Understanding the science behind pain can be a powerful tool in combating your chronic pain. Pain Neuroscience Education (PNE) (otherwise known as Therapeutic Neuroscience Education) is the cornerstone of modern pain treatments, and for good reason!
This study states that, “The use of pain neuroscience education (PNE) has been shown to be effective in reducing pain, improving function and lowering fear and catastrophization.”
Understanding what’s happening in your body
When you’re dealing with any illness, often the unknown is what is most frightening. Having a long-term pain condition and not understanding what is causing it or how it works can feel worrisome.
This study explains that pain education can be individualized: “Pain neuroscience education incorporates the multidimensionality of a pain experience and helps patients reconceptualise pain through understanding the multiple neurophysiological, neurobiological, sociological and physical components that may be involved in their individual pain experience”.
This essentially means that knowledge you can gain from PNE enables you change the way you think about pain, allowing you to introduce new coping methods, effectively changing your experience of pain.. PNE can replace fear and uncertainty with reassurance and empowerment.
Understanding that chronic pain doesn’t equal damage
Acute pain (the kind you get when you have injured yourself) is an alarm system. You’re supposed to take notice because this type of pain is telling you that something is wrong! Even though chronic pain is a faulty alarm system, meaning it isn’t indicating damage, it can be hard to turn off that innate reaction to pay attention to your pain.
Often this natural reaction to focus on pain, can lead to hypervigilance. This means that pain patients are paying so much attention to their pain that it becomes detrimental. This study explains, “individuals who live with chronic or recurrent pain may develop a pain-specific ‘hypervigilance’ as a result of continual effort to detect painful sensations and other pain-related information, which may in turn exacerbate the pain experience”.
This hypervigilance can often lead to catastrophizing. This means patients are worried about their pain constantly and even anticipating pain in situations that haven’t happened yet. Hypervigilance and catastrophizing can be highly emotionally distressing and can often reduce functioning.
The perception that pain equals damage can make people fearful that they are going to make their pain worse or harm themselves by engaging in activity. This often leads to people avoiding specific activities. A patient might avoid activities which have previously caused pain or an initial injury- this behaviour is known as fear avoidance.
Fear avoidance can severely limit functioning, which in turn can lead to deconditioning. This simply means that muscles become weakened when they are not being used, and your body becomes less fit. This has an effect on your general health. When you do then try to engage in activity, it becomes even more painful because your body is not physically prepared for it. This often compounds the fear avoidance, as the activity did cause pain, so the patient thinks they were doing the right thing by resting.
Anticipating pain can also increase pain, as this study explains, “Fearful anticipation of pain seems to pre-activate brain regions involved in both the sensory and emotional intensity of pain and primes a stronger initial pain response”.
Learning about pain science can give you the knowledge that chronic pain doesn’t equal damage. This can quell hypervigilance,catastrophizing and fear avoidance as patients realise that the pain they are in isn’t dangerous, even though it’s painful. This study explains that, “Education focused on helping patients re-conceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system can enhance pain self-efficacy”.
Being constantly stuck in a state of high alert and worry can really take its toll on your body as well as emotional state. Your body is not designed to be in this state of ‘fight or flight’ for a long period of time. Therefore stress can actually increase your chronic pain. Of course, chronic pain is stressful to deal with. So, stress causes pain and pain causes stress: it becomes a vicious cycle.
Learning about your pain can help to reduce that stress. As you tackle incorrect and frightening beliefs about chronic pain and instead replace them with knowledge and empowerment, stress can be reduced. This can help you to break the stress and pain cycle, in turn reducing your pain.
The way that patients perceive their pain is often a major barrier to increasing their functioning. By tackling fear of pain and replacing it with a sense of confidence, functioning can start to be increased.
Once fear is quelled, patient’s are more likely to engage in activities which they have previously avoided. Often the knowledge that it’s safe to engage in activity can be enough to encourage patients to increase their activity levels. Patients may start to engage in exercise, to get back to work and regain general daily functioning.
As functioning increases, the body becomes stronger and reconditioned: this reduces pain! This study states that through pain education, “altered cognitions may change the pain experience, thus resulting in reduced pain and increased function”.
Calming an overactive pain system
Hypervigilance can also contribute to central sensitization, essentially increasing pain messages because patients are so aware of them. This study states that, “chronic pain patients have a heightened sensitivity to pain (e.g. low threshold and tolerance) because of increased attention to external stimulation and a preoccupation with pain sensations“.
As PNE reduces this fear, it is also reducing this sense of situations being threatening. This changes the feedback being sent to the brain, over time helping to teach the brain that these situations do not need to cause pain as explained here.
