Pain Theory Continued

November 21, 2020

In my last blog I discussed the Progression of Pain Theory looking at one of the first theory’s from the ancient Athenian philosopher  Plato  to more recent theories by David Wall and Ronald Melzack which views pain through a mind-body perspective. At present pain is defined as “an unpleasant sensory and emotional experience associated with the actual and potential tissue damage or described in terms of such damage”. This definition fits well when considering the biopsychosocial pain model which recognises an individual’s biology or pathology, cognitive aspects and social aspects of an individual’s life.

The biopsychosocial model was first introduced in medicine by George L. Engel and was mostly related to all chronic illness. Engel’s model suggested that as a medical illness became more chronic in nature, then psychosocial “layers” e.g., distress, illness behaviour, and the sick role emerged to complicate assessment and treatment. Later, J.D. Loeser, applied this model to pain. Taking into account these perspectives, there were four dimensions related to the idea of pain: nociception, pain, suffering, and pain behaviour.

  • Nociception refers to the physiological components associated with sensory input—such as nerve receptors and fibre
  • Pain is described as a subjective perception resulting from sensory input.
  • Suffering can be seen as a negative affective response to nociception or pain.
  • Pain behaviour is described in one’s actions while suffering from pain e.g. fear of recurrence of injury often leads to inactivity which, in turn, can delay the progression of recovery.

The current Biopsychosocial model is described as a pain experience with three dimensions,

Biological factors, psychological factors and social factors.

  • Biological factors include genetics, physiology, neurochemistry, tissue health
  • Psychological factors include perceived control, catastrophic thinking, depression, anxiety, hypervigilance
  • Social factors include socioeconomic status, social support, social learning, scepticism.

As time has gone on and our understanding of pain theory has developed, how someone experience pain unique to the individual and their circumstances. When assessing chronic pain conditions as exercise physiologist we have to consider all of these components in order to effectively treat an individual and get the best outcome possible.

Stayed tuned for my next pain theory instalment where I will look at the assessment process and what Exercise physiologists need to consider when assessing chronic pain.

Claire Hills ( B.EXSpSc,Grad.Dip.(Clin.Ex.Phys))
Senior Accredited Exercise Physiologist (AEP) (ESSAM)

References

Adams, L., & Turk, D. (2018). Central sensitization and the biopsychosocial approach to understanding pain.  Journal Of Applied Biobehavioral Research ,  23 (2), e12125. doi: 10.1111/jabr.12125

The Biopsychosocial Approach. (2020). Retrieved 24 September 2020, from https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach

 

Prehabilitation in Workers Compensation: Enhancing Function, Reducing Downtime

September 1, 2025
As the global population ages and the prevalence of musculoskeletal conditions continues to rise, the demand for orthopaedic surgeries has surged dramatically. With this increase comes a growing emphasis on not just the surgical intervention itself, but also on the preoperative phase as a critical window of opportunity to enhance patient outcomes. One of the most promising strategies emerging in this space is prehabilitation—a proactive, personalized approach to preparing patients physically and mentally for surgery. Prehabilitation can be broadly defined as a personalized exercise program designed to improve physical function and optimize recovery outcomes for any upcoming surgical intervention. In the context of workers compensation, prehabilitation offers additional value. By maintaining or even improving a patient’s physical function prior to surgery, individuals are often able to remain engaged in modified or light-duty work roles. This not only supports their psychological well-being and financial stability but also contributes to faster and more sustainable return-to-work outcomes post-surgery. A recent meta-analysis by Punnoose et al. 2023, found that a targeted prehabilitation program increased muscle strength, improved joint function and led to a higher health-related quality of life (HRQOL) scores. These findings were consistent with patients undergoing Total Knee Replacements (TKR), Total Hip Replacements (THR) and lumbar spine surgery. Some clinical applications are listed below: Targeted approach of 4-6 weeks, with 2 sessions per week. This aligns with physiological evidence suggesting that a minimum of 4–6 weeks of strength training is needed for neuromuscular adaptations. Mixture of supervised and unsupervised intervention Multimodal programs (e.g. combining exercise with education or psychological support) may enhance outcomes By improving outcomes and reducing recovery timeframes, prehabilitation stands out as a cost-effective, proactive approach to treatment.  James Chandler Workers Compensation Specialist ‑ Team Leader South (AEP, ESSAM) Exercise Rehabilitation Services – WA

