The Diary of a Pain Scientist with Dr. Kieran O’Sullivan


I have for some years now, been reading articles and scientific papers by Dr. Kieran O’Sullivan. Some of these quotes are from papers, articles and others are from interviews. Dr. Kieran O’Sullivan is one of the lesser known pain experts, but in my opinion deserves a lot more attention, for the great work that he does.

Dr. Kieran O’Sullivan is a researcher and lecturer at the University of Limerick, Ireland. In addition to his teaching and research at the University of Limerick, he also works in clinical practice as a Specialist Musculoskeletal Physiotherapist. Dr. Kieran is also part of the group at PainEd, which also includes Prof. Peter O’Sullivan.

Without further ado, here are 30 quotes from Dr. Kieran O’Sullivan:

“If a person believes their back is vulnerable and could be easily injured, they are more likely to avoid usual activities or move too carefully, which limits the potential for recovery.” Dr. Kieran O’Sullivan

“In fact, what caused some people like me in my profession to get insecure is that many of the studies are showing that actually more treatment from physiotherapists, chiropractors, and more MRI scans, rather than being helpful, might actually be adding to people’s disability because we can make people more frightened that they have a serious problem.” Dr. Kieran O’Sullivan

“In my home, intermittently the house alarm goes off if a bird flies into the window, for example. But the alarm system thinks somebody has broken the window because it’s the adjustment isn’t quite done right. When you have persistent pain, your central nervous system, the nerves that give you the sensation of pain, become hypersensitive. So, even something simple, like stretching a ligament in your back, causes intense pain. The patient understandably will think “Oh, that’s dangerous,” whereas what’s really happening there is the alarm has become hypersensitive and what we need to do is unwind that sensitivity. That includes activity, stress management, and sleep.” Dr. Kieran O’Sullivan

“Despite the large amount of research undertaken on low back pain (LBP), it remains a very common and costly musculoskeletal disorder. It is now widely acknowledged that LBP is a complex disorder, with numerous contributing factors, including physical, biological and psychosocial factors, as well as genetic and environmental interactions” Dr. Kieran O’Sullivan

“We’ve probably treated back pain for too long as being an injury of tissues. For example, when somebody hurts their back and goes to see their doctor or physiotherapist, they commonly get asked “How did you injure it?” When you have persistent back pain, we’re not dealing any longer with a tissue injury – we’re dealing with pain.” Dr. Kieran O’Sullivan

“An example I would give is you’ve probably had a headache yourself. Would you say that you’ve always injured your head when you’ve gotten those headaches? I would say probably not. We’re quite comfortable with the idea that I can have abdominal pain or head pain without injury. But we have an assumption that back pain is always caused by and proportional to injury. Of course, that’s common because it often starts as an injury.” Dr. Kieran O’Sullivan

“There’s an opportunity here to embed real change which will have lasting impact on people’s lives. As physiotherapists we can lead the way in building resilience through public health programmes, encouraging activity, understanding pain is not just about bones and muscles and not always looking for a quick fix.” Dr. Kieran O’Sullivan

“It’s all about treating the person, not just the bones or the muscles. Globally there are vast levels of misinformation around conditions like back pain, such as the idea that structures such as bones and discs can go out of place. Not only is this inaccurate, the fear it creates actually adds to disability. “ Dr. Kieran O’Sullivan

“Disability due to chronic low back pain (CLBP) has actually increased in recent decades, indicating a need for significant change in CLBP management. Improved outcomes in other chronic health conditions (e.g. cardiovascular diseases, cancer), illustrate the requirement of changes in both (i) beliefs and (ii) behaviours.” Dr. Kieran O’Sullivan

“Injury prevention or return to sport after injury: there is very little evidence that SS (Static stretching) is effective. In contrast, there is considerable evidence that progressive strength training programmes, which typically include an eccentric component, reduce injury risk, pain and disability in a range of musculotendinous conditions, as well as hastening return to sport.” Dr. Kieran O’Sullivan

“There are times when more treatment is good, but, in the last few decades, these one-dimensional approaches, where we’ve given everybody exercise or everybody medication and not treated other aspects of their problem, haven’t really been effective. There is evidence that some people are better off without too much treatment.”  Dr. Kieran O’Sullivan

“It’s not that these treatments are necessarily bad, but they generally tend to look at one thing. So, if you come in with back pain and your back pain is related to being overweight, being stressed, having poor fitness, poor flexibility and those kind of things, doing a one-dimensional thing like strengthening your back muscles or going on a diet on its own isn’t going to fix all the components.”  Dr. Kieran O’Sullivan

“What is important is that we identify the impact pain has on people’s lives, understand their personal and unique barriers to recovery and empower them to regain control of their lives.” Dr. Kieran O’Sullivan

“While people with chronic pain may be very stiff and sore in their back, it appears that overall health factors such as stress, sleep, mood, activity levels are very important. In particular, how a person thinks about their back problem is critical.” Dr. Kieran O’Sullivan

“Low Back Pain (LBP) is a very common condition, affecting a large amount of the population. The best approaches to managing LBP often contrast with the beliefs of the public about LBP” Dr. Kieran O’Sullivan

“movement is definitely good, but the way in which people with back pain move tends to be difficult and awkward. We see this manifested in things like sitting posture. If I told you now to look at your sitting posture, your instinct would probably be to do something like brace your shoulders back and sit up straight. That’s understandable. If you really teased that out and I asked you “Why aren’t you sitting like that already?” you would probably tell me “Well, that’s because it’s uncomfortable and unnatural.” If you think about the friends and the people you know or see in a cafe, the people who are sitting relaxed and looking comfortable are the people without pain and the people with the most distressing and disabling pain are sitting upright and fidgeting like crazy.” Dr. Kieran O’Sullivan

