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If you’ve ever helped a client feel better while secretly doubting the explanation you were taught, this conversation is for you. Pain researcher Mark Johnson joins me to interrogate the quiet “hidden curriculum” in modern health care: a WEIRD, tissue-centric worldview that can be lifesaving in acute injury but can also trap both clinicians and patients when pain lingers. We talk about why the biomedical model still matters, and why it can also reach a point where it stops being the best guide for what happens next.

We get specific about how pain is shaped by more than anatomy. Mark explains how metaphors and word choice can change physiology through threat and vigilance, why militaristic “battle” language can backfire, and how labels like “chronic” may act as a nocebo by making pain feel permanent and identity-defining. We also explore prediction, priors, and “past adversity influencing now,” not as a moral failing or “maladaptation,” but as adaptive systems responding to an environment that often mismatches our biology.

To hold the complexity without drowning in the biopsychosocial checklist, Mark introduces an integral AQAL lens: inner experience, outer physiology and behavior, shared systems and environments, and shared culture and meaning. From there we move toward salutogenesis and a practical “sense of coherence” built on comprehensibility, manageability, and meaningfulness. We finish with hands-on takeaways for manual therapists: soothing touch, careful reframing, and community-based support like health coaching that helps people rebuild a workable story around their lives.

If this reframes how you talk about pain in the room, subscribe, share the episode with a colleague, and leave a review so more clinicians can find it. What word or phrase about pain are you ready to stop using?

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