Prediction, pain, and the power of context: toward a contemporary identity for the chiropractic profession
Newell, Dave, Segal, Solomon, Rossettini, Giacomo, O'Neill, Soren, Lothe-Raven, Tim, Lothe, Lise, Weiniger, Steven, du Rose, Alister, Beira, Brad, Walker, Keith, Esteves, Jorge E and Thacker, Mick (2026) Prediction, pain, and the power of context: toward a contemporary identity for the chiropractic profession. Chiropractic and Manual Therapies. ISSN 2045-709X (In Press)
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Newell D CMT 2026 full article OA.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Background: Musculoskeletal (MSK) pain is a leading cause of disability worldwide, with low back and neck pain among the largest contributors to years lived with disability. For many people with persistent pain, mechanisms are increasingly understood as arising from altered regulation at multiple loci rather than simple ongoing tissue injury. This challenges chiropractic’s long-standing reliance on body focused explanatory models centred on correcting structural lesions or dysfunction. Main Body: Active Inference (AIF) provides a contemporary framework for understanding pain perception as an embodied, context-sensitive process of sense-making. Here, inferences concerning threat or safety are informed by information generated across multiple interacting levels (neural, physiological, psychological, behavioural, and socio-cultural), and pain emerges when threat-related inferences remain persistently weighted as trustworthy. From this perspective, manual therapy may be understood as a coherent ensemble of interacting sensory, affective, interpersonal, and contextual cues that together reshape expectations, meaning, and action. We revisit the concept of Contextually Aided Recovery (CARe), a lens that sees the therapeutic encounter as a rich space of potential contextual modulation and affordances and argue that chiropractic’s distinctive contribution lies in combining skilled manual contact with the deliberate shaping of context to support adaptive regulation. Conclusion: We propose that integrating AIF and CARe offers the chiropractic profession a coherent, evidence-aligned route toward a more contemporary identity, with implications for practice and education.
| Item Type: | Article |
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| Additional Information: | The journal has provided an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. |
| Schools: | AECC School of Chiropractic |
| Depositing User: | Jessica Tovey |
| Date Deposited: | 13 Aug 2026 14:20 |
| Last Modified: | 13 Aug 2026 14:20 |
| URI: | https://hsu.repository.guildhe.ac.uk/id/eprint/667 |
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