BackgroundPain is the most common reason for people to present for healthcare. The vast majority of patients treated by physiotherapists report pain, yet it is only in the past few decades that the scientific study of pain has yielded substantial progress in its treatment. The shift in focus -from studying tissue damage to studying pain itself -was arguably prompted by the recognition that the pain people report frequently does not match up with the condition of bodily tissue. Therefore, the assumption that pain reflects tissue state had to be reconsidered (Wall & McMahon 1986). Thus emerged the pain sciences -multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. This focus on the mechanisms underlying pain has required knowledge from diverse fields -including neurology, immunology, endocrinology, epigenetics, psychology and physiology -among others. It has catalysed a seismic shift in physiotherapy and changed the underpinnings of clinical reasoning, expanding and deepening clinical practice and student training, empowering patients, and has thereby influenced research practice. This ultimately has raised the profile of the physiotherapy profession by contributing to its shifting from its origins as a profession that was reliant on expert opinion to a profession that now relies on scientific evidence.
Key concepts that have shifted our understanding of painScientific research on pain has largely converged in support of three 'game-changing' concepts that have fundamentally shifted physiotherapists' understanding and treatment of pain (Box 1). The first game-changing concept is that pain is not a signal that originates from bodily tissues (Wall & McMahon 1986). Rather, pain is now thought to be a highly motivating perceptual experience that seems to be generated on the basis of a perceived need to protect bodily tissue from harm (Moseley 2007). The second game-changing concept is that pain is not a dependable indicator Background: Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences -multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain.
Objectives:In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession.Method: A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession.Results: Scientific research on pain has largely converged in support of three 'game-changing' concepts that have shifted the physiotherapy profession's understanding and treatment of pain:(1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous syst...