Pain Education Is Stuck — And We Know It

Pain Education Is Stuck — And We Know It

There’s a new paper out from Moseley and team.
They’ve renamed Pain Neuroscience Education (PNE) to Pain Science Education (PSE).
Same message, but now with comics, VR, and some storytelling added in.

They’re trying to freshen it up.
But anyone paying attention knows… it’s still the same old stuff.

Pain is a brain output.
Pain doesn’t mean damage.
If you change how you think about pain, your pain might go away.

That’s the pitch. It always has been.

But Let’s Be Real

The model hasn’t changed. Just the wrapping paper.
Still focused on explaining.
Still preaching from the top down.
Still acting like pain is a belief problem — and they’ve got the belief correction manual.

But does it actually work for most people?

The research says... not really.
And in clinic? It misses the mark more often than it hits.

The Neuromatrix: Useful Once. Now Just in the Way.

The whole thing is built on the neuromatrix model.
That pain comes from the brain, and we just need to update the software.

It sounded smart 20 years ago. But now?
It feels more like a belief system than actual science.

And yet, it’s treated as fact.
Taught in courses. Sold to patients. Backed by authority.
And if it doesn’t help someone? That’s their fault.
“They didn’t get it.” “They weren’t ready.” “You didn’t teach it well enough.”

But no one stops to ask:
What if the model itself is the problem?

A Different View

Bud Craig’s work shows us something deeper.
Pain isn’t just a brain trick.

It’s a homeostatic emotion — like hunger or thirst.
It comes from the body when things are out of balance.

• Inflammation

• Acidic tissue

• Nervous system overload

• Fatigue

• Low energy

• Disconnection

You don’t fix those things with metaphors.
You fix them with movement, rhythm, breath, food, recovery, trust.

You don’t talk the body out of pain.
You help it feel safe again.

It’s Time to Say It Plainly

The problem with PNE isn’t just the method.
It’s the mindset.

It’s the attitude that “we know better.”
That the brain is the answer to everything.
That patients need to be re-educated.

And that if the education fails — it’s on them.

That’s not science.
That’s sales.

And the worst part? It’s delivered with a smile, a TED Talk, and a research grant.

The Brain Took Over the Room

Let’s call it what it is.

Neuroscience didn’t just join the conversation — it took over.
The conductor became the soloist.
And now everything revolves around the brain.

Pain is no longer in the tissue. Not in the immune system. Not in the gut.
Nope — just a misfiring prediction machine that we need to talk into calmness.

We’ve lost the whole person by obsessing over one organ.

Taleb Saw This Coming

As Nassim Taleb wrote in Antifragile:

“When it comes to narratives, the brain seems to be the last province of the theoretician-charlatan... Add neurosomething to a field, and it suddenly sounds scientific — even when it’s just psycho-neuro-babble.”

The brain-based model gives the illusion of control.
But it hasn’t delivered the outcomes it promised.

So Here’s the Truth

We don’t need more education.
We don’t need another metaphor.
We don’t need another cartoon or animation explaining how pain is a brain output.

We need a new path. One that starts in the body.

One that:

• Builds real capacity

• Resets balance

• Teaches through experience, not slideshows

• Trusts the body's signals, not overrides them

Thanks for the Input. We’ll Take It From Here.

Neuroscience had its moment. It gave us some tools.
But it’s not the whole answer.

It’s time physios, coaches, patients, and people doing the real work reclaimed the space.

We’re not here to be educated.
We’re here to heal.
And that starts by turning down the noise — and tuning back into the body.

Let’s move forward.
With honesty. With humility. With both feet on the ground.

What If Pain Was Just Your Body Asking for Balance?

Have you ever felt pain creep in after a stressful day or tough workout, even when nothing was technically “wrong”?
No injury. No big trauma. No obvious cause.
Just… pain.

That experience might seem mysterious — or frustrating — but it’s not a glitch.

