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A woman in a sparkling pink skirt stands next to a man in a blue shirt eating sandwhiches next to their pram. their heads tilted towards each other and they are smiling, clearly in love. The text reads: Falling in love with Nociception again.

nociception pain reflection Oct 03, 2022

By Laura Rathbone

Do you remember the time you first found out about nociception? I do. I remember being a second year physiotherapy student at the University of Central Lancashire in Preston and listening to a visiting lecturer from Finland telling us a story about transduction and transmission of noxious stimuli and I was hooked! So hooked I ended up in Finland for my 3rd year neuro-rehab and paeds placements - I ended up marrying the first Dutch man I got drunk with but that’s another story….

The next time I fell in love with understanding nociception, and I mean that kind of deep passionate love where you stay up all night swapping stories and hanging off every word, I was in Kings’ College listening to Prof Mick Thacker explain phenotypic switching and take us up the neuroaxis to the spinal cord and the brain (and back down again!).  I’ve benefited from Mick’s teaching and guidance ever since and he has a way of constantly re-energising your passion and love for physiology as it relates to the human capacity to experience and generate meaning.

An old photo of some of my revision in St Thomases hospital, London. I was usually hidden in a back room on breaks, holding a mug of coffee surrounded by books and notes and trying to remember it all...Learning this stuff is a constant commitment and a process of error/updating.

 

Sitting amongst hundreds of colleagues from around the world at the IASP World Congress in Toronto, it's happenend again. Listening to researchers (and especially the researchers I would call friend) demonstrating the absolute beauty and intricacy of the nociceptive system and its complex interactions with the immune system and our conscious perceptions and I find myself once again, in awe of my incredible body. Knowing that beyond the skin covering that I can see, these processes are happening in me, and they are happening in you and all mammals on the planet in some way or another.

 

I’m struck but just how much we know about nociception and the humility of the experts in this area to acknowledge and be inspired by all the stuff we don’t yet know. I think it takes a certain type of person to be a nociception neuroscientist! Patient and dedicated to the mission of understanding the truth and the vision of supporting clinicians and doctors to find better and more effective approaches for people with pain.

 

In recent years, there has been a narrative trend encouraging therapists to be careful about how they apply and integrate their knowledge of nociception in the clinic and I’m for it. The long established idea that nociception is not the same as pain, one being a sensory process within the neuroimmune system, the other being the subjective, unique, personal and private experience, is fair. Nociception is neither necessary or sufficient as Lorimer Mosely has said many times.

 

But, let’s not fall out of love with this biology all together! I’m often struck by just how easily we have let go of this knowledge, as if shimmying out of a too-tight bra at the end of the day (speaking of which.… 😉) relieved not to feel the discomfort of trying to understand and apply complex neuroscience in the clinic.

 

It’s absolutely not possible for me to tell you all about nocicpetion in a blog (I’ll be releasing a Grey Paper on this in 2023 so head to The Subscription to receive these!), but I’m hoping that if you haven’t read much about nociception recently, you might just feel inspired to get back into that research and start the (yes I know it’s hard) process of finding your love again for the deep, complex neuroscience. 

 

Does it give you new clinical skills? Maybe, maybe not. 

 

But does it help you feel more informed and make sense of your own pain experiences and the pain experiences of the people around you? 

 

Yes. And that’s worth it for me.

 

Laura x

 

Laura Rathbone is a Specialised Pain Consulting Therapist bringing together her knowledge of physiology, rehabilitation, psychotherapy and communication in her clinical offering for people experiencing complex and persistent pain.  She spends much of her time supporting clinicians to develop their knowledge and skills to develop their own practice and be able to support more people with complex pain. She is committed to holding a knowledge translation space with her Subscription writing regular in-depth papers, developing courses and inviting subscribers to join the live recordings of her two podcasts: The Speak Easy - a private podcast for subscribers and Philosophers Chatting with Clinicians - a public and free podcast for all people interested in pain.

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