Explain Pain Supercharged is the latest publication from the Neuro Orthopaedic Institute (NOI) based in Australia. The institute's core philosophy is to “create and provide evidence-based multimedia resources and courses for the treatment of pain.”1 Readers may be familiar with the authors' book Explain Pain,2 first published in 2003. For those who are unfamiliar with the concept of Explain Pain as a therapeutic intervention, it refers to a range of educational strategies that aim to help a person reconceptualize his or her pain. Understanding the biology underpinning pain can reduce pain and optimize function.
Explain Pain Supercharged builds on Explain Pain but is geared toward clinicians treating people experiencing pain and anyone teaching people about pain (e.g., chiropractic educators). The book first dives into pain theories, pain biology, and the evidence base for Explain Pain interventions. Sections follow this on education and learning, including key competencies needed by clinicians to effectively develop and deliver Explain Pain curricula. The next sections provide empowering metaphors and stories that can be used with patients. The book finishes by bringing everything together, providing four sample curricula.
The biology sections are preluded with the following foretelling quote from Dr. Mick Thacker: “If we are to accept the immense privilege of helping people understand their pain and how they can recover from it, then we are absolutely obliged to know what it is we are talking about and if that requires some serious work, then so be it.” It is clear that some significant work went into developing these sections; the authors detail key aspects of pain biology through the use of thoughtful illustrations and stories that often personify physiology to make it humorous and memorable (e.g., story of romance and subsequent breakup between NGF and NGF receptor in relation to peripheral sensitization). Clinical pearls are presented along with the basic science, including assessment techniques that can help identify likely biological processes that may be contributing to a person's pain. Chiropractic educators may find these sections particularly useful if they are looking for engaging new ways to relay complex biological processes to students and interns.
A common theme throughout this book is that humans are adaptable, as they have biological interdependence and redundancy. This promotes survival but also makes it difficult to reverse problems such as persistent pain. The book discusses in detail how clinicians may unintentionally facilitate rather than treat persistent pain. This should be of interest to all chiropractic educators, as the book challenges common explanations and metaphors that appear to stem from well-meaning educators and clinical supervisors. For example, certain seemingly benign explanations may rob a patient of his or her self-efficacy and negatively impact long-term outcomes (e.g., your spine is out, I will realign it; your rib is stuck, and I will get it moving again; or your spine is unstable, I will teach you core stability). Some of the props that educators endorse are also challenged, such as disk bulge/herniation models used as patient education tools. As a solution, the book offers more evidence-based and empowering explanations, metaphors, and stories. Practical tips are offered on how and when to challenge patients' misconceptions related to their pain. Further, in the context of learning and complex systems, the book discusses linear versus emergent processes, pain being emergent in nature. Chiropractic educators may find this section helpful, as there are engaging questions that can be used to help identify students with linear tendencies (e.g., those determined to find the “root cause” of pain.)
Explain Pain Supercharged leaves no shortage of topics for chiropractic educators to brood over. For example, considering recent scientific advancements, the authors describe how aspects of the peripheral nervous system and spinal cord function like the brain. This makes one ponder the question of where the “brain,” as an analyzing or predictive system, starts and ends. Explain Pain Supercharged, like Explain Pain, is brain-centric. Examples of this include descriptions that pain is an output of the brain, that pain is in the brain, and that the brain decides whether to protect. However, a biopsychosocial approach is also advocated throughout the book, as is an appreciation of the complex and inseparable interplay of the body's systems. This leaves a sense of incongruence; is pain in the brain or in the person? Although not explicitly detailed in the book, the brain appears to be necessary but not sufficient for pain.3 Rather than taking a brain-centric approach (and commit the mereological fallacy; see Bennett and Hacker4), maybe pain educators should relay the view that pain emerges from an embodied organism that is coupled to others and embedded in a dynamic society.3 While this debate may seem philosophical, it has significant implications for how pain is explained and how patients respond.
A weakness of this book is the absence of an electronic version at the time of this review. Although the aesthetics of the wire binding, softcover, and paper are undeniable, electronic versions are easily searchable, easy to transport, and, of course, durable. This is important, as this is the type of book that people will constantly revisit.
Overall, this book is highly recommended. It can help chiropractic educators avoid confusing nociception with pain and to relay the message that people are complex and adaptable (bioplastic) rather than fragile machines. Further, it may spark some chiropractic educators to start advocating the idea that persistent pain can be treated rather than simply managed.
