Interestingly, Explain Pain does not have a single valid study to show that their strategies reduce people’s pain. However they are often able to get people to shut up about their pain via gaslighting. Likewise specific exercise and graded exercise programs have never been shown to be superior to “merely remaining active” through a hobby. The commercialisation of unnecessary and sometimes harmful programs is entirely on the basis of studies which do not compare apples with apples, and often do not even pretend to be trying to reduce pain, just get people to accept it and basically stop whinging, which they call “catastrophising”. Reduction of catastrophisation is not associated with a reduction in pain. There are so far just two significant variables for pain reduction in the case of chronic non cancer pain which doesn’t have adequate explanatory pathology: empathetic support (who knew) and being appropriately active given individual constraints (eg ME/CFF/ESS/long Covid, all have vigorous activity contraindicated).
OMG YES! On my website I have gone through every study referneced in Explain Pain and NOT ONE shows it to be effective. I have listened to Lorimer Moseley LIE through his teeth on podcast after podcast, as he gloats about Explain Pain (which made him rich, famous, and scored him and OAM) and ALL of it is based on lies, and low quality science! I cannot explain enough how revered this man is in Australia, in physiotherapy. And its all been a con! I have been talking about this for years, but I'm just a patient! When I point out the lack of evidence, people get defensive...obviiously they can't admit they've been gaslighting their patients with useless therapies and trying to brainwash them into 'understanding how pain works, deep down in your belly'...as if THAT is going to help!
IMO Lorimer Moseley has done more HARM to people living with chronic pain than any other individual! His ideas on catastrophising alone caused therapists to insist that my pain was due to fear and anxiety, despite the fact that I'm a pretty chill person. Pain sux, but I don't catastrophise, I'm not anxious about it, and I don't fear movement, or the pain that results. Moseley talks of being kind and being empathetic, but he cared for nothing but making a name for himself, and making money. Off the backs of people's suffering. And people are being denied opioids, which are safe and effective for them, cos pain is in the brain, and you just need to change your brain to change your brain...no medications required!
The bigger problem, however, is what I am already writing about for next week. HOW did a whole industry, the entire physiotherapy population, get completely bamboozled by Explain Pain? How did the majority of htem buy this book and believe in its bullshit? Just because Lorimer had a charismatic stage show? He's degraded to the same four Dad jokes these days, but he's still selling his wares on podcasts. How did NO ONE check the science, read teh citations and reslised that it does not work? that there is not one piece of evidence to show it works? Ooh, its got these cool pictures, and its a fun idea - so simple! Lets just believe it and torture patients with it! Lorimer and Explain Pain taught me that science is very, very flawed. And pain science is full of charletans. Meanwhile, patients suffer.
The PREVENT trial made me dance and sing. (I think that's what it was called? Adrian Traeger, effect of Explain Pain on acute back pain). Shows conclusively that EP does not work, doesn't do anything except annoy patients. But Lorimer still twisted it around. Desperately trying to remain relevant. But people still treat him like a god - he's a liar and a conman.
Ok, sorry, enough. This man's work has been my nemisis for years. I am rather passionate and so grateul when I find others who see right through his rubbish.
Empathetic support. Ironic, THATs the so very simple thing that health care professionals don't want to know about. Cos its very hard to be empathetic all day long, every day. I get that. But if you can't provide that (and this applies to all areas of health care) then take a break or change careers. Its that essential. and there are some MONSTERS in health care. But that's another story.
As for being active, totally agree too. I have always exercised, and advocated for it. I am discovering that CIDP makes that very difficult, however. Very fine balance between 'enough' and 'too much' go to couch jail! But with the support of an empathetic physio, I am working on it!
Thanks for commenting. Sorry for the rant. Its so exciting to find someone who is not blinded by Lorimer-love.
I think that the Explain Pain training program can be helpful to health professionals but it’s not in any way a treatment and shouldn’t be inflicted on patients because used as therapy (especially used blindly) it can do enormous harm. Surprisingly, physios (at least in Australia) believe all kinds of BS. Many still do acupuncture or dry needling, still use kinesiotape, still use percussion guns, still use laser, still prescribe specific exercise for chronic pain, still think posture can cause pain, still think asymmetry causes pain, etc etc. All of these and more are ubiquitous in the practice of physiotherapy in Australia. I can’t comment on other countries but imagine it’s similar.
I'm sure it is too. I think this is because they don't have any effective treatments for chronic pain. But, again, Moseley and Butler, told them that physio can CURE chronic pain. And the industry believed them. But all this did was set everybody up for failure. Physios became frustrated when patients didn't respond they way they were told they would, then they became disillusioned, but no one questioned the validity of the therapy. In most cases, what happened was victim blaming. Because Lorimer built in the same fail safe that all pseudoscienctific treatments do - if it doesnt work, then you just don't understand pain properly. So its the patients lack of understanding, or willingness to learn that is the problem. Not the therapy. And yes, therein lies a LOT Of harm.