It’s your body doing exactly what it’s designed to do.

Let’s unpack a game-changing idea that could help you understand your pain differently — and manage it more gently, wisely, and effectively.

Pain Isn’t Just a Warning — It’s a Message from Inside

We’ve been taught to think pain equals damage.

Twist an ankle → pain.
Throw out your back → pain.
Easy, right?

But what if pain could happen without damage?

What if pain sometimes comes from your internal chemistry being off balance — like when you’re inflamed, overly acidic, exhausted, or just run down?

That’s exactly what a fascinating study by Kelly et al. (2013) showed — and it lines up perfectly with the work of neuroscientist Bud Craig, who describes pain as a “homeostatic emotion.”

Translation?

Pain is your body’s way of saying: “Hey — things inside aren’t okay. Help me find balance.”

This Chart Sums It Up Perfectly 👇

In the study, researchers injected a mix of chemicals into people’s muscles — things your body naturally makes during exercise, like:

• Lactate (produced when things get anaerobic)

• ATP (your body’s energy currency)

• Hydrogen ions (acid), which lower pH and increase acidity

Each mix mimicked what happens inside your body under increasing stress — from light movement to intense exercise or ischemic conditions (like blood flow restriction).

And here’s what happened:

• At low doses (near normal pH), people felt non-pain sensations — stuff like heaviness, fullness, warmth, twitching, or fatigue.

• As the chemical levels increased and acidity rose, people started reporting pain — often described as dull, hot, or aching.

• At the most acidic condition (pH 6.6), 100% of participants reported pain, even though there was no injury.

In other words:
Chemistry alone was enough to make people feel pain.

Why This Is Such a Big Deal

This study proves something many people with persistent pain already feel deep down:

You don’t need a torn ligament or disc bulge to feel pain.
You just need your internal system to be under pressure — physically, chemically, emotionally — and your brain will signal pain as a way to get your attention.

Bud Craig’s research puts it beautifully:

Pain is a homeostatic emotion — a feeling that motivates you to restore balance, just like thirst or hunger.

That means pain isn’t just an “alarm system” or a brain misfire.
It’s your body’s way of saying,

“I’m out of rhythm. Please slow down, adjust, and support me.”

🧪 What This Graph Really Shows (in Plain Language)

At the most intense level (similar to blood flow restriction or overtraining), everyone felt pain — even though there was no damage, no injury, and no emotional context.

💡 Why this matters:
It proves that your body alone — without needing an injury or a psychological trigger — can send signals up to the brain that are strong enough to cause real pain.

🚨 Bottom-Up Pain, No Damage Required

This graph breaks the myth that pain only happens when:

1. You’re hurt

2. Your brain “misinterprets” safe signals as dangerous (which is the focus of many modern pain education models)

Instead, it shows:

Sometimes your body chemistry alone can push the system into pain — even if there’s nothing structurally wrong.

Your muscles and tissues have sensors that detect acidity, fatigue, and other signs of internal stress. When those sensors are triggered enough, they fire pain signals straight up the spinal cord to your brain.

No story. No emotion. Just raw, bottom-up input.

🧭 So What’s the Takeaway?

If you're in pain and nothing seems “wrong” on your scans, you’re not imagining it.
Your body might just be in a state of imbalance, and the signals are getting loud.

This is why recovery often needs more than mindset work — it needs real support for your physiology:
hydration, breathing, rest, movement, and rhythm.

So… What Do You Do With This?

If pain is your body’s call for balance, then managing pain becomes less about “fixing” and more about listening + supporting.

Here’s how that might look in real life:

1. Zoom Out from the “Injury” Narrative

If your pain isn’t linked to a fresh injury, consider:

• Am I underslept?

• Stressed or emotionally stretched?

• Under-recovered from training or work?

• Eating or drinking in ways that support or stress me?

Sometimes, it’s not about the area that hurts — it’s about the system being overloaded.

