Dr. Morten Høgh: Neuroscience-based pain management

Modern physiotherapy increasingly recognises that pain is not merely a symptom of tissue damage, but a complex, context-dependent experience shaped by neurobiology, expectation, learning, memory, social factors, and biological homeostasis. In this webinar, Dr. Morten Høgh—specialist musculoskeletal and sports physiotherapist and co-author of Smertebogen—presents a deeply evidence-based and clinically practical framework for understanding and treating pain using contemporary neuroscience.

Drawing on the European Pain Federation Core Curriculum and decades of research, the session explains why nociception is an ideal but not sufficient trigger for pain, why pain intensity varies with context, and how clinicians can use mechanism-based reasoning to recognise hyperalgesia, sensitization, and the powerful role of descending modulation. The webinar integrates laboratory insights (e.g., peripheral and central sensitization, phenotypic neuronal changes, allodynia) with real-world clinical assessment and decision-making, emphasising how neuroscience helps clinicians distinguish injury, inflammation, sensitization, and widespread pain mechanisms.

Dr. Høgh uses vivid clinical demonstrations—including hyperalgesia and allodynia on injured skin, and the P4 test provoking “known pain” at the SIJ—to illustrate how clinicians can interpret nociceptive responses, differentiate inflammatory from non-inflammatory mechanisms, and avoid common diagnostic pitfalls such as nominal structural labels (“derangements”, “instability”, or other “tooth-fairy diagnoses”). The course also discusses placebo/nocebo science and the neural basis of expectancy, highlighting how therapeutic alliance and patient education directly modulate pain processing.

By the end, clinicians will be able to apply a neuroscience-based framework to acute, persistent, and complex pain presentations and integrate these concepts into communication, education, and treatment planning.

Learning Goals

1. Critically appraise the distinction between nociception and pain and evaluate how multisensory input, learning, memory, and contextual factors interact to shape clinical pain presentations.
2. Analyse sensitization mechanisms (peripheral, central, descending modulation) and interpret their clinical manifestations such as hyperalgesia, allodynia, and widespread pain.
3. Evaluate the diagnostic limitations of structure-based labels (e.g., “derangement”, “instability”) and apply mechanism-based reasoning to differentiate inflammatory, nociceptive, and non-nociceptive contributors to pain.
4. Integrate neuroscience-based assessment strategies—including interpretation of primary vs secondary hyperalgesia—into clinical decision-making for acute and persistent pain.
5. Design patient-centred education and intervention strategies that leverage evidence-based principles of expectancy, therapeutic alliance, and descending pain modulation.