The Shoulder Physio Podcast #47: Active Inference, Pain, and Movement with Dr Mervyn Travers
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May 27, 2025 Dr. Mervyn Travers, a physiotherapist and strength coach, dives into active inference, a cutting-edge concept in pain science. He explains how our brains predict bodily responses, reshaping our understanding of persistent pain. Mervyn emphasizes the importance of movement experimentation in recovery and the need to rethink how exercise is prescribed in pain management. He also highlights the influence of culture and prior beliefs on pain perception, advocating for compassion and nuanced approaches in patient care.
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Brain as Prediction Machine
- Active inference views the brain as a predictive machine minimizing surprise or prediction error to maintain preferred biological states.
- Pain and conscious experiences are predictions that the brain confirms or updates via sensory inputs and actions.
Pain Beyond Tissue Damage
- Pain is a conscious experience shaped by prior beliefs, culture, and social context, not only tissue damage.
- What patients are told and expect influences their pain perception as much as biological factors.
Explore Patients’ Pain Beliefs
- Clinicians should deeply explore patients' pain beliefs and social context to understand their internal pain model.
- Accept that some patients’ models are fixed and this reduces clinician burnout and unrealistic expectations.
