EP 8 - Nociplastic pain with Morton Hoegh

Join Morton & Ben as they chat about the complex and confusing world of nocicplastic pain Nociplastic pain is......  Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. Morton & Ben discuss..... Whats the difference between a pain descriptor and a pain mechanism? Why does the term nociplastic pain exist? What was the need for it?What mechanisms might underpin nociplastic pain? What treatments might help nocicplastic pain? Should it be a focus of treatmentAfter qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). From 2010-12 he joined the multidisciplinary Pain: Science & Society MSc-program at King's College London (UK). Between 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University, where he is now associate professor. Recent paper on Nociplastic pain - https://www.jospt.org/doi/10.2519/jospt.2025.13335  

Join Ben as he dives into the world of neuroplastic pain!  "Neuroplastic pain is a type of chronic pain that occurs when the brain misinterprets safe signals from the body as dangerous. It's not imaginary, but it can be treated psychologically" Ben asks....... Can we really say that pain is from the brain simply because of the absence of structural issues? Is FMRI more reliable at diagnosing the pain source than MRI? Can neuroplastic pain rule out nociplastic pain & associated nociception?

Join Ben as he dives into the tricky subject of if exercise should be fun! Fun is good! But maybe we need more than fun to really inspire us. Sometimes we have to do things that aren't fun but they are easier or convenient  Instead we may need to focus on the benefits and value that we gain even if thew process is not fun or enjoyable!

In this episode Ben dives into the world of uncertainty in healthcare Ben discusses 3 main areas. Uncertainty for clinicians with tests and treatments, uncertainty for patients and then communicating uncertainty. One of the biggest areas is the emotions associated with uncertainty, often anxiety of not knowing what is going to happen Here are two papers discussed  The ubiquity of uncertainty in low back pain care https://pubmed.ncbi.nlm.nih.gov/36215924/ Tolerating Uncertainty - The Next Medical Revolution?https://pubmed.ncbi.nlm.nih.gov/27806221/  

Join Ben for the latest episode and he explains why a movement snack is quite different to an exercise snack!  One of the key differentials is INTENSITY! Movement snacks are really about pain and not about fitness! Give it a listen.....

Join Ben for the 3rd episode of the info snacks Cor-Kinetic podcast This episode looks at the initial appointment fundamentals that should be covered. Ben explores this from both a person focused and traditional clinical perspective.  Check out the upcoming Cor-Kinetic mentorship starting on the 23rd September https://www.cor-kinetic.co.uk/online-mentorship Research  Kamper SJ, Haanstra TM, Simmons K, Kay M, Ingram TGJ, Byrne J, Roddick JM, Setliff A, Hall AM. What Do Patients with Chronic Spinal Pain Expect from Their Physiotherapist? Physiother Can. 2018;70(1):36-41.  https://pubmed.ncbi.nlm.nih.gov/29434416/ Subialka JA, Smith K, Signorino JA, Young JL, Rhon DI, Rentmeester C. What do patients referred to physical therapy for a musculoskeletal condition expect? A qualitative assessment. Musculoskelet Sci Pract. 2022 https://pubmed.ncbi.nlm.nih.gov/35334352/ Lim YZ, Chou L, Au RT, Seneviwickrama KMD, Cicuttini FM, Briggs AM, Sullivan K, Urquhart DM, Wluka AE. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother. 2019 https://pubmed.ncbi.nlm.nih.gov/31227280/ Smuck M, Barrette K, Martinez-Ith A, Sultana G, Zheng P. What does the patient with back pain want? A comparison of patient preferences and physician assumptions. Spine J. 2022 https://pubmed.ncbi.nlm.nih.gov/34551322/ French SD, Nielsen M, Hall L, Nicolson PJA, van Tulder M, Bennell KL, Hinman RS, Maher CG, Jull G, Hodges PW. Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions. Pain. 2019 https://pubmed.ncbi.nlm.nih.gov/31356451/    

Join Ben as he discusses the question of "Why is my patient not getting better" Even though we have average prognosis and effects of treatments at a population level, we often don't know about the patient in front of us Ben looks at: RCTs - What are they good for? Prognosis & response to treatment and also the concept of prognostic factors that will affect outcomes for patients

Join Ben as a he revamps the Cor-Kinetic podcast with the all new info snacks format These will be 20-30 minute snacks on clinically relevant topics. In this episode Ben talks about how he would read a paper and what to look for in the relevant sections through the lens of being a clinician  There are no real hard and fast rules about what constitutes good research as this can be subjective and relate to the question being asked. But these are some foundational things that Ben would look for! This is not designed to be the bible on research as obviously it is only 20 minutes long : )

In this episode Ben is joined by John Kiely Ben & john get into the weeds around complex systems, stress and whats important with regards to coaching!

Join Lianne and Ben as they discuss exercise and some of the mechanisms involved along with some other questions including: Is exercise more than just physical? Are treatment targets mainly physical? What should be measured in exercise research? Where to go next? Check out Lianne's paper here Exercise Interventions for Persistent Non-Specific Low Back Pain - Does Matching Outcomes to Treatment Targets Make a Difference? https://pubmed.ncbi.nlm.nih.gov/32580060/