Today we’re talking with Matthias Weinberger, a German physical therapist who has a great understanding of newer treatments for pain - and is able to explain them with flair.  I’ve asked him to comment about his work and help us understand newer theories of pain.

How To Cope With Pain:  How did you choose physical therapy?
Matthais Weinberger:  I was born in 1973, attended all the schools that one needs in order to have a stellar career ;)  served in the German Army for a year (we still have the draft), and tried working for an insurance company for 2 years, sitting in front of a computer all day long.  I finally found my true calling - physical therapy, which I’ve been doing for 8 years now.

HtCwP:  What is your clinical practice like?  Are you doing research, too?
MW:  I work at a newly-opened outpatient clinic in Germany.  Roughly 1/2 my time is spent treating patients in an intensive rehabilitation program (3-4 weeks of care), and the other 1/2 is with a variety of outpatients.

I’m not doing any research per se - I see myself more as someone who’s taking all the new and exiting scientific findings, and incorporating them into daily practice.  A lot of studies that are done work only in the lab - because they’re time-consuming or because of some restrictions like expensive equipment.  My goal is to find a way to make the treatments practical, so more people can benefit from them.

Lateral thinking is my specialty - always has been - and so I see connections between different fields of study that in the end form a bigger picture - about ourselves, our brains, and about pain and its treatment.  It’s this approach that has helped me understand what the Neuromatrix theory of pain is all about - and develop ideas about possible ways to treat chronic pain.

A few years ago, for example, I described a way to treat pain in paraplegics by visual feedback.  However, I didn’t have the resources to do it myself.  Imagine my surprise when a few months ago Lorimer Moseley published a study that did just that.  There are others out there who are doing the research - I can sit back and relax.

My job really is explaining what’s happening in neuroscience to my colleagues and to lay people.  That’s what I’m good at - and that’s what I want to do.

HtCwP:  How did you get interested in working with patients with pain?
MW:  It comes with the PT territory really.  Most of my patients have some form of pain - in addition to restricted movement, poor posture and other ailments.  Often a full range of motion was restored very early on in treatment, but despite an obvious improvement in function, the pain persisted.

After reading the work of Ramachandran, I realized that pain and injury don’t necessarily go together, but that pain is a second “illness” that has to be treated on its own.  I can’t stress this enough:  pain is something that stands on its own.  Pain doesn’t need injury.  If the brain thinks something isn’t right, pain can be the signal that tells us to please go and have a look.

HtCwP:  What pain disorders do you treat most often?
MW:  My specialty is back pain.  Another area of great (and personal) interest is chronic tendonitis, especially Achillodynia [Achilles tendon in your heel - HtCwP].  Although some recent work has revolutionized this field, we still need to focus on changes in the brain that happen at the same time, as well as changes in the tissues.

HtCwP:  Do you use graded motor imagery treatment?  mirror imagery work?  other similar things?
MW:  I haven’t had that much opportunity yet to work with the first 2 treatments.  However, in treating low back pain, I help people strengthen their back muscles, and give them verbal confirmation and touch feedback.  Visual feedback is difficult because we can’t see our own backs – this is another reason why we’re more prone to develop chronic painful problems there.  I’ve had some astonishing results with this technique over the years.

HtCwP:  What’s your understanding of how these things work to relieve pain?
MW:  I base most of my understanding on Harris’ thesis that pain is like motion sickness:  there’s a part of the brain that compares movement intention, visual feedback and movement execution.  If these 3 pieces of data don’t add up, pain is the result.

If you “show” your brain center that your arm or leg is moving as intended, the pain is gone.  In the long run, the maladaptive processes in the somatosensory cortex vanish, and the pain stays gone forever.

Also, the brain is incredibly lazy.  It builds maps and memories, and instead of really looking, it just retrieves the information it needs from those maps and memories.  The unfortunate thing is that these degrade over time and don’t represent the real situation - and that leads to pain. That’s why feedback therapies work - they refresh the cortical representation, and the brain is able to make sense of the situation again.  The pain stops.

Several studies have shown that people with chronic pain conditions have less cortical grey matter than those without pain.  My take on this is that the brain is hard-wired for the painful condition.  It doesn’t need all the extra grey matter because there’s nothing to be updated and processed.  In chronic pain, the brain has decided that pain is all there’s ever going to be, so why not reduce all the space that’s devoted to learning something new?

By giving feedback - tiny bits of data at first - you try to convince the brain that there are still things out there worth having a second look at.

HtCwP:  Can you give us a couple of clinical examples?
MW:  Well, Ramachandran had a patient who had lost one hand, and was instructed to perform mirror exercises, after which the phantom pain went away.  Ramachandran called it the first successful amputation of a phantom limb.

The best example for other painful problems is myself.  I had an unfortunate accident while mountain-biking a few years ago.  I landed on my head - the helmet shattered in a few places.  Since then, I have very tight neck muscles on my right side only, especially in the mornings.  The best treatment is simply using a back scratcher over those muscles for as few as 30 seconds.  After that, I can turn my head without any discomfort.  This tiny bit of feedback of a different sensation is enough for my brain to conclude that there’s nothing wrong in that area and relax the muscles.

HtCwP:  You recently started a blog, “The Neurotopian”… what got you interested in that?  How do you like doing that?
MW:  I started reading blogs a few years ago and always liked what I saw.  Blogging is truly a very innovative invention.  Everybody who has something to say can share pieces of his/her knowledge on the web.  And since sharing is like trading – everybody wins!

HtCwP:  Any comments about your photography?

MW:  More about Art as a whole.  Having discovered photography about 3 years ago, I became obsessed with it about a year ago.  It’s amazing to see how the whole creative process changes one’s personality (or vice versa).

HtCwP:  Anything else you’d like to add?
MW:  Thanks for the opportunity to introduce myself.

Thanks to Matthias for some great information!  Matthias will also be participating in my September pain blog carnival, so look for more of his thoughts then.  -HtCwP

*** Only 2 more days to enter our contest, Your Most Creative Way To Relax!

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