"a World of HURT: A Guide to Classifying Pain" Overview Interactive Live Webinar May 15&16, 2021

This two-day live interactive webinar introduces information critical to the assessment and treatment of patients with acute, sub-acute and chronic persistent pain. Translating pain mechanism research into clinical practice this webinar teaches pain clinicians when to use, how to classify and treat pain as it relates to the peripheral and central nervous system. A Pain Mechanism Classification System (PMCS) will be outlined and guide selection of patient education and active care interventions for each pain mechanism. The PMCS assessment will be demonstrated through video and paper case studies to aid application to pain clinicians’ practice. This webinar highlights a subgrouping framework, PMCS, which addresses the pain continuum from acute, subacute and chronic stages covering chemical, structural, mechanical, cognitive, emotional, social, psychological and cortical mechanisms. This webinar integrates pain science research into a biopsychosocial dynamic approach with breakout sessions of practical application for patient education and active care interventions. Promoting a common language between pain clinicians of all disciplines and patients. Included in this webinar, breakout sessions of active peripheral nervous system neurodynamic evaluation and treatment and central nervous system sensorimotor evaluation. The PMCS patient education and active care interventions support all patient ages and musculoskeletal to neurological diagnoses suffering from pain.

Speaker biography

Annie O’Connor, MSPT, OCS, Cert. MDT is Founder and CEO of a World of Hurt, LLC a dedicated consulting, teaching, telehealth and research company for the application of Pain Mechanism Classification System into MSD & Neurological clinical practice. In addition, she is a Clinical Manager at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago.  Annie has co-authored 2019, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach 3e, Liebenson C (ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2020 and 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 6 & 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection.  She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice”. Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings.  She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She teaches nationally and internationally the World of Hurt training courses, a six course training series designed for interdisciplinary application of the PMCS into clinical practice. She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain and neurological spasticity at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS) serving on the Exercise Committee, and McKenzie Institute. She continues to treat orthopedic, neurological patients, and canines with pain to achieve the best life possible through her Chicago based private practice and the Shirley Ryan Ability Lab.

Melissa Watson, MSPT, Cert. MDT is Vice President of the World of Hurt, LLC and assistant instructor for the World of Hurt six training courses. She received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Burr Ridge Outpatient Center with 17 years of clinical experience in neurological rehabilitation. Melissa is a Master Clinician and certified clinical instructor with the Shirley Ryan Ability Lab where she mentors other clinicians and students on their professional and clinical development.  She is a recognized mentor in utilizing Pain Mechanism Classification System for Neurological Patients with MSD Pain and Spasticity. She is practicing clinically in the Day Rehabilitation setting with a research interest in musculoskeletal pain and applying both pain classification and MDT principles within the neurological population for spasticity. She is currently leading a Day Rehab Pain Group Committee where she is leads other Day Rehab clinicians on a research supported pain science education group that are focused on pain science education and active care treatment for patients with centrally dominated pain throughout 6 sites of care facilitating a standard for education through inpatient and outpatient clinicians in a large system of care. She certified in Mechanical Diagnosis and Treatment – McKenzie Method. She is an instructor of the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.





The presenters Annie O’Connor and Melissa Watson will receive an honorarium for teaching this course.


Annie O’Connor and Melissa Watson have no relevant financial relationships.

Course Objective(s)

At the conclusion of this course, participants should be able to:

1)  Briefly differentiate subjective and objective clinical characteristics for nociceptive, peripheral neurogenic, central sensitization, affective and motor / autonomic pain mechanisms.

2)  Use the Yellow Flag Risk Form high question patterns to individualize pain science education. 

3) Understand the need for self-rated outcome measures and psychometric measures for central nervous system pain mechanisms.

4) Classify dominating pain mechanisms using PMCS with paper and video patient cases. 

5) Prescribe active exercise and patient education for peripheral and central nervous system pain mechanisms. 

Course Outline

Saturday, May 15, 2021 (7.0 CEU’s) All times are PST

8:00                 Course Introduction – [WoH: Forward xi]


8:20                 Lecture: Pain Mechanism Classification System (PMCS) – Definitions, Research, & Clinical Practice Considerations [WoH: pg 19-23; 26-31; 35-38; 41-50; 52-55]


9:30                 Interactive Workshop: Discussion how pain mechanism classification fits into your clinical practice? Role play foundational Pain Science Education topics.


