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Pain and movement recalibration

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

When movement is limited by pain for too long, could the pain become a conditioned response to the movement? Rather than an accurate indication of the tissue state? Like Pavlov’s dogs salivating in response to a bell instead of food.

This article by Ben Cormack of Cor-Kinetic explores the potential to “recalibrate” painful movement by gradually breaking the association between the movement and pain with the “5 R’s of Rehab”:

  • Red flags — Rule them out.
  • Reassure — Probably nothing serious.
  • Reconceptualize — Pain as an alarm. Oversensitive.
  • Recalibrate — Graded exposure to varied movement.
  • Robust — Increase movement demand & build buffer.

I’m fascinated by this idea and think it has a lot of value, but I also wonder if the case for a primarily conditioned painful response is a bit overstated. Is that really a thing? I don’t doubt that it is possible, but is it common? I have clinically witnessed (and personally experienced) many chronically painful movements that really did not seem like a conditioned response persisting long after the resolution of any problem in the tissue. I think a stubborn source of tissue-driven pain (nociceptive pain) is highly plausible in many cases.

Just thinking out loud here.

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