Helping you replace maladaptive behaviours with adaptive behaviours
How patients perceive their pain can vastly influence their behaviours. Often pain patients will engage in maladaptive (meaning unhelpful) behaviours which increase their pain, reduce functioning and make coping more difficult as this study explains. Maladaptive behaviours can include avoiding exercise, not sleeping on a regular schedule, not eating well, withdrawing socially and more.
As patients change their beliefs and realise that they can take control of their pain, they are able to replace these behaviours with adaptive (helpful) behaviours. Often patients will start to socialize again, engage in regular gentle exercise, practice self-care and take responsibility for their own recovery. These adaptive behaviours not only help patients to cope more effectively, but actually help to reduce pain levels.
Improving mental health
Being in pain all the time, not being able to do the things that you used to enjoy and living in a state of fear and stress, can undoubtedly have a serious impact on mental health. It’s common to feel as though you are powerless against your chronic pain, unable to do anything to improve it. This study explains that “Barriers to greater pain self-efficacy for many patients are misperceptions or misunderstandings about pain.”
This sense of not being able to do anything about your pain is far from true. There are plenty of ways that you can effectively manage your chronic pain and regain functioning. By learning about the science behind pain, you can start to see clearly that you can actively improve things. Instead of feeling helpless and hopeless you can learn to live well despite your chronic pain! You can feel empowered and in control!
An understanding of why and how therapies work
With a renewed sense of confidence in moving and being active, patients can engage in therapies which can retrain their brains away from pain. These therapies can help to reduce symptoms, build fitness and tackle chronic pain.
Patient’s perception of the treatment offered for their chronic pain can vastly influence its outcome. If a patient is in the mindset that their pain cannot be treated, they are less likely to engage and follow through with therapy as explained here.
Knowing the science behind pain can allow patients to reframe their perception of therapies which may be suggested by their doctor. They can understand why these therapies are suggested and how they can help.
Pain Neuroscience Education as part of pain treatments
This study on using PNE as part of physiotherapy explains that, “educating the patient to re-conceptualize pain is a strategy through which physical therapists can foster self-efficacy, build relationships with patients, and enhance autonomous motivation, thus promoting behaviour change”.
This study focused on a case study of one woman, combining educational aspects with graded exercise, and manual physiotherapy techniques. They found that she thrived after this multimodal approach, concluding that she had the “ability to return to full work and no pain complaints.”
When used as a basis for other therapies, pain education can be highly effective in: “reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.”
You can ask your doctor about pain education. You may find that treatments you are referred to already incorporate PNE and if not, you could ask your therapist about it. You can learn more about pain science online through your own research, or even through a chronic pain relief app.
- Physiotherapy Theory and Practice, An International Journal of Physical Therapy, Volume 30, Issue 3, Kory Zimney , PT, DPT,Adriaan Louw , PT, MAPPSC, PhD, Emilio J. Puentedura , PT, DPT, PhD, (2014), “Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report”
- International Journal of Health Sciences, Vol. 2, No. 3, pp. 33-45, Adriaan Louw, Emilio J Puentedura, (2014), “Therapeutic Neuroscience Education, Pain, Physiotherapy and the Pain Neuromatrix”
- Physiotherapy Theory and Practice, An International Journal of Physical Therapy, Volume 32, Issue 5, Adriaan Louw , PT, PhD,Kory Zimney , PT, DPT,Emilio J. Puentedura , PT, DPT, PhD, Ina Diener , PT, PhD, (2016), “The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature”
- South African Journal of Physiotherapy, Adriaan Louw, Emilio J. Puentedura, Ina Diener, et al, (2019), “Pain neuroscience education: Which pain neuroscience education metaphor worked best?”
- BMC Musculoskeletal Disorders, Elizabeth Lane,Julie M. Fritz, Tom Greene, Daniel Maddox, (2018), “The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial”
- Journal of Rational-Emotive and Cognitive-Behavior Therapy, Jonathan M. Borkum, (2010), “Maladaptive Cognitions and Chronic Pain: Epidemiology, Neurobiology, and Treatment”
- Annals of Behavioural Medicine, Matthew S. Herbert, M.A.,Burel R. Goodin, Ph.D.,Samuel T. Pero, IV, B.S., et al, (2014), “Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis”
- PAIN, Volume 66, Issues 2–3, Pages 133-144, Ann J McDermid, Gary B Rollman, Glenn A McCain, (1996), “Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification”
Please note: This article is made available for educational purposes only, not to provide personal medical advice.