What makes you say so? Perhaps read: pnsnetwork.org/chronic-pn-pain/ and join the conversation there?

I'm not positive I understand your question, but, indeed, if you are dealing with a crisis (running from a hungry lion, dealing with a wailing child, trying to put out a kitchen fire, etc.) you very understandably might not immediately "feel pain" from a physical injury. Later, former crisis over but unusual sensations still coming from the injured body part, your brain would probably (and helpfully) "create pain" to prompt you to check out those sensations. "Pain" is created by a complex system. Some parts of that system are used to alert you to all kinds of danger, not just physical signals but emotional threats too (a big hospital bill, criticism from someone you thought was a friend, breaking up a love relationship). Moseley is most concerned by the challenge of "chronic" pain. Pain that causes us to unnecessarily restrict our life (and enjoyment of it) even when there is no or little immediate risk of physical harm. Neither Moseley nor anyone else I am aware of have taken head-on the challenge of neuropathic pain. Pain where there is no "proof" or "measurement" of signaling from our sensory nerves and certainly no "immediate" danger to our physical health. Yet a significant minority of people with neuropathic damage report lives seriously disrupted by pain or discomfort. Why only some and not all? The default assumption (largely ignoring the role of the brain and its "protectometer") is that there is some physical difference in those reporting serious pain. As far as I can tell, the proof of such difference is simply not there. On the other hand, there is lots of evidence of vast differences in the lifetime experience of patients, all of which can affect the way our brain "handles" sensory signals.

@@peripheralneuropathysuppor8948 thank you for your response and let me try to clarify! Pain's job is to protect us from life threatening or serious injury, which was established in this video. But say, in the hammer example, the hammer is already seriously injuring you. Therefore the brain knows it can't protect from the danger of having the hammer in your neck, because it's already there but there is no other danger to escape there.. In the example of needing to keep running from danger after serious injury it would make sense that your brain isn't going to alert you to pain if you still have danger to escape because it would cripple you. But does this mean, that in the hammer example, your brain is still protecting you from some perceived further danger by not sending you pain signals, and then only when it has time to realize you're not in any further immediate danger you start to feel pain? Or is it protecting you from what that level of pain would do to you? Because then why does he feel the knee pain so acutely and hasn't yet started feeling his neck?

I think your basic point is important: How can Moseley's message ("chronic pain can be treated!") be conveyed in a way that draws the patient in instead of pushing the patient away, feeling further dismissed and adding more psychological damage to what is (in many cases) an already heavy burden? It is a challenge that none of the chronic pain researchers have good answers for yet. Research (MRI's etc.) suggests that ignoring chronic pain is exactly the wrong approach. The longer the human is left swinging in distress the more the brain and spinal cord neuron cells grow additional receptors. This adds additional signals that our sensory processing centers and amygdala must try to cope with. You might want to invest in Moseley's book "Explain Pain." Moseley is the emotional face and sometimes leader of a growing worldwide attempt to deal with chronic pain. The basic question that few doctors address is "what is pain?" It has proved to be a rich and difficult question. Traditional medical teaching reinforces the natural interpretation we learn as a child: pain is something the body creates where the only role of the brain is to tell us "Where". The growing consensus is that the stresses of an entire lifetime (and genetics) sets many up to be unable to accept the reality that there is nothing that can be done to repair damage and then go on to focus on the positive. That aggressive pain relief early, when damage is first detected and treatment started, can bring the patient back into a functioning state before chronic pain starts causing additional changes to the nervous system's pain processing system. Please check out the video of David Clarke's presentation to our meeting in early 2022. And his book "They Can't Find Anything Wrong!" Mike

When considering PN pain it is important to recognize that current medical technology has no way to actually see the signaling from our sensory neurons. It can measure speed of large fiber signals and count density of skin neurons. But the brain is reacting to sensory information (or its absence with numbness). But the brain can over-react to innocent signals or create pain (a sense of impending danger) without any sensory signals. What is going on here? Why do some have such elevated pain/perception of danger? Conventional medicine always assumes a physical damage (which is what needs to be checked first), but almost never looks at the whole patient and his full history. Mr. Moseley has not (as of the last time I checked, more than a year ago), attempted to look at neuropathic pain. I'm still looking for someone to tackle PN pain using the perspective of modern chronic pain researchers. I (a non-scientist) tried my best with pnsnetwork.org/chronic-pn-pain/ Mike