2. Respect Your Chemistry

That graph didn’t lie:
Your pain may just be your body saying,

“Hey, it’s getting acidic and inflamed in here. Can we chill?”

So…

• Hydrate well

• Prioritize sleep

• Breathe slowly, especially under pressure

• Move gently (to encourage circulation, not exhaustion)

3. Feel First, Fix Later

Instead of immediately chasing solutions, try noticing what your body is asking for.
Sometimes it’s rest.
Sometimes it’s gentle movement.
Sometimes it’s just a moment to breathe and regroup.

Pain is often louder when the system is overwhelmed and under-heard.

Final Thought

Pain is real. It can be awful, disorienting, exhausting.

But it’s not always damage.
It’s often information. And your job isn’t to silence it — it’s to tune in, understand it, and respond wisely.

As Lao Tzu said:
“Do you have the patience to wait until your mud settles and the water is clear?”

That’s what self-care can be when we treat pain as a guide, not a glitch.

So next time your body whispers (or yells),
Don’t just ask “What’s wrong with me?”
Ask:

“What is my body trying to say — and how can I support it today?”

🔗 Exogenously Applied Muscle Metabolites Synergistically Evoke Sensations of Muscle Fatigue and Pain in Human Subjects
Authors: Kelly, L.A., et al.
Journal: The Journal of Physiology (2013)

Want to learn more and see how this makes sense through a case study ? Read on…

🎯 Case Study: Mark’s Lower Back Flare-Up and the Model That Finally Made Sense

Mark, a 44-year-old graphic designer and father of two, has had on-and-off lower back pain for about five years. He’s fit, doesn’t sit too much, and has no major injuries in his history.

But one week, after a few late nights, some emotional stress at home, and pushing through a few intense gym sessions, he wakes up and…
BAM — his lower back locks up again. Sharp, aching pain. Muscle tightness. Fear floods in.

Here’s how three common pain models would explain what’s going on — and how only one of them actually helped Mark feel seen and supported.

🩻 1. The Biomedical Model

What it says:

“You probably strained something again. Maybe your disc or facet joint is irritated. Better stop lifting and get some scans.”

What Mark does:
He rests, pops anti-inflammatories, and stops training altogether. His scan shows a mild disc bulge (which he already knew about). Nothing new, but now he’s more afraid.

Result:
Frustration, fear of re-injury, and no real answers. The pain slowly fades, but the anxiety remains.

🧠 2. The Pain Neuroscience Education (PNE) Model

What it says:

“Pain doesn’t mean damage. Your brain is just interpreting signals as dangerous because of stress or past experiences. Try reframing your thoughts and keep moving.”

What Mark does:
He tries not to catastrophize. He tells himself “I’m safe.” He walks. He does a few gentle stretches and tries mindfulness. It helps… a little.

But deep down, he still feels like something in his body is off.
He’s told “trust the process,” but the pain lingers. He starts doubting himself.

Result:
Less fear, more confusion. He's doing “everything right,” yet still feels pain.

🌡 3. The Homeostatic Model (Bud Craig’s Approach)

What it says:

“Your pain is real. And your body is telling you something is out of balance — not broken, but dysregulated.”

It’s not just your thoughts. It’s your chemistry:

• Poor sleep

• Emotional stress

• High-intensity training without recovery

• Low-grade inflammation

These all impact your body’s internal signals — and when the system gets overwhelmed, your brain sends the message: PAIN.

What Mark does:
He reflects.
“Ah — I’ve been skipping sleep. Stress is high. I trained hard but didn’t recover.”
He doesn’t panic. He doesn’t stop moving. But he also doesn’t push through.

Instead, he:

• Adjusts his training for the week

• Prioritizes rest and hydration

• Focuses on steady breathing and slow walking

• Eats anti-inflammatory meals

• Lets his system settle

Result:
Within a few days, the pain eases without fear. He feels more confident, not because he ignored the pain — but because he listened to it.

