Does back pain mean damage? Lorimer Moseley's red light test

In a TEDxAdelaide talk called Why things hurt (2011), the pain scientist Lorimer Moseley described an experiment from Moseley's own research team. Volunteers had a very cold piece of metal placed on the back of the hand while they were shown one of two lights, red or blue. Nobody told them what the lights meant. They were simply asked how much it hurt. When they saw the red light, it hurt more. In that talk, Moseley summed up the result in one line:

"The stimulus is exactly the same, what's different is the meaning of the stimulus."

Lorimer Moseley, TEDxAdelaide, 2011

The idea in plain words

Red means hot. So, Moseley explained, the sensible response to a cold touch that might be a burn is to make it hurt more, and get you to pull away. Nothing about the metal changed. What changed was how much protecting the body seemed to need.

That is the point the 1h Protocols back pain program builds on. Pain is real, but it isn't a damage meter. It works more like an alarm, and its volume moves with how protected your body feels. A back can hurt a lot on a day when nothing new has happened to it: the morning after a poor night, in a heavy week, or after someone has told you your spine is "crumbling".

Meaning matters for backs in a very ordinary way. In interviews with 23 adults with back pain in New Zealand, many said they had protected their back for years, often because of something a clinician had told them about it (Darlow et al, 2013). The words stayed with them long after the visit.

What the research adds, and where it stops

Moseley and the pain educator David Butler describe the aim of explaining pain as a shift: from seeing pain as a marker of tissue damage to seeing it as a marker of the perceived need to protect the body (Moseley and Butler, 2015). Both have an interest here: Butler directs Noigroup, which runs Explain Pain courses, and both receive royalties from the Explain Pain books.

Australia's national care standard for low back pain gives the reassuring part in numbers: more than 95% of low back pain cases do not have a serious underlying cause (ACSQHC, 2022).

Knowing this doesn't change much on its own, though. In a trial with 202 adults with new low back pain in Sydney, two one-hour sessions of pain education did no better for pain at three months than placebo sessions of listening without advice. Moseley was one of the authors (Traeger et al, 2019). The idea seems to matter most when it changes what you do on a bad day.

Serious causes of back pain are rare, and the program's check for warning signs comes first: its questions are a reason to get checked, not a sign that something is wrong. If a new flare isn't getting better after a few weeks, keeps getting worse, or worries you, see a doctor.

How this fits the Manage back pain program

In the 1h Protocol to Manage Back Pain, a quick check for warning signs comes first. Then chapter 1, "Why it keeps coming back", starts from your own last bad back day and shows three parts in it: the Alarm, the Guard and the Load. The Alarm is Moseley's idea in the program's words: pain is real, but it isn't a damage meter, and its volume moves with how protected your body feels, including after a poor night or a heavy week. The first chapter is free, so you can find your back-day pattern before you decide.

Source: TEDxAdelaide, Lorimer Moseley, Why things hurt, 21 Nov 2011 Research: Moseley and Butler, 2015 · Traeger et al, 2019 · Darlow et al, 2013 · ACSQHC, 2022