Painful Yarns Read online

  Pain, a textbook for therapists (Editors Strong, J et al) 2001, Elsevier, Edinburgh. This is a pretty occupational therapy- centric book that is aimed at allied health professionals. I have the inside word that the next edition will be far less OT-centric and include stuff from some of the key thinkers in pain from across allied health. So, the second edition will be a great resource.

  If you want to look at research studies that have explicitly targeted the explanation of pain biology as a treatment strategy, then here is a list of studies that I have done (I actually delivered the education for the first one, but not for any of the others):

  Moseley, GL (2005) Widespread brain activity during an abdominal task is markedly reduced by pain physiology education – fMRI evaluation of a patient with chronic low back pain. Aus J Physioth 51 49-52

  Moseley, GL, Nicholas, MK and Hodges, PW (2004) A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 20(5):324-30

  Moseley, GL (2002) Evidence for a direct relationship between normalisation of pain cognitions and improvement in physical performance in people with chronic low back pain after intensive education. Eur J Pain 8,1: 39-45

  Moseley GL (2003) Unravelling the barriers to reconceptualisation of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain 4(4) 184-189

  Moseley, GL (2003) Joining forces – combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain. J Man Manip Ther 11, 88-94

  Moseley, GL (2002) Combined physiotherapy and education is efficacious for chronic low back pain. Aus J Physioth 48, 297-302

  I know that there are other research groups looking at different applications of explaining pain, the effects in different settings and with different types of patients, but nothing I know of is published yet.

  post-script: call for stories

  This bit is for anyone who can write. In this book, the first edition of painful yarns, I have attempted to record the metaphors and stories that I have found particularly helpful in explaining pain. In subsequent editions, I would like to include those metaphors and stories that other clinicians and patients have found helpful. So, consider this an official call for stories, metaphors or any other mechanisms that you use to help Explain Pain. I am going to run a little competition called “The Gerald Award”. The Gerald Award will go to the author of the submission considered by the judges to be truly excellent. There is no rule that there can only being one winner of the Gerald Award nor that you have to be a clinician, or a patient or anything in particular. This competition is so splendidly unregulated that you could even be related to me, the publishers and distributors, and their affiliates. It will all come down to the judges’ decision. The winning submission (or submissions) will be published in the next edition of painful yarns. A portion of royalties will be allocated to the author of the winning submission, such that they will receive about 2p for every copy of Painful Yarns that is sold. So, if your submission is good enough, you really could make an absolute motza!

  Remember that the judges’ decision is final and the judges are:

  Me

  A mystery pain science guru or two

  A quasi-psuedo-cluster-block randomly selected group of five people who suffer from chronic pain and who have never heard about how pain actually works.

  So, send me your stories…

  www.painfulyarns.com

  * yarn: _yärn, noun, a tale, especially a story of adventure or incredible happenings

  In painful yarns, the names of some people & places have been changed to protect them from offence and me from prosecution! All the stories are based on true happenings. Like all yarns, however, the degree to which they stick to the facts is somewhat variable. In the words of Ben “Chow Mein” Hopkins, a dear friend and great story-teller, “Why ruin a really good yarn by sticking completely to the truth?”

  about the author

  Lorimer Moseley’s first name is Graham, which is his dad’s name. Lorimer is rather fond of his dad, which is why he sneaks the little ‘G’ in before Lorimer, which is Lorimer’s mum’s name and the name by which he has always been known. By sneaking the G in, Lorimer doesn’t get confused with all the other Lorimer Moseley’s out there.

  Lorimer graduated from the University of Sydney with an Honours degree in Physiotherapy. He then decided to be a musician. This was a daft decision & he would have starved if he didn’t eventually accept a job as a physiotherapist. To his surprise, he quite enjoyed being a physiotherapist. He was a physiotherapist at the New South Wales Academy of Sport for several years, then at the (Sydney) University Clinic for several years. He then undertook a PhD at the Pain Management Research Institute, Faculty of Medicine, University of Sydney. His supervisors were Prof Paul ‘The walking cortex’ Hodges, and A/Prof Michael ‘Mr CBT’ Nicholas. He gained a National Health & Medical Research Council Post-doctoral fellowship, first at the University of Queensland and then at the University of Sydney. He then moved to Oxford University in the UK, where he worked as a Research Fellow in the Department of Physiology, Anatomy & Genetics. In 2009 he returned to Sydney, where he is an NHMRC Senior Research Fellow at the Prince of Wales Medical Research Institute.

  Lorimer’s previous book, co-authored with David ‘Pain Science’ Butler, is Explain Pain. It is a real hit with clinicians, researchers & patients. The American Pain Society Review said Explain Pain should be in every clinician’s library! Lorimer agrees. So of course, should painful yarns.Lorimer’s experimental & clinical research has received international awards, including the very prestigious IASP Outsanding Clinical Scientist under 40 working in a pain-related field. Lorimer is author of 70 peer-reviewed publications on pain science & pain management.