I wasn't aware of how little physiotherapy helps, according to the science. I follow a lot of physios on twitter and have learned a lot from them. I can imagine how difficult that is to accept. The thing is, 20 years ago, when i was first diagnosed iwth RA, I wasn't refered to physio. But over the last few years, 5-10, everyone with chronic pain gets sent to physio. Probably because doctors aren't allowed to prescribe medications anymore. But its an expensive trail of disaster for most patients. And if we refuse physio, we are deemed 'non-complaint' or even drug seekers.
Neen I’m in favour of physios being an important part of the pain team because the physio should be an important ally for chronic pain patients in that they’re well qualified to help assess function and to support clients to engage in enjoyable and sustainable activity (even if it’s just an active hobby) that’s appropriate specifically for them. Unfortunately they get sidetracked by “programs” and “cures” that have no evidence over and above empathetic support and staying as active as is possible/safe. And of course they believe the BS they’ve been fed and when there isn’t improvement assume the client is resistant. Don’t get me started on the meds issue :-(
Yep...my current physio is great. He's a coach, and he keeps me on track. I think physios are excellent for giving people confidence that they're 'doing it right', but as you say, the truth is any activity that they enjoy and do regularly will be beneficial.
What I'm wondering is who vets these courses? Whats to stop anyone with money and marketing ability setting up seminars, webinars, and marketing whatever therapy they wish? Is there any oversight? Does anyone check this stuff? IMO all Moseley and Butler did was make old theories entertaining, unfortunatley they fudged the science along the way and vastly overstated the 'evidence'. Genius marketer, crap scientist. Bald faced liar, even. But there are no consequences for that. Moseley is still peddling his little bag of bull. Who overseas the science? I was googling, and in Australia, in relation to research, the individual organisations/Unis oversee their scientists. There is no over-arching body. Which seems problematic to me.
Neen these guys often run “studies” often in association with or funded by universities, followed by peer reviewed and published papers. I’m sure you’ve seen many of these and have a good understanding of how rarely they honestly compare the tested intervention and how universally they hype unimpressive outcomes. This doesn’t stop them from claiming evidence basis and going ahead with commercialisation of some ridiculous, unnecessary, or even harmful, purple hat protocol.
Interestingly, Explain Pain does not have a single valid study to show that their strategies reduce people’s pain. However they are often able to get people to shut up about their pain via gaslighting. Likewise specific exercise and graded exercise programs have never been shown to be superior to “merely remaining active” through a hobby. The commercialisation of unnecessary and sometimes harmful programs is entirely on the basis of studies which do not compare apples with apples, and often do not even pretend to be trying to reduce pain, just get people to accept it and basically stop whinging, which they call “catastrophising”. Reduction of catastrophisation is not associated with a reduction in pain. There are so far just two significant variables for pain reduction in the case of chronic non cancer pain which doesn’t have adequate explanatory pathology: empathetic support (who knew) and being appropriately active given individual constraints (eg ME/CFF/ESS/long Covid, all have vigorous activity contraindicated).
OMG YES! On my website I have gone through every study referneced in Explain Pain and NOT ONE shows it to be effective. I have listened to Lorimer Moseley LIE through his teeth on podcast after podcast, as he gloats about Explain Pain (which made him rich, famous, and scored him and OAM) and ALL of it is based on lies, and low quality science! I cannot explain enough how revered this man is in Australia, in physiotherapy. And its all been a con! I have been talking about this for years, but I'm just a patient! When I point out the lack of evidence, people get defensive...obviiously they can't admit they've been gaslighting their patients with useless therapies and trying to brainwash them into 'understanding how pain works, deep down in your belly'...as if THAT is going to help!
IMO Lorimer Moseley has done more HARM to people living with chronic pain than any other individual! His ideas on catastrophising alone caused therapists to insist that my pain was due to fear and anxiety, despite the fact that I'm a pretty chill person. Pain sux, but I don't catastrophise, I'm not anxious about it, and I don't fear movement, or the pain that results. Moseley talks of being kind and being empathetic, but he cared for nothing but making a name for himself, and making money. Off the backs of people's suffering. And people are being denied opioids, which are safe and effective for them, cos pain is in the brain, and you just need to change your brain to change your brain...no medications required!
The bigger problem, however, is what I am already writing about for next week. HOW did a whole industry, the entire physiotherapy population, get completely bamboozled by Explain Pain? How did the majority of htem buy this book and believe in its bullshit? Just because Lorimer had a charismatic stage show? He's degraded to the same four Dad jokes these days, but he's still selling his wares on podcasts. How did NO ONE check the science, read teh citations and reslised that it does not work? that there is not one piece of evidence to show it works? Ooh, its got these cool pictures, and its a fun idea - so simple! Lets just believe it and torture patients with it! Lorimer and Explain Pain taught me that science is very, very flawed. And pain science is full of charletans. Meanwhile, patients suffer.
