The Protectometer

Original Editor - Bridget Ward

Top Contributors - Bridget Ward, Robin Tacchetti, Jess Bell, Admin, Kim Jackson and Vidya Acharya

What is the Protectometer?[edit | edit source]

Lorimer Moseley and David Butler created a revolutionary patient-targeted book called Explain Pain (EP) to help individuals understand and manage the causes of their pain.[1][2] The overall concept of this book is that the pain experience is constructed in the brain, it is individual and it can be changed.[3] A specialised tool highlighted in Explain Pain is the Protectometer, which is an imaginary internal scale that balances dangers on one side and safety on the other. When the body feels danger, it moves into a protective mode which can present in many different ways such as muscle spasm, pain, fatigue, anxiety, etc.[4]

DIMs and SIMs[edit | edit source]

The Protectometer uses the concepts of DIMs (‘Danger in Me’) and SIMs (‘Safety in Me’)  to help understand why we experience pain.[1][2] DIMs are things that the brain might see as credible evidence of ‘Danger In Me’’. They may be: things we hear, see, touch, taste; things we do; things we think and believe; places we go; people in our life; and things happening in our body.[1] SIMs are things the brain might see as credible evidence of ‘Safety in Me’. They may be in the same categories as the above.[1] Moseley and Butler propose that ‘You will have pain when your brain concludes that there is more credible evidence of danger in me than there is credible evidence of safety in me’.[1] The overall goal for self-management of pain is to effectively decrease DIMS while increasing SIMS.[3] Mosley and Butler describe their EP book and the concept of DIMS and SIMS in the video below:

How does this Relate to Neurophysiology?[edit | edit source]

DIMs and SIMs are hypothesised by Moseley and Butler to be represented by ‘neurotags’ in the brain - i.e. groups of neural networks that evoke outputs from the brain, including pain.[5] This is based somewhat on Melzack’s Neuromatrix theory.[6] Moseley and Butler propose that these neurotags can be modified and changed, to change the perception of pain, by using the EP approach.[7]

What’s the Evidence?[edit | edit source]

There is growing evidence that the EP approach, which includes the use of The Protectometer and the concepts of DIMS and SIMs, is effective in reducing pain and perceived disability in those with chronic musculoskeletal conditions.[8][9][10] Research is ongoing, looking at the EP approach when used alone, and as part of a multimodal treatment approach.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Moseley GL, Butler DS. Explain Pain Supercharged. Adelaide: Noigroup Publications, 2017 p. 15-18
  2. 2.0 2.1 Moseley GL, Butler DS. The Explain Pain Handbook: Protectometer. Adelaide: Noigroup Publications 2015
  3. 3.0 3.1 Hunter JP. The Explain Pain Handbook: Protectometer by GL Moseley and DS Butler. Physiotherapy Canada. 2016;68(3):310.
  4. Prowse T. General Management of Paediatric Pain Problems Course. Plus. 2022.
  5. Moseley GL, Butler DS. Explain Pain Supercharged. Adelaide: Noigroup Publications. 2017 pp. 19 -25.
  6. Melzack R. Phantom limbs and the concept of the neuromatrix. Trends Neurosci 1990; 13: 88-92 cited in Moseley GL, Butler DS. Explain Pain Supercharged. Adelaide: Noigroup Publications. 2017 pp. 19.
  7. Moseley GL, Butler DS. Explain Pain Supercharged. Adelaide:Noigroup Publications. 2017
  8. Moseley LG, Butler DS. Fifteen years of Explaining Pain: The Past, Present and Future. J Pain 2015; (accessed 8 Mar 2018)
  9. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56.
  10. Butler DS, Moseley LG. Evidence base of Explain Pain Second Edition. Adelaide. Noigroup Publications. 2013. (accessed 8 March 2018)