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Unlocking the Mystery of Pain

Pain is a complex and often mysterious sensation that everyone experiences at some point in their lives. While we often associate pain with physical injury, it is essential to understand that pain is not solely determined by the extent of tissue damage. Pain neuroscience is a fascinating field that delves into the science behind pain, it’s causes, and how it is experienced. Pain Neuroscience Education (PNE) is a form of treatment that is designed to help individuals comprehend their pain experience. In this blog post, we'll explore the basics of pain neuroscience and how PNE can help us understand the pain experience in a simple and easy-to-understand manner.

The brain plays a crucial role in interpreting and modulating pain signals. Without the brain interpreting the information that is coming from our nerves and receptors, we would not experience a variety of sensations including hot, cold, pain, touch, etc. The main purpose of the pain response is to be a protective mechanism. If you hold your hand over a candle, you will eventually feel pain. But you will feel pain before permanent tissue damage to your skin and deeper structures. The brain is interpreting the increased heat on your skin as a threat and is sending signals (pain) telling you to remove your hand from the flame. If you leave your hand over the flame for too long, tissue damage will occur, and you will have pain that gradually improves until the damage heals. The length of healing time depends on the extent of injury. The body typically heals itself in a predictable fashion. That is why surgeons, doctors, and physical therapists know about how long you will need to wear a cast after a broken arm, or how long to protect a joint after surgery or injury. But what happens when pain lasts long after tissue damage has healed? Pain is not just a result of signals from damaged tissues. Our pain experience can sometimes be influenced by various factors including emotions, thoughts, beliefs, stress and past experiences.

Studies have shown cortical organizational changes in the brain in individuals with chronic pain, specifically chronic recurrent low back pain. Chronic is typically described as > 3 months, however this does not mean that changes in the brain happen at the 3-month point. What this describes is that there are actual physiologic changes that happen in the brain due to the chronic pain that can perpetuate the problem, impact movement patterns, and muscle function. In addition, the central nervous system, which consists of the brain and spinal cord can become sensitized. Which means that the nervous system can become more sensitive to stimuli and can start to perceive things that did not used to be painful as a threat and send pain signals. Picture a car alarm that is too sensitive and instead of someone having to break a window or ding the door, all they must do is brush up against it and the alarm goes off. That can be how our central nervous system responds. Remember that the brain interprets signals and determines what to do about it and if this system is sensitized then it can send pain signals where no tissue damage or threat exists.

“So, if there is no tissue damage, then you are saying all the pain is in my head?” No, absolutely not, the pain is real. Remember the only reason we feel pain in the first place is because the brain says we should. And in the case of chronic pain, the brain is saying that there is pain and so you experience pain. The system is faulty, and it needs to be corrected. Our brains have an incredible ability to change and adapt, known as neuroplasticity. This concept is fundamental to understanding how pain works. Neuroplasticity means that our nervous system can reorganize itself and heal, which can affect our pain experience. PNE helps individuals harness the power of neuroplasticity for better pain management.

Pain is an extraordinarily complex topic that is multifactorial and personal! In fact, each person's experience of pain is unique. Factors such as genetics, environment, and psychological state contribute to how we perceive and respond to pain. Unfortunately, chronic pain can turn into a downward spiral. There is a cycle where pain alters your behavior and beliefs, and limits your function and activity. This altered behavior and inactivity then typically raises pain levels which then starts the cycle over. PNE emphasizes the individualized nature of pain, encouraging a personalized approach to treatment.

PNE adopts the biopsychosocial model, which considers biological, psychological, and social factors that contribute to pain. By addressing all aspects of an individual's life, PNE provides a holistic approach to pain management. Understanding the neuroscience of pain empowers individuals to break the cycle of chronic pain. PNE teaches techniques and strategies to reframe thoughts, manage emotions, and promote positive neuroplastic changes, helping to alleviate persistent pain.

Education is key! However, it does require the recipient to be open to the information that is being provided, and open to trying to make changes that can break the pain cycle. PNE is not just about imparting knowledge but also about using education as a therapeutic tool. When individuals understand the science behind their pain, it can lead to reduced fear, anxiety, and stress, contributing to overall pain relief. The mind-body connection is a central theme in PNE. Emotional well-being, stress management, and relaxation techniques play a crucial role in influencing the perception of pain. By fostering a healthy mind-body connection, individuals can achieve better pain outcomes.

PNE is not limited to clinical settings. It provides practical tools that individuals can apply in their daily lives. From mindfulness practices to cognitive-behavioral strategies, incorporating PNE principles enhances overall well-being.

Pain neuroscience education offers a refreshing perspective on pain, emphasizing the interconnectedness of mind and body. By unraveling the mysteries of pain through education, individuals can take an active role in managing and overcoming their pain. Here at Healthwise Physical Therapy, our therapists are trained in PNE, and are here to facilitate the mind-body connection to improve your life and function.

Avery Levonuk, PTA

Specialty Certification in Orthopedics

Brendon Boyd, PT, DPT

Board-Certified Clinical Specialist in Orthopedic Physical Therapy


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