predictions so strong that they suck away the diversity, then I think we can lose perspective. And I think in a clinical reasoning sense, the magical mystery, and my favourite phrase is the fearful wonderful complexity of the human, can be so emotive that we might miss something really straight forward. It still fits into the model, but it’s simple. And we might choose not to read a paper that gives a really, to us, surprising explanation for something.
So I do think we need to be careful and the challenge for the really good clinicians – maybe it’s not just clinicians, right — The challenge we all face in life — is to integrate our own passion, reward seeking, and all those lovely things, with respect for diversity and complexity and difference — and someone else might not be in that space.
You know, maybe there was another speaker at this conference, and if you spoke like that to them, they might have been offended. I don’t know, I’m making that up and I have no one in mind. But we need to somehow, I think, in all of our relationships, therapeutic or otherwise, with data, with friends and family, and all that, I think we just need to not buckle down all that stuff. Embrace it, live it, be in the moment, but not let it cloud our sensory processing and our reading other people. When the patient does this (arms folded with scowl) and we keep going on about how beautiful the system is – that’s not very helpful.
That would be my response to that.
That was quite long winded, wasn’t it?
Shelly: Oh I love it. I’m just soaking it up. You’re, you’re really smart (laughter)
Lorimer: (laughter). Cool
Shelly: …and you confirm my biases
Lorimer: Ya great!
Lorimer: Ah, That’s great.
Shelly: Thank you, Lorimer.
Lorimer: It’s a pleasure.
Shelly: I know you’re so busy.
Lorimer: Ah stop it. You’re probably more busy doing all these. That’s great.
Shelly: Words Of Wisdom, Lorimer Moseley! I hug people. Are you a hugger?
Lorimer: (laughs and hugs)
Shelly: Thank you so much.
Lorimer: It’s a pleasure. But hang on. You said you were a hugger and you kissed me. This is a high strategy.
Shelly: No I did an ‘air kiss’. I didn’t kiss you. I just did the sound.
Lorimer: Ahh. But you know that’s a high risk. If a hugger meets a kisser, it’s a high risk of kissing the hugger’s ear.
Lorimer: This is a well known fact. It happened in my family with the beautiful Anna, with whom I share my life: she’s a kisser. My family are huggers. So Anna met my dad and went for the kiss, dad went for the hug, Anna kissed dad’s ear. What a way to start the relationship. But we’ve seemed to have worked that out.
Shelly: I think out of everything we just said, that’s the Words Of Wisdom.
Lorimer: That’s the Words Of Wisdom? (laughs)
Shelly: I’m gonna edit it for just that last part.
Shelly: Ok. Thank you.
Lorimer: See ya later.
Shelly: Thanks for watching this WOW Chat! I hope you enjoyed it as much as I did. It was an honour and pleasure to sit down with Lorimer and share some of his Words Of Wisdom with you all.
Check out some of my other WOW Chats with phenomenal people and interesting topics.
To learn more about Professor Moseley’s work, google him and you’ll find numerous books (and his new book, Explain Pain Supercharged with David Butler), free video presentations and other resources.