How to Fit Exercise into Your Lifestyle

September 1, 2025
As Exercise Physiologists, a large part of our role is to empower an injured worker to integrate exercise into their lifestyle – something that is easier said than done for everyone! A common misconception about exercise, is that, for an effective workout, it must be a gruelling 1-hour session in a gym or a 10km stomach churning run, however this is not the case! Here are some alternatives and strategies to gradually make positive changes to your life: One easy way is to add movement to tasks you already do. Walking or biking instead of driving short distances, taking the stairs instead of the elevator, holding your newborn as you perform a few quick (and safe!) squats or completing short exercises during TV commercials are simple ways to stay active without setting aside extra time. Another is to schedule ‘mini’ workouts like any other appointment. Set aside just 20 to 30 minutes a few times a week—whether in the morning, during lunch, or in the evening. Utilising exercise equipment that we give you during our initial assessment and picking a handful of exercises that you may particularly enjoy, is a great shorter alternative. Treating these moments as important and ‘you’ time can help build a consistent habit. Exercising with others can make it more fun. Invite a friend for a walk, join a fitness class, or play a sport with family. When you combine social time with physical activity, it feels less like a task and more like enjoyment. The same goes for a sport or hobby that you may like, whether it’s swimming, yoga, hiking or dancing! Experimenting with the introduction of one of these strategies can be an easier first step to making a positive lifestyle change. With a little planning and creativity, exercise can become a natural part of your lifestyle, helping you stay healthy and energized without adding stress to your day. Alexander Gerry Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services – WA

The Beauty of a program: Couch to 5k

June 19, 2025
If you have doom scrolled through Instagram/Facebook or YouTube recently you may have been bombarded with advertisements for a slew of different exercise programs. These all usually have something to do with what you value and target you with a preamble on how to get it, how did I shrink my waist size, how do I build muscle or how I rehabbed my knee pain. As an exercise physiologist it's my job to write these programs! Now although I don’t always enjoy interruptions to my news feed of cat videos and rugby highlights, I do actually think a lot of these programmes have merit! I love anything with a bit of structure that can help you progress yourself towards what you care about so today I wanted to write about one of my favourite programs of all time and that is the “Couch to 5km Running Programme” Why Running? I love running as an exercise choice, it gets you outdoors, it has increasing social connections via run clubs/park runs and is completely free! However, it’s hard to jump in to, I see a lot of people getting tripped up by some of the barriers that come with it. A lot of the people I see starting running don’t know about the many choices that come with exercise and in the exercise physiology business we call this the FITT principle! - Frequency – How often are you doing your running? - Intensity – How fast or slow are you running? - Time – How long should I run for? - Type – Why run over biking or rowing? A dedicated programme takes care of these for you, and I think the Couch to 5k programme does a fantastic job of introducing you to all these different ideas. Language! The first thing I love about the “Couch to 5k” is its language. The use of simple and direct language leaves a bit of room for interpretation. You can see clear above on your first Tuesday run you will run for 1 minute and walk for 1 minute. In this small interval that speed is utterly and entirely up to you. Go as slow as you like or as fast as you like however I want you to run for the entire minute! Keeping things simple is so important and this guidance is exactly where I would want you to start off as a beginner runner, have some fun and run! Progression! From week to week the running times can be seen to get bigger and bigger! Slowly but surely these intervals only increase by 1 or 2 minutes at a time. Between each session you will be able to notice small increases, but your fitness catches up with that! The whole point of a programme is that it starts small and works up, no single day itself should feel like an insurmountable workout but by the end you’re able to run a whole 5k! Rest! This program builds in rest days and rest periods so well. Each day is spaced out giving some time for you two recovers but not so much so you can get some fitness in! Within the workouts as well these intervals leave you working for the right amount of time each workout. Goals Too often when working out our goals are too big and lofty. Being able to make big changes start with small actions and goals. You can’t change yourself image in one day so I like the time frame of 6 weeks (in some programmes 6-12 weeks) because by the end we have a set definable goal of what we want to achieve, and we can really feel thar progression of fitness! Mathew Walker Exercise Physiologist Exercise Rehabilitation Services ‑ WA
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