  ‘Explain Pain’

  A book for clinicians and pain sufferers

  ISBN (10 digit) 0-9750910-0-X

  ISBN (13 digit) 9 780975 091005

  Butler D, Moseley GL, Noigroup Publications, Adelaide, South Australia, 130pp, over 90 illus/diagrams, half-canadian wirebound.

  ORDER VIA www.noigroup.com

  Knowledge is power! David Butler and Lorimer Moseley’s acclaimed Explain Pain is a neuroscience picture book for health professionals and the public. It explains why you hurt, especially pains that continue when the body should have healed. Explain Pain also includes empowering information which allows the sufferer to select the best treatment path.

  Clinical trials and recent brain imaging studies show that learning about pain neurobiology can immediately desensitise key brain areas and, therefore, pain perception. Based on this, Explain Pain covers some amazingly complex scientific ground without burdening readers with unnecessary jargon. It tells stories, brings the body to life and makes you wonder as you read, ‘why do textbooks and some health professionals make such heavy weather of science when I can understand it quite easily here?’

  ‘Overall, this is a great book. It is packed with the right messages for patients and healthcare providers... I highly recommend it for one’s patient library and as an introductory summary for those who are entering the field of pain management.’

  ‘The authors present four goals: to communicate basic science information to clinicians and their patients, to educate people with pain so that they can gain understanding and have less fear, to assist people in pain to make good management choices, and to outline modern management models. They have succeeded on all four fronts.’

  John D. Loeser, MD Professor of Neurosurgery & Anesthesiology, University of Washington

  ‘This book bridges the gap between people’s experience and neuroscience... I strongly recommend it to all practitioners whatever their expertise and to anybody whose pain is playing the loudest tune.’ Margaret Mayo Physiotherapist

  ‘Not only do the authors present complex concepts and physiology
in simple and memorable language, they also manage to deliver the material in a clinically useful way... I can’t think of any practitioner who deals with pain who shouldn’t read and use this book.’ Nicholas Lucas Osteopath

  Noigroup Publications | NOI Australasia Pty Ltd | Neuro Orthopaedic Institute 19 North Street, Adelaide, South Australia 5000 | www.noigroup.com T +61 (0)8 8211 6388 F +61 (0)8 8211 8909 E [email protected]

  Notes

  1. Coppers: Police officers.

  2. Cricket: Cricket is a sport played throughout the British Commonwealth.

  3. To bore out: To ‘bore out’ means to make the engine’s cylinders a bit wider so as to turn a 2000cc engine into a 2200cc engine. Extractors do something to make the exhaust come out of the engine more efficiently - they ‘extract’ the air. Somehow. The side effect is that they make the car sound a bit chunkier. My mate Stevie put extractors on his VW beetle because he reckoned it make it sound like an RX-7. I reckon it sounded like a food processor.

  4. 1,165 km is about 726.5 miles.

  5. Team T-shirts: We thought it was funny first year of the race to call it the First Annual Hitchhiking Race for Charity, and got printed T-shirts with “FAHRC – Beat your mates to home base”. Then again, we were 22.

  6. Ute: Ute is short for utility – a bit like a pick-up truck only smaller. Farmers have them mostly. Crazy’s ute looked a bit like this:

  7. Wagga Wagga: It is only permissible to call Wagga Wagga ‘Wagga’, if you have spent enough time in Wagga Wagga to realise that Wagga Wagga is not ‘Wagga’, but that ‘Wagga’ is an affectionate shortening of Wagga Wagga. Otherwise, always call Wagga Wagga Wagga Wagga.

  8. A swag: A swag is a roll-up canvas bed, complete with mattress and bedding.

  9. Heckyl & Jive: Crazy’s phrasing, not mine.

  10. Neurolysis: Neurolysis refers to the destruction of nerves, or nerve tissue, by burning it, cutting it, or injecting it with chemicals.

  11. Noxious means dangerous. Think of noxious chemicals, noxious weeds – they are dangerous chemicals and dangerous weeds. A nociceptor is a special type of nerve that responds to anything that is dangerous. For example, dangerously hot, dangerously cold, dangerously low on oxygen, dangerously high in acid. We have nociceptors in almost every tissue in our body.

  12. Nerve or tract?: Technically, the optic nerve is a tract, not a nerve. Tracts don’t leave the central nervous system, whereas nerves do.

  13. The yadda yadda yadda layer: This is not the real name of the layer of photosensitive neuronal cells that sit underneath the cones and rods that make up the retina, but it will do.

  14. Seeing is interpretation: The indefatigable Chris Murphy told me that this reminded him of a saying in NLP: “the map is not the territory”, which Smurphy reckons means that what you see is not what is really there, but your interpretation.

  15. Uluru: Once known as Ayers Rock

  16. The Darwin Awards: The Darwin Awards are given to people who die because they did a remarkably stupid thing. The awards honour the contribution that such morons make to natural selection, by removing themselves from the gene pool. http://www.darwinawards.com/

  17. Dodgy proverb: This may not be a completely accurate account of the famous proverb.

  18. Opiate-related: Opiates are officially called narcotic alkaloids, which is why we call them opiates. Morphine is the most famous opiate. The opiate-related system refers to neurones that use opiates to communicate. The nervous system uses opiate-systems as natural pain-killers, but there are other pain-killing systems that don’t use opiates. We call those systems non-opiate systems.