✅ Takeaway: Pain as a Homeostatic Emotion

Mark’s back wasn’t “broken” — his body was overloaded.

The biomedical model told him he was fragile.
The PNE model told him it was just his brain.
The homeostatic model? It told him his body and brain were working together to send a useful signal.

And that changed everything.

When “Healthy Habits” Backfire

Training with Low Energy Availability: When “Healthy Habits” Backfire

Imagine this: you’re someone who genuinely cares about your health.

You’ve been reading, learning, and experimenting.

You want to optimize your body, so you start intermittent fasting—skipping breakfast, eating a light lunch, and having a big dinner.

You’re also vegetarian, which feels great ethically and digestively.

You’ve ramped up your strength training and walking, thinking you’re ticking all the right boxes.

And yet… something feels off.

The Case of the “Healthy” Person Who Feels Like Crap

Meet Alex.

Alex isn’t new to exercise. They love staying active, and they’re committed to making smart choices for their health.

But lately, they’ve noticed:

🔻 Sore muscles that linger for days instead of bouncing back.
🔻 Workouts feel harder—even though they’re training consistently.
🔻 Less energy and motivation—despite getting enough sleep.
🔻 Tight, stiff muscles that don’t seem to recover properly.
🔻 Nagging joint discomfort—especially around the knees and hips.

What’s going on? Isn’t intermittent fasting supposed to help with recovery and longevity?

The Molecular Breakdown: What’s Happening Inside

1. Energy Availability & Protein Deficiency

Your body runs on fuel, and when you increase training without increasing nutrition, things start breaking down.

In Alex’s case, skipping breakfast & eating a light lunch means they’re in a low-energy state for most of the day. This creates:
⚠ Reduced muscle protein synthesis (MPS) – The body struggles to repair and grow muscle.
⚠ Increased muscle breakdown – The body starts using existing muscle for fuel.
⚠ Poor tendon & joint repair – Because connective tissues also need amino acids for recovery.

Since Alex is vegetarian, protein intake is already a challenge. Plant-based protein sources tend to be:

• Lower in essential amino acids (especially leucine, key for muscle repair)

• Less bioavailable (meaning the body absorbs them less efficiently)

This isn’t to say vegetarianism is bad—but without careful protein planning, strength training adaptations suffer.

2. Intermittent Fasting & Cortisol

Skipping meals increases cortisol levels—which isn’t necessarily bad. In the short term, cortisol helps with alertness and fat mobilization.

But in Alex’s case, consistent fasting + heavy training = chronic cortisol elevation. This leads to:
❌ Increased muscle breakdown (catabolism).
❌ Reduced recovery (cortisol opposes muscle repair).
❌ Tighter, more rigid muscles (because they aren’t getting the nutrients to stay pliable).

Ever feel like your body just won’t loosen up despite stretching, foam rolling, and massage? That’s what happens when your muscles aren’t recovering properly.

3. Why Alex Feels Stiff, Sore, and Drained

On a molecular level, this combination of low protein intake + intermittent fasting + increased training leads to:

🚨 Less mitochondrial energy production – Muscles feel weak, heavy, and slow to recover.
🚨 Reduced collagen synthesis – Tendons and joints start feeling achy and more prone to irritation.
🚨 Increased metabolic waste buildup – Muscles feel stiff, sore, and less responsive.
🚨 Lower glycogen storage – Energy crashes happen more often.

Alex thinks they’re doing everything right. But in reality, their body is in a mild survival mode, prioritizing essential functions over peak performance.

How to Fix It: Smart Adjustments Without Losing the Benefits

1️⃣ Prioritize Protein Timing & Quality

• Aim for 1.5g protein per kg body weight per day.

• Ensure each meal has at least 20-30g protein (especially post-workout).

• Consider a plant-based protein shake if whole food sources aren’t hitting the target.

2️⃣ Reassess Fasting Strategy

• A lighter fasting window (e.g., 12-14 hours instead of 16+) might be better for muscle recovery.

