The San Diego Pain Summit #sdpain brought together over 120 clinicians from eight countries. Largely made up of physiotherapist’s with a special interest in pain, it was also well represented my massage therapists, Feldenkrais practitioners, exercise practitioners and even an osteopath or two. The first event of its kind in the world, it was wonderfully put together, blending science and clinical concepts.
With my pain training coming out of Sydney University medical school, my usual ‘pain gang’ are largely medically orientated bunch, and I frequently feel that I’m having to defend my position as a manual therapist working with a chronic pain population, particularly because osteopaths are often seen as very manual technique orientated. At #sdpain it was affirming to be surrounded by people who were working in the field of chronic pain as manual therapists, confidently applying approaches such as pain education, graded movement approaches and lo and behold, manual therapy, with good clinical outcomes. I felt very at home!
Lorimer Moseley kicked off proceedings on day one with his witty, funny, engaging and incredibly relevant science and clinical information. The idolisation of the man by the group at large was evident by their engagement, the lines of people afterwards to ‘pick his brains’ and the subsequent frequent references to him and his work by virtually all of the speakers that followed. It sometimes felt like a weekend of worship at the altar of Explain Pain.
And rightly so. Moseley and his equally charming co-author, David Butler, literally ‘wrote the book’ and in doing so, started a revolution that has had a massive, world wide influence on our understanding and treatment of chronic pain, particularly in the world of manual therapy. They have lead the charge with innovative research and accessible courses showing how to apply the research clinically.
For practitioners engaging with their material, opening this Pandoras box can be both exciting and terrifying, and for many, the truth that lies in the science can make it prohibitively scary to engage with (as discussed here earlier and here by Jason Silvernail). Explain Pain helps make the transition from the dark side of a biomechanical model to the more widely excepted biopsychosocial model as pain free(??) as possible.
Jason Silvernail followed Lorimer with a beautiful, big picture overview of how getting practitioners both medical and manual, as well as society as a whole, to shift their understanding of pain, is it tough but worthwhile pursuit.
Cory Blickenstaff demonstrated how teaching patients to move within pain free ranges can help to reassure their sensitised nervous systems that movement doesn’t need to be a frightening experience.
On the final day, Eric Kruger, a US physical therapist doing a PhD in psychology at the University of New Mexico, presented ‘Pain in the face of uncertainty’. Listening to him speak, I had an urge to start high-fiving people around me, not unlike the first time I listened to Peter O’Sullivan on this pod cast whilst I was doing the grocery shopping at Coles one Sunday! He focussed around why our patient’s uncertainty about their predicament largely drives their feelings of helplessness and frustration, and how reassurance, rapport and a listening ear are more valuable than we can often imagine. He emphasised that allowing patients to express their pain is important and validating. He also strongly advocated setting expectations of flare-ups as being a normal part of the rehab process, which helps the patient to stick with the treatment approach when that inevitable first flareup occurs, rather than walking away and seeing their treatment experience as yet another failed treatment.
All of the other speakers were fantastic, and the similar themes, language and approaches that were consistently coming across in their respective modalities were reassuring. It continually demonstrated a baseline understanding that all of the speakers were operating from – that of a biopsychosocial approach played out in daily practice with every patient who walks in the door.
From a social perspective, the conference for me has been a hit! I have made many wonderful connections and have enjoyed my time in San Diego. I hope to be able to return next year and can’t recommend it highly enough.