  19. Clever crimes? In the Snowtown murders, victims were killed for their social security payments and the bodies were put in a disused bank vault. It seems bizarre to me that one would take the risks involved in multiple murder, risks that I imagine are substantial, in order to collect the social security payments of the people you have murdered. If murder is your preferred means of income, would it not be more sensible to murder one rich person than a dozen poor people?

  20. Glen20: A disinfectant spray that is meant to hide smells but really just marries them.

  21. Revised stump: The wound where his leg had been removed 20 years earlier had degenerated over time, so he had to have a bit of the stump re-amputated and a fresh stump with healthy tissue created.

  22. Probability: There may be a slight flaw in this reasoning.

  23. XXXX: ‘Four X’ is a Queensland beer. Outside of Queensland, it is known as cow urine.

  24 Whoopee birds: I suspect this is not their official zoological name.

  25 TMBA: The most beautiful Anna, with whom I share my life & my children.

  26 Box jellyfish: The box jellyfish is also lethal and has no central nervous system. Jacko would hate that.

  27 Of least concern refers to the remote chance that the Eastern Brown will ever become extinct.

  28 "Right. OK. Really!? WOW!": Let’s be honest, we have all done this more than once.

  29 "A minute to live!" I made up the mobile phone and ambulance call bit.

  30 Working week: Truth be known it is probably only about 34 hours a week, but one must keep up appearances.

  31. Popper: a fruit juice in a small carton with a straw attached to the outside.

  32. Original?: I have written this as though I was the first person to ever wonder about the relationship between injury severity and pain. I wasn’t. In fact, this relationship has been the subject of much writing, but I will still pretend I thought of it. In actual fact, it was just that I didn’t really believe what I had read because it sounded rather stupid.

  33. A nociceptor: Nociceptor is the term given to nerve cells in your body that respond to dangerous things. To learn about how they work and the role they have in pain, read Explain Pain, which is in the reference list at the back of this book.

  34. Suck your brains out: OK OK OK, I know that you can’t really suck your brains out via your ear and that you would be more likely to inflict damage on the ear apparatus, but it sounds so much better to say ‘suck your brains out’. Suck your brains out. See?

  35. Production at McDonalds: Of course in reality, the true champions at the job of Production were only champions because they could keep changing the timers without anyone noticing, so that they never had to throw anything out. I made a point of not doing this, partly because I was afraid of giving someone a bacteria burger and partly because I was afraid of getting caught.

  36. Gofer: The ‘gofer’ was the general tasks person, the dog’s body. Called gofer because they go for this and go for that.

  37. Clinical uniform: I thought our socks were bad, but we were Milan compared to the girls. They had to wear the most abominable creations I have ever seen. They were called culottes:

  culotte (k__-l_t’) n. A woman’s full trousers cut to resemble a skirt. Often used in the plural.

  More accurately – ‘a woman’s full trousers cut to resemble a Yak.’

  38. Selmer Mk VI: If you haven’t heard of a Selmer Mk VI, it is the ants pants, the bees knees, of saxophones – presents the serious muso with a real dilemma. I tried it on Keith:

  LM: Both the Mk VI and your daughter are stuck inside a burning house. You can only make one trip in…

  39. Ornithology: From when I got Ornithology to about 3 months before I wrote this, I thought Charlie Parker called his tune Hornithology, as a pun on the playing the horn. I was corrected by someone in a seminar I was running and I was so completely convinced that she was wrong that I made a joke of it. But she was right and I was wrong. If you read this, oh sufferer of the presenter’s unjustified wrath, I am really sorry.

  40. Grobbitz: That particular part of the male anatomy in which, or on which, one doesn’t want to get hit. I remember Shane Warne getting middle-pegged by Freddy Flintoff in the now famous 2006 Ashes series (for which the entire English team (named so because at least 3 members were bonafide Englishmen) got Queen’s honours (Paul Collingwood most famously, for
his total of 7 runs) – shows that all one has to do for such things is to win a series every twenty years. Anyway, that is beside the point). When Warne had again taken up his stance at the batting crease, the commentator resumed in proper Kensington Plum “Flintoff to Warne, one ball left”. Classic.

  41. Catastrophising (awfulising): OK OK OK this was a bit catastrophic – perhaps I wasn’t quite this concerned.

  42. Empathy: There is actually good evidence that we all activate parts of our brain that are involved in pain, the so-called ‘pain matrix’ when we see someone else being injured. Scientists call it the ‘neural correlate of empathy’. If the network of neurones in the brain that produce pain are sensitised (this happens in persistent pain), then this empathy response will be greater, possibly great enough to produce pain. Take a look at the reference list because there are some good books on how the pain systems become more sensitive.