• If sticking with a long fast, prioritize a high-protein meal right after training.

3️⃣ Support Recovery & Flexibility

• Hydration & electrolytes – essential for muscle pliability.

• Active recovery (walking, foam rolling, self-massage) – clears metabolic waste.

• Smart strength training – not just more, but better quality and timed with nutrition.

Final Thoughts: Strength Isn’t Just About Training—It’s About Recovery

Many people fall into the trap of thinking “more training = more results.”

But when energy and protein intake don’t support that increased demand, strength doesn’t translate into function—it just turns into stiffness, soreness, and fatigue.

Want more adaptable, stronger muscles?
👉 Feed them.
👉 Recover well.
👉 Train smarter, not just harder.

Your body isn’t a machine—it’s a living system that thrives on balance.

Find yours, and you’ll not only feel stronger, but you’ll actually move and function better.

Why We Need to Move On From Shockwave Therapy for Tendons

Why We Need to Move On From Shockwave Therapy for Tendons

By Physio Daniel O’Grady

Let’s talk about shockwave therapy for tendon pain.

It’s been around for a while, but is it really worth your time, money, and effort?

A new, high-quality study shows the answer is clear:

No, it’s not.

This research is a game-changer.

It shows us that it’s time to leave shockwave therapy behind and focus on better, more effective ways to recover from tendon pain.

Let me explain why this study matters and why it’s time for us to move forward.

A Study You Can Trust

This wasn’t just another small, poorly done study.

This was a randomized controlled trial—the gold standard of clinical research.

The researchers wanted to find out if shockwave therapy actually helps people with insertional Achilles tendinopathy, a common type of tendon pain.

Here’s what made this study so reliable:

• Participants were randomly split into two groups: one got shockwave therapy, and the other got a fake, sham treatment.

• Both groups received the same high-quality exercise program and education about their condition. The only difference was the shockwave therapy.

• Participants and assessors were blinded—they didn’t know who got the real treatment. This helped eliminate bias and ensured the results were fair.

What Did the Study Find?

After 6 weeks and 12 weeks, the results were in: there was no difference between the group that received shockwave therapy and the group that got the sham treatment.

That’s right—shockwave therapy didn’t improve pain, function, or any other outcome.

Even with a solid exercise program alongside it, shockwave therapy offered no extra benefit.

This finding is consistent with previous research, which has also failed to show that shockwave therapy is effective for tendon pain.

Why Does This Matter?

Shockwave therapy is expensive, time-consuming, and often uncomfortable.

If it doesn’t work any better than a fake treatment, why are we still using it?

This study tells us it’s time to stop chasing ineffective solutions and focus on what actually helps.

The good news? We already have effective tools for tendon recovery: exercise and education.

Why This Study Stands Out

This research wasn’t just any study—it was done right. Here’s why it’s so trustworthy:

1. It included 76 participants, enough to ensure the results were reliable.

2. It measured real-world outcomes, like pain, function, and quality of life. These are the things that actually matter to patients.

3. It followed modern clinical guidelines, allowing participants to keep walking, running, and staying active as long as their pain was manageable. This makes the results much more applicable to everyday life.

Meet the Expert: Professor Peter Malliaras

One of the lead researchers on this study was Professor Peter Malliaras, a world-renowned expert in tendon rehabilitation.

He’s spent decades helping people recover from tendon pain and is a leader in evidence-based approaches to treatment.

Professor Malliaras has published numerous scientific papers on tendon pain and regularly trains physiotherapists around the world.

His work emphasizes what really works—like load management and exercise—and steers us away from outdated or ineffective treatments.

If he’s saying shockwave therapy doesn’t help, you can trust that it’s based on solid evidence.

A Better Way Forward

So, what should you do if you’re dealing with tendon pain?

The answer is simple: Focus on exercise and education.