9:45      Break


10:00               Lecture: Nociception Pain Mechanisms Subjective & Objective Characteristics - Patient Education and Active Care Intervention [WoH: pg 59-104;102-104] [WoH: pg 64-65; 77-79]


11:00                Interactive Workshop: Nociception Paper Cases Classification Exercise


11:30                Interactive Workshop: Directional Preference Extremity


12:00    Lunch 


1:00                  Lecture:  Peripheral Neurogenic Pain Mechanism (PNPM) Subjective & Objective Characteristics – Patient Education and Active Care Intervention [WoH: pg 105-185; 183-185, 150-166]


1:45                  Interactive Workshop: PNPM Paper Cases Classification Exercise          


2:00      Break


2:15                  Interactive Workshop: Neurodynamic Evaluation Upper and Lower Limb Active Tests & Exercise [WoH:  pg 158-166]


3:15                  Case Study: Video or Live Demonstration: PNPM


4:15                  Debrief Day 1: Question & Answers


4:30      Adjourn


Sunday May 16, 2021 (7.0 CEU’s) All times are PST


8:00                  Lecture: Central Sensitization, Affective, Motor/Autonomic Pain Mechanisms

Subjective & Objective Characteristics – Patient Education and Active Care Interventions [WoH: pg 222-223; 202-203; 260; 327-328]


9:15                 Interactive Workshop: CNS Paper Cases Classification Exercise


9:45      Break


10:00                Words Workshop: Central Sensitization & Affective Pain Mechanisms CBT Pain Science Education and Active Care Intervention and Video Patient Cases [WoH: pg 204-209,216-218,236,261-263, 272-280 281,316,335-343]; introduce the Yellow Flag Risk Form [WoH: pg 258]; Patient Education Handouts [WoH pg ix, 39-40, 82-83, 206-215; 264-265, 269-271,276-277, 337-338]; Psychometric Tests – FABQ [WoH: pg 198-199], PASS [WoH: pg 257], PHQ-9 [WoH: pg 257]


11:30                Lecture: Documentation and Goal Setting


12:00    Lunch


1:00                  Interactive CBT Workshop: Role-playing clinician and patient pain science topics: Explaining CNS mechanisms, Traffic Light Guide to Movement Safe Pain, Pain Journal, Batteries Exercise



2:00     Break   


2:15                  Interactive Demonstration: Motor / Autonomic Pain Mechanism Left / Right Discrimination Evaluation Demonstration and Video Patient Case [WoH pg 328-335]


3:45                  Summary of Pain Mechanisms – “Lamp Analogy – 5 Steps to a Pain free Life” 


4:15                  Debrief Day 2: Question & Answers


4:30      Adjourn



Saturday, May 15, 2021 8am-4:30pm PST

Sunday, May 16, 2021 8am-4:30pm PST

Online via ZOOM. 

Registration Information

Target Audience: This course will benefit Physical and Occupational Therapists, Chiropractors, Osteopaths, Physical Therapist Assistants, Occupational Therapy Assistants, Medical Doctors, Psychologists, Athletic Trainers, Massage Therapists, Personal Trainers and any other practitioners who are involved in treating musculoskeletal pain.

Registration Fee: The registration fee is $250 for Providence caregivers, $450 for all other registrants.

The " a World of HURT: A Guide to Classifying Pain"  Book is recommended for this course.  If you need to purchase a book, please email Joanna.mullett@providence.org for information on how to purchase a book at the discounted price of $55.

Refund Policy: Full refunds less a $25 administrative fee will be granted if cancellation is requested by May 1st, 2021. No refunds will be made after that date unless the course is cancelled by Providence Rehabilitation Services, in which case full refunds will be issued.

Contact Hours: This course qualifies for 14.0 contact hours for Physical Therapists, Physical Therapy Assistants, Occupational Therapists, and Occupational Therapy Assistants in Oregon. Providence is also an approved provider for physical therapy continuing education in New York State. This course may be approved for other disciplines and states, please email rehab.courses@providence.org if you have questions regarding CEUs.