The Adventures of a Pain Expert with Mick Thacker, PhD


I have for some time now, been viewing lecture and reading articles and scientific papers by physiotherapists Mick Thacker. Some of these quotes are from articles, lectures and some are from scientific papers. Mick Thacker is one of the lesser known pain experts, but in my opinion he deserves a lot more attention, for the great research and work that he does.

Dr. Mick Thacker qualified as a physiotherapist from West Middlesex University Hospital School of physiotherapy and worked as a specialist musculoskeletal physiotherapist at several London teaching hospitals. He undertook and passed with distinction advanced training in manual therapy before completing a Master’s degree at University College London.

Dr. Thacker completed his PhD at King’s College London. He started his PhD under the godfather of pain science Professor Patrick Wall and he has continued to forge a path towards a better understanding of the role of the immune system in chronic and neuropathic pain. His PhD thesis focused on neuro-immune interactions and pain, looking into the role as chemokine CCL2 as a key mediator of neuropathic pain.

Recently Dr. Thacker was invited to join the curriculum development team of the International Association for the Study of Pain (IASP).

Without further ado, here are 20 quotes from physiotherapist Mick Thacker:

“If you think you can understand pain, without understanding biology, physiology, histology, immunology you’re mistaken” Mick Thacker, PhD

“When I first started to read about pain as an undergraduate student (30, yes 30, years ago!) most textbooks aimed at physiotherapists would address it in relation to specific anatomical sites and/or specific structures. The Cailliet series of books springs instantly to mind.

The subliminal (and often not so subliminal) message that arose from these texts was that pain was generated in the joint/muscle/tendon etc and then travelled via ‘the pain pathway/s’ to the brain where it was perceived as an exact copy of what it started out as….. pain! This perspective had its origins in and loyalties to dualism.

These ideas needed to be challenged and together with a group of the most motivated and talented people I have ever worked with, we attempted (largely within the auspices of the PPA and the odd Aussie or two) to do something about offering alternative paradigms.” Mick Thacker, PhD

“What we attempted to convey was that pain is not a stimulus that travels up specific pathways and is then perceived in its original form, but rather that it is a perception and action that limits and protects us from actual or potential threat. This inevitably led to attention being shifted supraspinally to the brain. I remember the difficulty we had in getting ‘the peripheralists’ to make the “journey up the afferent neuron”, as Pat Wall encouraged us to.” Mick Thacker, PhD

“Pain is not a good indicator of tissue damage… Except when it is! The skill is knowing when!” Mick Thacker, PhD

“Pain is an embodied element of suffering encapsulated by an experience of the person within the society and culture in which they live.” Mick Thacker, PhD

“Traditional physiotherapy has based its management of back pain on anatomical, tissue-based principles and biomechanics” Mick Thacker, PhD

“An essential component of an enactivist approach in clinical practice involves allowing the patient the freedom, time and environment to express their thoughts, feelings, perceptions and experiences, and encouragement to find self-motivated novel strategies to understand and manage their pain.Anyone lucky enough to have listened to Louis over the years would have got the message: listen to the patient; understand how they feel and think; watch them move and interact with their environment; make them feel special and then get them to do things in a way they are able to, and want to (accepting sometimes they themselves don’t know what that is).” Mick Thacker, PhD

“This way of thinking is ultimately about agency; agency is the capacity of a person to act in any given environment. Importantly, agency allows us to determine and control our “life worlds”; the subjective experiences we choose to encounter. What we all want is full agency, i.e. freedom of choice to do what we want when we want, although society and culture limits this to varying degrees depending on the socio-political conditions. In terms of health, we expect to have full agency, but illness, and especially pain, have direct and deleterious effects on this. Patients often report a loss of agency, manifested as limitations in activities of ADL, sport and hobbies. Often with persistent pain, agency is absent on the part of the individual and they report that pain has agency over them” Mick Thacker, PhD

“Hyperalgesia to mechanical stimuli also occurs outside the site of injury/inflammation and involves a central mechanism.Thermal hyperalgesia occurs at the site of injury, and has a peripheral mechanism.” Mick Thacker, PhD

“Today most physiotherapists are aware of the non-peripheral origin of pain; the mantra ‘pain is in the brain’ is recited daily within the clinic. I accept my own role as a causative agent in its unceasing memetic power, but I am no longer comfortable with the premise on which the statement is made. Whilst I readily acknowledge that brains are necessary for the perception of pain, the important question is – are they sufficient?Much of the teaching of leading figures within the field suggests that brains are sufficient for pain. If we accept this position we must understand the implications and accept the responsibility of conveying this information to patients, especially in light of the misunderstandings and emotions that often arise.” Mick Thacker, PhD

“We still have about a 40 per cent drop out rate in our profession in the first five years and the single biggest reason for that is that people feel inadequate – and that’s because we’re still providing inadequate explanations and inadequate paradigms. We need to update our knowledge to a 21st century paradigm that helps us better understand the pathologies we see; keep the person and their problem at the focus of what we are doing and incorporate mechanical therapies into a bigger schema.” Mick Thacker, PhD

“But if we have a disc problem, a facet joint problem or a nerve problem in our spinal patients then we’ve got to raise the suspicion that a significant component of their pain may be due to some neuro-immune interactions.” Mick Thacker, PhD

“Pain that persists in people, particularly in back pain, may have a significant immune component” Mick Thacker, PhD

“I would argue that you are you and it is you that has a brain and, whilst your brain is necessary for you to be alive (and for the perception/experience of pain), it is not sufficient to be you! In addition, many pain experts are guilty of fallacious statements such as “your brain decides” or “your brain thinks,” suggesting that brains are somehow distinct from you and capable of independent ‘thought’. This produces a position that the philosopher Andy Clark has termed ‘brain bound’. Unfortunately this has also had the effect to ‘restructualise’ pain i.e. it is anatomically located in the brain.”  Mick Thacker, PhD

‘We need to see pain in its fullest context and question the effects of purely mechanical-based therapies on these conditions” Mick Thacker, PhD

“The Immune system not only influence ‘lower level’ neuronal response to nociception but acts as a key communicator within ‘higher level’ neuronal nociception/pain processing.” Mick Thacker, PhD

“I remain unconvinced that brains are sufficient for pain in the traditional sense, although readily accept that they are generative, that is capable of the formation of a ‘virtual copy’ of afferent inputs including noxious ones. It is wise however to remember that pain is not an afferent input. I believe that the only entity sufficient for the experience and perception of pain is the person. This simple yet vital construct demands that we influence the whole person and the world in which they live, not just their brain!” Mick Thacker, PhD

“Pat (Professor Patrick Wall) had a clear objective to alter the perspective of pain as a purely sensory experience and rather to see it in terms of integrated, action orientated phenomena.A more simple way of understanding this paradigm is to think of it in terms of a“need state”that promotes a co-ordinated and multi-system “strategy which generates our sense of ease or distress”. I still think this is a message largely unheeded by many who manage pain.” Mick Thacker, PhD

“The concept of pain as a need state has recently caught the attention of philosophers, most notably Colin Klein who suggests that pain is an imperative sensation. Here, sensation is used differently to the classic definition. Imperative sensations suchas thirst, hunger, tiredness and pain do not describe or represent how the world is, but rather they are requirements to act; in the case of pain, to do something in an attempt at relief. Furthermore, imperatives are not representational; they do not mean that something definable is happening where the pain is felt.” Mick Thacker, PhD

“Thermal hypersensitivity is probably more accurate than mechanical hypersensitivity to indicate tissue damage…” Mick Thacker, PhD