Exercise, when done right, strengthens your tendon and helps it handle the demands of your life—whether that’s walking, running, or sports.

Education helps you understand your pain and manage it with confidence.

These approaches are backed by strong evidence and don’t rely on expensive, unproven add-ons like shockwave therapy.

The Takeaway

Let’s be bold: It’s time to move on from shockwave therapy.

The evidence is clear—it doesn’t work better than a placebo.

Instead, we should focus on the bigger picture: building resilience, managing load, and using proven strategies to recover from tendon pain.

Your recovery doesn’t need gimmicks or quick fixes.

It needs patience, the right exercises, and a focus on what really matters.

It’s just about to tick over to 2025—let’s leave ineffective treatments behind and embrace what works.

If you’re ready to take control of your tendon pain start with a comprehensive evaluation with expert Physio Daniel O’Grady.

Research link:

Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial

Moseley’s Red/Blue Light Study: Why It’s Time to Move On

Moseley’s Red/Blue Light Study: Why It’s Time to Move On

Let’s talk about Moseley’s infamous red/blue light study—a research piece from nearly 20 years ago that somehow still gets rolled out as a cornerstone of pain science education.

It’s a clever experiment, sure, but it’s wildly overused to justify his unwavering commitment to the neuromatrix model.

Here’s the thing - it’s an extremely superficial look at pain that doesn’t hold up when you dig deeper.

Worse, its oversimplified conclusions have caused real-world harm to patients and clinicians alike.

I think it’s to time we moved on.

What Does the Study Actually Show?

In the study, a noxious cold probe was paired with either a red light (associated with danger, tissue damage) or a blue light (associated with cold, less dangerous).

Participants rated the pain unpleasantness as higher with the red light, but pain intensity—how physically strong the pain felt—didn’t change.

This means that context (the visual cue) affected the emotional evaluation of pain (unpleasantness) but not the raw sensory experience (intensity).

This is an interesting finding—but very narrow.

It’s about exteroception (external cues like vision) influencing pain perception.

That’s fine for a lab-controlled experiment on acute pain, but it tells us nothing about interoception, chronic pain, or the real-world complexity of pain.

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In a recent 2023 podcast, Moseley doubled down on his study with this quote:

“There were some people for whom, with the blue light they reported no pain and with the red light they reported pain eight out of ten. And that’s a very severe pain. There are other people who reported the same level of pain in each situation. And in scientific terms we describe those people as idiots (laugh) because their brains are not picking up on these cues that everyone else is picking up on.”

This is deeply problematic for several reasons:

• Dismissive attitude: Referring to participants as "idiots" because they didn’t conform to the expected pattern is disrespectful and ignores the complexity of individual pain responses and the fact that they can trust their bodies experience without being contaminated with external distractions (a rare and amazing skill to be honest)

• Moseley uses phrases like "pain eight out of ten" without distinguishing whether he means intensity (strength) or unpleasantness (emotional impact). However, based on the study results, the only dimension that showed such variability in response to the cues was pain unpleasantness, not intensity. This lack of clarity can be misleading

• Pain intensity and pain unpleasantness are distinct dimensions, and conflating them obscures the actual findings of the study. It risks overstating the impact of visual cues, as they DIDN’T alter the sensory intensity of the pain but only its EMOTIONAL interpretation.

• Failure to update his model: Instead of recognizing that his study barely scratches the surface of pain complexity, Moseley doubles down on his original findings, refusing to appreciate their limited scope.

• Ignores interoception and chronic pain: His study is about acute nociceptive pain modulated by visual cues. Chronic pain, which involves interoceptive processes (e.g., inflammation, fatigue, homeostatic dysregulation), isn’t even in the same ballpark.

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Moseley’s study isn’t a bad experiment—it’s just wildly overgeneralized. Here’s why:

• It only applies to exteroceptive pain: The study is about surface-level pain influenced by external cues (red/blue light). It says nothing about deeper, interoceptive pain (e.g., from muscles or organs), which involves different brain regions like the insular cortex.