His message is not to push through pain. That causes flare ups that are completely disabling. His message is that you can reduce chronic pain by very gradually exposing the body to movement and nervous stimulus and allowing the brain to relearn an appropriate sensitivity to the stimulus. This should be coupled with cognitive therapies that allow the brain to be convinced that the threat is not as bad as it perceives. I don't know if/how this relates to PN as that involves changes to the integrity of the nerves, but I have been through 3 years of very disabling back pain and come out the other side over the course of 6-9 months. Unfortunately I now have some symptoms of CRPS in my knee and leg and it's a whole other level of complexity and disability when it comes to trying the same therapies.

If you've come this far with pain, keep going. Train that brain, train your human.

I'm a "true believer" in Dr. Moseley's perspective. There is no "one-size-fits-all," of course. Suggest you check out the recording from Jan 2022 support group meeting with Dr. David Clarke (published 2/10/22). See kzbin.info/www/bejne/o4vNfmd-pZ2no6c Mike Foxworth

The "progressive" nature of (most [thank you!]) PN is a mystery. As are most aspects of PN. Mine is "usual", i.e., progressive. When I was diagnosed in 1997, during the early days of the internet, (can you hear the geezer in me?) I was told literally nothing other than "idiopathic". Probably pre-diabetes. I was almost 100 pounds overweight, but no one mentioned that (no awareness -> no data -> no patient guidance). I lost the weight and am no longer pre-diabetic. So why does it progress? No one knows, but the smart-money answer seems to be that "something" bad is still there, grinding away at my neurons. Possibly a genetic predisposition that my foolish eating triggered (I have excuses, but, then, there are always reasons for stupidity) I gradually started changing my diet and gradually losing weight, but it was almost a decade before I got a WEE game system and got into a true daily exercise routine. Almost another decade and an advisor lent me a copy of the textbook used to train personal trainers and I FINALLY got the information on the body that explained (to me) the "use-it-or-lose-it" connection between neuron disease, strength and balance. I have been a disciple ever since, trying to bring focus on to the long-term threat for (admittedly) most patients - physical disability. And the logical need for exercise. With exercise, my leg muscles are stronger now than they were 2 years ago. My balance continues to decline because the numbness has crept up above my knees and perhaps into my fingers. I'm fighting back. It's a losing battle, but so is life itself. Mike Foxworth

The video and the essay/presentation it was based on reflect two observations. First, many diseases have vigorous collections of support groups who provide the "shock troops" needed to get government sponsorship for research (only governments have enough money to sustain the kind of research needed). All "big" diseases do. Except "normal" PN. So, we asked "Why is that?" Second, when we looked, we saw the dead remains of lots of groups that started and then died. Inquiries always found that their leaders were unable to find successors. We came to a simple conclusion that seems relevant to the "usual" case. That conclusion does NOT explain why rarer non-progressive forms do not have long-term support group leaders. I hazard a guess that the lack of awareness of neuropathy in general makes the "small numbers" problem even more of a challenge. The foundation that champions use of IVIG for a rare form of PN has managed to survive in spite of its small patient population numbers. It has benefited both from the intensity of its members AND from cooperation with other neuropathy support groups. But IVIG does work for that form, not a claim that other forms of neuropathy can make. Perhaps treatments will emerge, and the picture will change. Meanwhile, our support group leaders are precious and leadership succession is a grave challenge.

Jean, that sounds a lot like Neuropathy, but it would require a physician's diagnosis to make sure. Please see a local neurologist if possible. Also, we operate a support group that can provide coping and treatment options from people who have a similar situation. Visit pnsnetwork.org. I hope this helps. The Periperal Neuropathy Support Network. Jud