The first game-changing concept is that pain is not a signal that originates from bodily tissues (Wall & McMahon 1986). Scientific 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). Key concepts that have shifted our understanding of pain 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. 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 focus on the mechanisms underlying pain has required knowledge from diverse fields – including neurology, immunology, endocrinology, epigenetics, psychology and physiology – among others. Thus emerged the pain sciences – multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. Therefore, the assumption that pain reflects tissue state had to be reconsidered (Wall & McMahon 1986). 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. 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. Pain is the most common reason for people to present for healthcare.
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