The Word is Out


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Following the recent two day Know Pain workshop with the The Physiotherapy & Orthopaedic Medicine Service (POMS) in Lichfield, here’s a link to their newsletter containing a review of the weekend: 

A huge thanks to Paula Deacon for arranging the workshop. It was great to work with such a dedicated team of clinicians and even better to see and hear you putting your Know Pain know how into action with patients following the course.

If you’d like to arrange an in-house Know Pain experience for your team, send me an email: 

2 Day Know Pain Course Review

Feedback is essential in education. Without it, it’s impossible to know if you’re achieving what you’ve set out to achieve.

I was delighted to run a 2 day Know Pain course with Helen Preston from Preston’s Health in Peterborough recently. I was equally delighted to receive Helen’s feedback and course review. Many thanks Helen.


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My thoughts on the Know Pain course by Helen Preston@prestonshealth


Thanks Mike for giving your time and energy to educate us all at Prestons Health.


I can highly recommend the course to all therapists who treat persistent pain.


It is remarkable to think an average of 1% of undergraduate time in physiotherapy education is given to pain science. It dawned on me that all therapists treat pain in some shape or form and the absence of this as a core subject in undergraduate therapy education institutions is quite remarkable. However, this course goes a way in bridging that gap, whether you are a new grad or an old timer like me!


A real strength of this course is its multidimensional nature and just how practical it is in its application to clinical practice. What makes it different from pain courses I have been to before (and i have been in a few!) is how it focuses on the therapist as an educator. Hand on heart, I never considered myself primarily as a teacher before. This course changed that for me. The course provided insight into adult learning theory, which was extremely enlightening as to why my therapeutic approach had worked with some and not with others. I genuinely now approach every clinical interaction with a different hat, much more aware of my role as an educator and the patients learning styles.


Mike has become famous in the physio world for his use of metaphors and he draws on these throughout the course. I am now picking up and utilising patient generated metaphors in treatment planning for my patients. My patients had been handing me clues into how to tap into their potential before and I hadn’t even noticed. Now I do!


I particularly enjoyed the second day when Mike explored lots of different ways to approach pain education. Song lyric analysis. Chinese fingertraps (my patients love these) PHODA. Too many to mention them all!


In summary, Mike’s approach to teaching us as teachers was refreshing and full of insight. There were lots of opportunities for us to synthesise our learning with group activities and case studies at the end. I have to also mention the simply fabulous learning material for the course too. The handouts and file are very well thought out and having our very own Know Pain USB card with the presentations will help ensure the vast amount of information is not forgotten.


All in all, a course well worth investing in. And thoroughly enjoyable. Highly recommended.



Helen Preston BSc (Hons)


Chartered Physiotherapist

Prestons Health





Mind the Gap: The Misleading Language of Pain

Mind the Gap: The Misleading Language of Pain

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Have you ever sat in a Doctor’s waiting room and noticed your pulse quicken when reading the posters on the walls? I know I certainly have. The images and words that we use to make sense of pain are all too often misleading and unhelpful. Let me explain…

A huge amount of international research has taught us that we all need to rethink pain for two reasons. Firstly, pain is always produced by the brain. Think about it; your big toe cannot tell your brain what to do. This would be similar to the tea lady telling the boss of a large company when and how to react (although this might sometimes be preferable!).

Secondly, the pain you experience is based on your brain’s response to a threat. Just like your heart keeps beating without you having to do any thinking, your brain is constantly scrutinising the world around you and asking, “How dangerous is this situation?”


This is why a sprained ankle would hurt less when there’s a double decker bus heading straight for you! It might also explain why seeing the following poster, with all it’s threatening signs of damage and disease on the waiting room wall might grab your attention.

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From our brain’s perspective, threat information trumps all other information!   

It has been said that, “Pain is an ideal habitat for worry to flourish”. Unfortunately, without thinking and/or understanding, many healthcare professionals unwittingly increase the brain’s response to threat through the words and images that they use to explain pain.

Here are a few examples. In a study last year, Ben Darlow and his colleagues down in New Zealand found some significant gaps in how clinicians and patients communicate (See Figure 1). It’s clear to see how the worrying words that we use have an enduring impact on a person’s beliefs about the cause of their pain.


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 Figure 1

So, next time you are sat in that waiting room, keep in mind that, whilst those words and images on the walls are designed to inform you, they might also be worrying and misleading you.



Here at Know Pain we are currently working on a poster that is not only less frightening and more informative, but is also based on up-to-date evidence from international research. Watch this space!



—Darlow, B, Dowell, A, Baxter, G, Mathieson, F, Perry, M, Dean, S. (2013). The enduring impact of what clinicians say to people with low back pain. The Annals of Family Medicine. 11 (6) 527-34.

A Practical Guide to Persistent Pain Therapy

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