Dr. Michael Shacklock - Clinical Application of the Pain Paradigm: Challenging the Challenge

Synopsis: Pain has become a real paradigm in the diagnosis and treatment of various musculoskeletal problems, the main reasons being that such problems often cause pain and various treatments for the actual musculoskeletal disorder (aka nociception) are not always effective. Since the physical health disciplines started to integrate the pain sciences more than 20 years ago, clinical reasoning and treatments have changed dramatically, not the least of which is application of psychosocial mechanisms. These include cognitive behavioral and patient education strategies, which essentially “Change the way patients think, feel and behave” and are not specifically directed at nociception. These have been wonderful and truly productive changes in our profession. However, my opinion is that we must review some of this and expose areas of weakness and further development. This presentation will evaluate the original Cartesian proposal about nociception and pain and challenge the way we changed our practice when Descarteʼs ideas were confronted. Basically, this presentation will challenge the challenge. In taking on the pain sciences, interesting phrases were invented: “No brain, no pain. All pain is in the brain”. Because of the brain, “A positive response to treatment does not necessarily validate the diagnosis.” “Central sensitization produces false positives in diagnosis so physical testing is no longer as important.” Furthermore, various errors have occurred in the integration of the pain sciences and this presentation is aimed at highlighting some of these and providing solutions for these problems. Clinical reasoning aspects will be discussed and these will include: - relationships (or lack thereof) between biological and psychosocial mechanisms - confusing causality and co-existence - does central sensitization produce false diagnosis? Michael Shacklock, DipPhysio, MAppSc, FACP, received his graduate qualification at the Auckland School of Physiotherapy, New Zealand, in 1980. He worked in public hospitals in the medical, surgical, paediatrics, orthopaedics, intensive care and burns areas around New Zealand before being employed in private practices, treating spinal and sports injuries in Nelson and Auckland. In 1985 he moved to Adelaide, Australia, working at the Royal Adelaide Hospital and private practices around Adelaide. He then completed his Masters degree (ManTher) at the University of South Australia in 1993. He received a Fellow of the Australian College of Physiotherapists for his monograph and international best seller text book, Clinical Neurodynamics, Elsevier, Oxford, 2005. In addition to his neurodynamics book, he has published two other books, Moving in on Pain (Elsevier) and Biomechanics of the Nervous System: Breig Revisited. He also authored, co-authored and mentored numerous research projects and articles, commentaries and clinical papers in international peer reviewed journals and is a reviewer for, and is on the International Advisory Board of, Manual Therapy journal, United Kingdom. His special interests are neurodynamics, pain, and musculoskeletal function. He continues to give invited presentations and workshops at conferences, elite sporting and sports medicine facilities, universities, hospitals and seminar hosts around the world. Michael is an active clinician, has more than 30 years' experience in treating patients and is recognized as an international leader in the diagnosis and treatment of musculoskeletal disorders with a neural aspect