“While we know that increasing activity levels among people with CLBP significantly reduces disability, people with CLBP often remain relatively inactive. While this “behaviour”may be criticised, one may argue that this is a sensible strategy to adopt based on their existing (albeit inaccurate) beliefs” Dr. Kieran O’Sullivan

“The idea that pain is always an accurate indicator of whether a body part is damaged is still widely held, despite being completely out of touch with contemporary neuroscience. For example, people with what appears to be significant tissue “damage” often report no pain, while others with seemingly “normal” scans can report terrible pain” Dr. Kieran O’Sullivan

“Many forms of activity, e.g. running and bending which are not harmful to the body, are considered somewhat dangerous and a potential cause of “wear and tear” Dr. Kieran O’Sullivan

“recuperation from CLBP is considered to be more related to the “magic” hands (or needle/scalpel/scan) of the clinician or health service rather than factors the person themselves can learn to control such as physical activity, stress management, sleep and thoughts” Dr. Kieran O’Sullivan

“In summary, to increase activity levels among people with CLBP, we need to (i) shape their beliefs and better contextualise what is happening to their body (e.g. rarely is tissue damage the biggest concern); (ii) eliminate fears that everyday activities are dangerous even if they are difficult initially, and (iii) empower patients to regain control through active self-management strategies such as physical activity.” Dr. Kieran O’Sullivan

“We’ve spent decades becoming obsessed with the idea that “If I just get the right diagnostic test or scan or assessment, I’ll find out which tissue is injured, be it a disk, ligament, or bone. Then I can just cut it out or rub the pain away. Unfortunately, what this has led to is more scans, more physiotherapy, more surgery, more medical interventions, and yet our outcomes are very poor.” Dr. Kieran O’Sullivan

“You can’t see this, but I’m getting balder. Every day I look in the mirror, I’m getting balder. But nobody would ask me if I’m getting terrible headaches because of it, because there’s no suggestion that – you could joke and say I have degenerative scalp disease, but really that’s just genetics and a process of aging. The stuff we see on scans is very much like that. But people tend to think this disc degeneration is a pathology and it’s not, no more than baldness is a pathology.” Dr. Kieran O’Sullivan

“It’s not because back pain has become more common. It looks like it’s more so because we have ways of frightening people that are unhelpful.” Dr. Kieran O’Sullivan

“If you wanted to help people lose weight, we know that diet is a huge part of that, but you can’t just tell people “Eat less.” You have to help change their beliefs about what is contributing to obesity and then try and help change their behaviors, because things like obesity are influenced by things like socioeconomic factors, your mood, your motivation and so forth. Back pain is the same. If a person thinks their back is damaged and that movement and activity is dangerous, I wouldn’t blame them for avoiding things like movement and activity.”Dr. Kieran O’Sullivan

“One thing that very often helps patients, in terms of trying to understand how back pain is a health condition like any other, is talking about cold sores. We’re generally very comfortable with the idea that health conditions like cold sores have a biological trigger, like a virus. But also that that virus is only a problem if you’re a bit run down – maybe stressed or sleep deprived, or maybe drinking too much in Ireland, these kinds of things.

All of those parts are important. You wouldn’t have gotten the cold sore without the virus. But equally, I know myself, I’ve had cold sores in the past, that cold sore is not a problem at the moment because I’m otherwise healthy.

Again, if we look at things like headaches; you might have a previous disposition to headaches, but if you expose yourself to too much alcohol, or stress, or sleep deprivation, if you have a young baby in the house, they could easily come back.

We can look at back pain from that perspective. Yes, you may have some things that sound like wear or tear on an MRI scan, or you may have some muscles that are a little bit weak or a little bit tight, that might be one component of it.” Dr. Kieran O’Sullivan

“Movement is good, but particularly, relaxed movement is good. If you look at people with chronic back pain, they’ve almost forgotten how to move easily. They cannot sit easily, they cannot dress easily, they cannot roll in bed easily. Not only are these movements painful but it’s understandable that it causes people to stop moving and to avoid activity. But that leads to further deconditioning.” Dr. Kieran O’Sullivan

“It was a series of public talks and we focused on five or six of the key misunderstandings we felt that were seen in the evidence, that were seen to be important for the members of the public to get. In amongst these, we were trying to get across the message that pain is very real and very disabling, but chronic back pain is not an injury anymore. It’s far more like a headache and stomach ache, where there are a whole range of factors involved.

We know that from all the studies that will say the correlation between what we see on scans or what surgeons feel when they go in to operate on people, and pain is very poorly related. The pain is real, but it’s no longer about injury. If people still think injury, they will think it’s like a sprained ankle – “I must rest it and avoid it.” Dr. Kieran O’Sullivan

“So, doctors, physiotherapists and other healthcare professionals are notorious for telling people what not to do. For example, they’ll tell people “Here’s a way you can get fit, but don’t swim, don’t walk, don’t bend, don’t garden, don’t golf, and don’t do this,” and we leave them very few options.

The last few misconceptions – the idea that if it hurts, it’s dangerous. Again, we’re not encouraging people to go out and injure themselves or make themselves very sore. But something can hurt and not be harmful, the reason being is that it looks like when you have chronic back pain, your alarm system has started to misfire.” Dr. Kieran O’Sullivan

“Another misconception is that more treatment is always useful. We have a lot of evidence, and again this might sound like a bad business model for me to be saying this, that if you’ve got some back pain but you’re generally healthy and you’re able to cope and keep active, you would be better served by staying away from too many healthcare professionals and continuing to cope.” Dr. Kieran O’Sullivan