Pain - subjective experience (FS-13)

Focused symposium (FS)
Tuesday 4 July 2017, 13:45-15:15
Ballroom East

Reis F1, Madden V2, Wideman T3
1Federal Institute of Rio de Janeiro, Physical Therapy, Rio de Janeiro, Brazil, 2University of Cape Town, Cape Town, South Africa, 3McGill University, Montreal, Canada

Learning objectives

  1. To present the latest developments on neuroscience focusing on links between emotional processes and persistent pain
  2. To understand the current state of the evidence about pain as a classically conditioned response, and the implications for clinical reasoning and research
  3. To present how clinicians’ insight into patients’ experiences can be enhanced by a novel approach to clinical pain assessment


Neuroscience aspects of Emotional Control of Pain and its Disruption in People with Chronic Pain Conditions: Neuroimaging studies have allowed researchers to examine the cortical and subcortical neural basis of pain-emotion interaction (Bushnell, Čeko and Low, 2013; Schweinhardt and Bushnell, 2010; Loggia, Mogil and Bushnell, 2008; Ossipov, Dussor and Porreca, 2010; Petrovic, et al., 2000). A growing number of studies are providing evidence that pain-related fear is first and foremost an emotional state considered a key factor in maintaining chronicity (Swinkels-Meewisse et al., 2006). It is proposed that individuals who have catastrophic pain beliefs and misinterpret their pain as being highly threatening are more prone to become afraid of movements. It has been suggested that pain-related fear can be acquired via associative learning mechanism, such as classical (Pavlovian) conditioning (Gross and Canteras, 2012). Can pain be a classically conditioned response?: The persistence of pain after tissue healing is sometimes attributed to an acquired ability of non-harmful stimuli to evoke pain, even in the absence of harmful stimuli. This classical conditioning model for pain enjoys substantial endorsement from the clinical community (Madden and Moseley, 2015) and has been cited in research papers (Nijs et al., 2015; Zusman, 2008) but is poorly supported by scientific evidence (Madden et al., 2015). These data will be presented and discussed with a view to prompting discussion and debate about their consequences for clinical reasoning and research agendas. Keeping the "I" in pain: Novel approaches for integrating the subjective pain experience into theory, research and clinical practice: Pain is defined as a subjective experience, yet research and practice commonly emphasize its objective measurement. Qualitative methodologies are specifically designed to address the subjective experience, but are underutilized in the study and management of pain. While intensity, frequency and certain aspects of quality can be readily quantified, the personal meaning of metaphors, stories and analogies are often lost in this process. This presentation will highlight the benefits of using qualitative methodologies to advance the study and management of pain and to present a novel framework for integrating qualitative and quantitative in the context of pain.

Implications / Conclusions

By focussing on the most recent and important studies, this symposium will give attendants an account of current concepts of emotion and emotional regulation in chronic pain and an important biopsychosocial view. These concepts should influence clinicians clinical reasoning and researches.


  1. Pain
  2. Emotions
  3. Behavior and Behavior Mechanisms

Funding acknowledgements

Felipe Reis receives fundings from “Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ” and from "National Counsel of Technological and Scientific Development – CNPQ"

Relevance to physical therapy globally

Pain is the most common healthcare complaint of patients upon presenting to a primary practitioner. As such, people with pain comprise the bulk of a physiotherapist’s patient load. Pain is both a sensory and an emotional experience, and is therefore inseparable from emotional influences. However, the relationship between pain and emotion is complex and multifaceted. Clarification of this relationship is relevant for all physiotherapists who treat people with pain.

Target audience

This focused symposium is relevant for all physiotherapists who treat people with pain.


Programme subject to change