The 50th anniversary of the World Congress of Pain is over. A final day of lectures, posters and workshops is complete. What did I learn today? Internet delivered physiotherapy? A couple of very informative posters and engaging presenters discussed the challenge of chronic whiplash. Firstly, Peterson and her team presented the results of their recent clinical trial. 140 people were randomized to a) twice weekly in-person physiotherapy incorporating education and supervised exercise or b) internet delivered physiotherapy with exercises…

I’ve never had the chance to listen to or meet Nobel prize winners. Today was the day. Basic science royalty in the house at the World Congress of Pain. PIEZO channels – say what? Dr Patapoutian has performed research investigating sensory modalities, and most particularly, that of pressure and proprioception. His lab identified PIEZO1 and PIEZO2, mechanically active ion channels that are expressed in mechanosensitive cell types (I copied that from the abstract!!!)

I have blogged on this previously, but a very hot topic at the World Congress of Pain has involved the topic and appropriate use of the terminology involving Central Sensitization (CS). In essence, this term has been abused by many over the years. The definition very clearly relates to a physiological response within the central nervous system. However, it has been co-opted by clinicians to help provide an explanation for ‘unexplained pain’. In essence, this needs to stop. Clinicians should not be using this word – it is not a diagnosis.

This week is a privilege. I am attending the World Congress of Pain, whereby 3500 delegates from 102 countries come and share their passion for pain. There are basic scientists, clinicians, academics, imagers, interventionists, research staff, students and people with lived experiences of pain (PWLE). All are dedicated in understanding pain further to assist the broader community in their journey to a rewarding life. It is also the 50th anniversary of IASP. I have attended 8 congresses in person and the one virtual congress in 2021, so it is a favourite.

My last post resulted in a particularly good question – given that there were top-down measures of central nervous system (CNS) hyperexcitability evident in the person with lived experience ( PWLE) pain, how do you test for temporal summation (TS) and conditioned pain modulation (CPM). Great question, and apologies for the oversight in not covering that ahead of time. Well, here goes. Temporal Summation (TS) – the accelerator Temporal summation and CPM are terms used to describe central nervous system (CNS) transmission and processing of pain.

Persistent pain is complex – and that’s the easy place to start! I’ll get to the operational definition of pain shortly. But I was reminded this week that some clinicians are not thinking of pain mechanisms when treating patients. I was tasked with reviewing a person’s progress, months after they decided to pursue further conservative rehabilitation following an initial evaluation of their persistent pain following a motor vehicle collision approximately 18 months previously.

Well, that was fun. I was honored and privileged to speak at the quadrennial IFOMPT physiotherapy conference in Basel, Switzerland. I love catching up with professional colleagues from across the globe, especially ones that tolerate my nerdiness for science. To be surrounded by others passionate about musculoskeletal pain and research is fantastic. So, what’s new you may be asking.

Flabbergasted, simply flabbergasted (as they sing in Sesame Street – yep, I’m old, but I do so appreciate some nostalgia). Not for a decade had I come across this faulty assumption. And there it was – the 3rd party’s first request in line with their request to provide an independent evaluation of an injured person was: Please address the following:
1. There was only $3627.84 worth of damage to the vehicle, indicating the severity of the impact.

OK, a 56-year-old person walks into a health clinic for further evaluation of their persistent low back pain. They reported being in a motor vehicle collision where a vehicle turned in front of theirs and despite their best attempts at braking, a frontal collision mechanism resulted. They did all the right things. They went to their doctor who encouraged them to keep moving, advised them to purchase some over-the-counter medications and referred them to physiotherapy.