The pain and movement reasoning model: introduction to a simple tool for integrated pain assessment

Pain is no longer considered to be simply the transmission of nociception, but rather an output subsequent to the complex interactions of homeostatic systems. Manual therapists' clinical reasoning needs to incorporate this complexity in order to develop individualised effective treatment plans. Pain classification strategies attempting to assist clinical reasoning traditionally define multiple types of pain - nociceptive, neuropathic, centrally sensitised - potentially fitting elements of the pain experience to linear independent systems, rather than embracing the multiple dimensions. It is our contention that pain should not be classified unidimensionally. In all pain states consideration should be given to the combined influence of physiological, cognitive, emotional and social inputs, all of which have the potential to influence nociception. The Pain and Movement Reasoning Model presented in this paper attempts to capture the complexity of the human pain experience by integrating these multiple dimensions into a decision making process. Three categories have been created to facilitate this - central modulation, regional influences, and local stimulation. The Model allows for the identification of a predominant element to become the focus of treatment but also for the identification of changes to clinical presentation, where new treatment targets can emerge.