•“Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body”
•“Pain is the output. Nociception is one of the inputs. All of the inputs are evaluated when we’re talking about pain, I think, according to this question: How dangerous is this? Based on everything I know, which is all of the information available to me right now, how dangerous is this really?”
•“The amount of pain you experience does not necessarily relate to the amount of tissue damage you have sustained”
•“There’s no such thing as a pain stimulus. Nothing has the property of pain. It’s an emergent property of the human.
•“The relationship between pain and the state of the tissues becomes weaker as pain persists”
•“Thinking that we have a slipped disc has the potential to increase back pain. But what if this piece of knowledge we have stored is inaccurate, just like our notion of a slipped disc? A disc is so firmly attached to its vertebrae that it can never, ever slip. Despite this, we have the language, and the pictures to go with it, and both strongly suggest it can. When the brain is using this inaccurate information to evaluate how much danger one’s back is in, we can predict with confidence that, if all other things were equal, thinking you have a slipped disc and picturing one of those horrible clinical models of a slipped disc will increase your back pain.”
•“The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain and knee osteoarthritis). Yet we continue to avoid the truth that tissue damage, nociception and pain are distinct. I would go so far as to suggest that even the use of these erroneous terms – pain receptors, pain fibers and pain pathways – leaves the patient with chronic pain feeling illegitimate and betrayed, and leaves the rehabilitation team lacking credibility when they look beyond the tissues for a way to change pain.”
•There are probably clinicians who hang on to the idea of pain equalling tissue damage. I suspect they either don’t see complex or chronic pain patients, or, when they do, they presume that those patients are somehow faulty or psychologically fragile, or, tragically, are lying.”
•“Inflammation is a primitive form of defence that is essential to the tissue repair process. Think of the swelling, redness and pain after injury as part of your own internal repair system and be grateful for it”
•“Anything that changes your brain’s evaluation of danger will change pain”

•“Change the way we think about chronic pain – Pain in the brain, immune system, endocrine system, feels the same as tissue pain”
•“The longer you have pain, the better your spinal cord gets at producing danger messages to brain, even if there is no danger in the tissue”
•“For many people in persistent pain, this is a critical issue to understand and well worth repeating. In this sensitised state, the brain is being fed information that no longer reflects the true health and abilities of the tissues at the end of the neurones. Put another way, the brain is being told that there is more danger at the tissues than there actually is. The gain of the system is increased. Brain responses such as movements, thoughts, autonomic and endocrine responses are now based on faulty information about the health of the tissues at the end of the neurone”
•“Stress can contribute to nerve sensitivity or pain system sensitivity. Stress lives in the brain, and therefore the experience of people with chronic pain often is that their pain increases as they become more stressed”
•Modulators broadly fit into one of three categories: prioritization, meaning and transmission/processing. Prioritization depends on the survival value of a nociceptive stimulus. Observational data abound; for example, the extensive work with military and civilian injuries – the soldier feels little pain until he is safe behind lines.
•“When you massage skin, you are moving tissues and also sending useful impulses to the brain. So, movement and touch are useful ways to refresh your ‘virtual’ and actual body”
•“What is pain? Is it simply a symptom of tissue damage or is it something more complex? One way to approach this second question is to determine whether it’s possible to have one without the other – tissue damage without pain or pain without tissue damage. And you can answer that one yourself – ever noticed a bruise that you have absolutely no recollection of getting?
•“Pain is usually triggered by messages that are sent from the tissues of the body when those tissues are presented with something potentially dangerous."
•The exact amount or type of pain depends on many things. One way to understand this is to consider that once a danger message arrives at the brain, it has to answer a very important question: “How dangerous is this really?” In order to respond, the brain draws on every piece of credible information previous exposure, cultural influences, knowledge, other sensory cues, the list is endless”