The PREVENT trial made me dance and sing. (I think that's what it was called? Adrian Traeger, effect of Explain Pain on acute back pain). Shows conclusively that EP does not work, doesn't do anything except annoy patients. But Lorimer still twisted it around. Desperately trying to remain relevant. But people still treat him like a god - he's a liar and a conman.
Ok, sorry, enough. This man's work has been my nemisis for years. I am rather passionate and so grateul when I find others who see right through his rubbish.
Empathetic support. Ironic, THATs the so very simple thing that health care professionals don't want to know about. Cos its very hard to be empathetic all day long, every day. I get that. But if you can't provide that (and this applies to all areas of health care) then take a break or change careers. Its that essential. and there are some MONSTERS in health care. But that's another story.
As for being active, totally agree too. I have always exercised, and advocated for it. I am discovering that CIDP makes that very difficult, however. Very fine balance between 'enough' and 'too much' go to couch jail! But with the support of an empathetic physio, I am working on it!
Thanks for commenting. Sorry for the rant. Its so exciting to find someone who is not blinded by Lorimer-love.
I think that the Explain Pain training program can be helpful to health professionals but it’s not in any way a treatment and shouldn’t be inflicted on patients because used as therapy (especially used blindly) it can do enormous harm. Surprisingly, physios (at least in Australia) believe all kinds of BS. Many still do acupuncture or dry needling, still use kinesiotape, still use percussion guns, still use laser, still prescribe specific exercise for chronic pain, still think posture can cause pain, still think asymmetry causes pain, etc etc. All of these and more are ubiquitous in the practice of physiotherapy in Australia. I can’t comment on other countries but imagine it’s similar.
I'm sure it is too. I think this is because they don't have any effective treatments for chronic pain. But, again, Moseley and Butler, told them that physio can CURE chronic pain. And the industry believed them. But all this did was set everybody up for failure. Physios became frustrated when patients didn't respond they way they were told they would, then they became disillusioned, but no one questioned the validity of the therapy. In most cases, what happened was victim blaming. Because Lorimer built in the same fail safe that all pseudoscienctific treatments do - if it doesnt work, then you just don't understand pain properly. So its the patients lack of understanding, or willingness to learn that is the problem. Not the therapy. And yes, therein lies a LOT Of harm.
I wasn't aware of how little physiotherapy helps, according to the science. I follow a lot of physios on twitter and have learned a lot from them. I can imagine how difficult that is to accept. The thing is, 20 years ago, when i was first diagnosed iwth RA, I wasn't refered to physio. But over the last few years, 5-10, everyone with chronic pain gets sent to physio. Probably because doctors aren't allowed to prescribe medications anymore. But its an expensive trail of disaster for most patients. And if we refuse physio, we are deemed 'non-complaint' or even drug seekers.
Neen I’m in favour of physios being an important part of the pain team because the physio should be an important ally for chronic pain patients in that they’re well qualified to help assess function and to support clients to engage in enjoyable and sustainable activity (even if it’s just an active hobby) that’s appropriate specifically for them. Unfortunately they get sidetracked by “programs” and “cures” that have no evidence over and above empathetic support and staying as active as is possible/safe. And of course they believe the BS they’ve been fed and when there isn’t improvement assume the client is resistant. Don’t get me started on the meds issue :-(
Yep...my current physio is great. He's a coach, and he keeps me on track. I think physios are excellent for giving people confidence that they're 'doing it right', but as you say, the truth is any activity that they enjoy and do regularly will be beneficial.
What I'm wondering is who vets these courses? Whats to stop anyone with money and marketing ability setting up seminars, webinars, and marketing whatever therapy they wish? Is there any oversight? Does anyone check this stuff? IMO all Moseley and Butler did was make old theories entertaining, unfortunatley they fudged the science along the way and vastly overstated the 'evidence'. Genius marketer, crap scientist. Bald faced liar, even. But there are no consequences for that. Moseley is still peddling his little bag of bull. Who overseas the science? I was googling, and in Australia, in relation to research, the individual organisations/Unis oversee their scientists. There is no over-arching body. Which seems problematic to me.
Neen these guys often run “studies” often in association with or funded by universities, followed by peer reviewed and published papers. I’m sure you’ve seen many of these and have a good understanding of how rarely they honestly compare the tested intervention and how universally they hype unimpressive outcomes. This doesn’t stop them from claiming evidence basis and going ahead with commercialisation of some ridiculous, unnecessary, or even harmful, purple hat protocol.