• It separates pain intensity from unpleasantness: The findings show that context changes unpleasantness (salience), NOT intensity.

• But in real-world chronic pain, those dimensions are deeply intertwined and modulated by systemic factors like inflammation and central sensitization.

• It ignores chronic pain altogether: Chronic pain is a much messier phenomenon involving altered interoception, disrupted homeostasis, and central sensitization. This study doesn’t even begin to address that complexity.

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Unintended Harmful Consequences

By clinging to this superficial study, Moseley’s work has contributed to serious downstream problems:

• Gaslighting patients: Patients with chronic pain are often told their pain is just a "brain output," implying it’s all in their head. This dismisses the real interoceptive and structural factors driving their pain, leaving them feeling invalidated and alienated.

• Oversimplified treatments: The idea that context alone can “rewire” pain has spawned treatments that focus on changing the brain’s interpretation of pain while ignoring physical contributors like mitochondrial dysfunction, inflammation, and recovery deficits.

• Therapist confusion: Clinicians trying to reconcile this brain-centric model with their patients’ real-world experiences often find it doesn’t work. Chronic pain doesn’t behave like the tidy pain in Moseley’s lab study, and therapists are left frustrated and unsure how to help.

Bud Craig’s Interoceptive Model: A Better Framework

Bud Craig’s work on interoception offers a much more realistic and applicable model for understanding pain:

• Pain as a homeostatic emotion: Pain reflects disruptions in the body’s internal state, integrating interoceptive signals with emotional and cognitive processes.

• Role of the insular cortex: Unlike the neuromatrix model, Craig’s framework emphasizes the insular cortex as a hub for processing interoceptive inputs (e.g., inflammation, fatigue) and driving adaptive responses.

• Chronic pain as a prediction mismatch: Craig’s model explains chronic pain as a mismatch between the brain’s predictions and the body’s actual internal signals, a more accurate representation of what patients experience.

This framework doesn’t just make more sense scientifically—it aligns better with what patients and therapists see in the real world.

The unpleasantness of tonic pain is encoded by the insular cortex

While Moseley’s red/blue light study has been widely cited, its focus on acute skin-based sensations (exteroception) offers little relevance to the kind of pain most patients bring to a physiotherapist.

In stark contrast, Schreckenberger’s study, The unpleasantness of tonic pain is encoded by the insular cortex, dives into the mechanisms of interoceptive pain, the deep, internal discomfort often experienced in muscles and other tissues.

Schreckenberger’s research highlights how muscle pain—the type of pain patients commonly report—activates the insular cortex, which encodes the unpleasantness of pain tied to homeostatic dysregulation and internal states.

Unlike superficial findings from Moseley’s study, which rely on external cues like light, Schreckenberger’s work reflects real-world pain mechanisms and offers a far more valid framework for understanding and treating the persistent pain that drives patients to seek care.

This critical distinction underlines why Moseley’s study, despite its fame lacks practical relevance.

Time to Retire the Red/Blue Light Study

Moseley needs to stop using this study as the cornerstone of his arguments.

It’s outdated, oversimplified, and irrelevant to the complexity of chronic pain.

Pain science has moved on, and so should Moseley. His refusal to update his model—despite the clear limitations of this study—shows a troubling lack of humility.

The future of pain science lies in embracing complexity, not reducing pain to a “brain output” but understanding it as a dynamic interplay of interoception, homeostasis, and real-world biology.

Bud Craig’s interoceptive model offers a path forward.

Let’s stop relying on superficial lab studies and start focusing on what truly helps patients.

If Lorimer Mosely was open to question - this is what I would love to know…

"How do you see your red/blue light study, which focuses on external skin pain, applying to the deeper, internal pain that most patients experience in muscles or joints? And do you think its widespread interpretation might have unintentionally led to oversimplified treatments or left some patients feeling dismissed?"