Pain Neuroscience Education

Can simply educating you about pain resolve your pain?

Pain is a normal human experience and the inability to experience pain provides a significant risk to survival for any human being. However, living in consistent pain is not a normal human experience and can be a powerful motivating force to seek help.

Traditional musculoskeletal education models have focused heavily on biomedical education focusing on anatomy, biomechanics, and pathoanatomy (how anatomical issues can cause a pathological experience i.e. pain). In these educational models, clinicians aim to explain a pain experience to patients from a tissue perspective, be it contrasting healthy and injured tissues, or highlighting a mechanical deviance from normal expected patterns of movement or a disease state such as degenerated tissues i.e. discs or cartilage. Although these models may have clinical value in more acute phases of injury, surgical, or disease states, they lack the ability to explain complex issues associated with pain, including issues with the peripheral and central nervous system such as central sensitization, facilitation and inhibition (issues of pain that are coming from the brain, spinal cord or peripheral nerves that are not due to anatomical deviances), neuroplasticity (how the brains neuronal connections are always changing), immune and endocrine changes, all of which have been implicated in more complex and persistent pain states. Countless studies have shown that these biomedical educational models not only show limited efficacy in alleviating pain and disability, but may even increase patient fears, anxiety, and stress, negatively impacting patient treatment outcomes.

This traditional model of explaining pain and its attempts to alleviate pain and patient disability needed an upgrade. People in pain are always interested in learning more about their pain, and this educational model upgrade of teaching people about pain biology and physiology is called pain neuroscience education (PNE). PNE aims to explain to patients the biological and physiological processes involved in a pain experience and, more importantly, take the focus away from issues associated with anatomical structures such as muscles, cartilage, discs etc. PNE has been shown to provide compelling evidence in reducing pain, disability, pain catastrophization, and limited physical movement.

The question is, where does PNE fit in with manual therapies like Osteopathy, Physiotherapy and Chiropractic? Do they work better together, or is PNE alone enough to reduce peoples pain?

A number of studies utilizing PNE without any therapeutic intervention were shown to be ineffective at reducing peoples pain levels. However, 5 of 6 of the most competent studies showed that when PNE is combined with a therapeutic intervention, physiotherapy or other, they were able to produce a significant reduction in the pain experience of the patient.

To conclude, the old approach of tissue damage equals pain, or that evidence of degenerative changes through X-ray or MRI or any other form of imaging is the evidence of a person’s pain, is no longer the go to answer in the modern pain neuroscience world. In order to resolve a patients pain, any practitioner involved in the treatment of pain should include pain neuroscience education alongside any therapeutic intervention to fully inform the patient about how the human body creates pain and processes pain.

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Kris Rai

Ostheopath