What is a really helpful model or understanding for a clinician listening that's working with patients or a patient themselves? What do you think is the most accurate model to our current understanding of pain that can produce meaningful insights and direction?

Yeah, look, I certainly resonate with the clinical move that you've just discussed there.

I think, I guess I would, I don't know that I have the perfect answer for that, but if I think about how I might frame this, I think it would be discussing this aspect of, I think what we're seeing here is... a variety of systems that are trying to protect you.

And what we think often can occur when pain lasts is that sometimes they become too sensitive.

So they respond really quickly and to stuff that normally doesn't.

before this happened wouldn't have been painful.

And oftentimes this can be things like allodynia, so pain with touch or thing, you know, that sort of aspect, that can be like a nice way to illustrate it.

Try not to say it depends, Tash.

So what do you actually do in the session? Do you simply teach people about how they're perceiving pain and why?

We try to make this, you know, very patient focused, so understanding the things that they're having challenges with, the things that they might want to do, but then also what their understanding of their condition is.

So it is actually asking a lot of questions to understand if there might be different beliefs, different knowledge, different understanding that is, first of all, either blocking them from undertaking something like exercise, but also that might be a contributor to pain.

I mean, anytime that you start to exercise, many people, for example, will get a flare-up of pain or stiffness or swelling, and for many people that's taken as a sign, "This isn't good for me," when in fact, when we kind of understand how pain works, what we realize is that there's quite good evidence in osteoarthritis that the pain system is oversensitive or hypersensitive, meaning that it's reacting to things that isn't necessarily damaging or dangerous to your joint.

But in order to get it less sensitive, you basically have to give that system a nudge.

You have to give it a stimulus for change, and exercise is great for that.But that allows us to start to reduce the overprotectiveness of the system.

So there's knee rehab programs to try and divert from knee replacement or delay knee replacement, but they don't often include this sort of conversation.

That's right.