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Pain Science Education - Part One

What is it and how can it help your patients

Posted on 03/21/2025 12:46
Tags: education | pain | pain management | physical therapy |
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Physical therapists working with patients with (chronic) pain should consider use of Pain Neuroscience Education to help this population reach their goals.

Pain is a normal human experience, and without the ability to experience pain, people would not survive. (1) 
Living in pain, however, is not normal. (2) 

We often treat patients in physical therapy who have been struggling with pain for extended periods of time.
Frequently it is difficult to overcome and seems to be impossible to resolve.
One strategy to help people experience less pain and disability is to explain to people the biology and physiology of their pain experience.(3) 

Much of our education as physical therapists guided us to educate patients on the anatomical and biomechanical aspects of pain.
While this may be of great value for acute injuries or immediate postoperative periods, for chronic pain these traditional models may not only be limited in their efficacy but also induce fear. (4) 
It has been proposed that this dichotomy of teaching people suffering from pain about anatomy, versus pain science, may be a reason why educational models often fail.(5)

Pain neuroscience education (PNE), also known as therapeutic neuroscience education (TNE), consists of educational sessions for patients describing in detail the neurobiology and neurophysiology of pain and pain processing by the nervous system. (6) 

This educational approach has been used by physical therapist since 2002 in various countries and differs considerably from traditional education strategies such as back school and biomechanical models. (7) 

This is due to how likelihood of pain chronicity may not likely be caused by unhealthy or dysfunctional tissues but brain plasticity leading to hyper-excitability of the central nervous system, known as central sensitization. (8)

 

References

  1. Moseley GL 2007a Reconceptualising pain according to modern pain sciences. Physical Therapy Reviews 12: 169–178
  2. Butler DS, Moseley LS 2003 Explain Pain. Adelaide, NOI Publications.
  3. Louw A, Butler DS 2011 Chronic pain. In: Brotzman SB, Manske RC (Eds), Clinical Orthopaedic Rehabilitation, 3rd edn. Philadelphia, PA, Elsevier.
  4. Greene DL, Appel AJ, Reinert SE, Palumbo M A 2005 Lumbar disc herniation: Evaluation of information on the internet. Spine 30: 826–829.
  5. Butler DS, Moseley LS 2003 Explain Pain. Adelaide, NOI Publications
  6. Louw, A., Diener, I., Butler, D.S. and Puentedura, E.J., (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation, 92(12), pp.2041-2056.
  7. Clarke, C.L., Ryan, C.G. and Martin, D.J., (2011). Pain neurophysiology education for the management of individuals with chronic low back pain: A systematic review and meta-analysis. Manual therapy, 16(6), pp.544-549.
  8. Nijs, J., Girbés, E.L., Lundberg, M., Malfliet, A. and Sterling, M. (2015). Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Manual therapy, 20 (1), pp. 216-220.
  9. Autio, R. A., Karppinen, J., Niinimaki, J., et al. (2006). Determinants of spontaneous resorption of intervertebral disc herniations. Spine, 31(11), 1247-1252.
  10. Louw A. (2014). Therapeutic Neuroscience Education: Teaching People About Pain
  11. Zimney K, Louw A, Puentedura E J 2014 Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: A case report. Physiotherapy Theory and Practice 30: 202–209.
  12. Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract. 2016 Jul;32(5):385-95. doi: 10.1080/09593985.2016.1194652. Epub 2016 Jun 28. Review. PubMed PMID: 27351903.
  13. Blickenstaff, Cory & Pearson, PT, MSc (RHBS), BA-BPHE, Neil. (2016). Reconciling movement and exercise with pain neuroscience education: A case for consistent education. Physiotherapy Theory and Practice. 32. 1-12. 10.1080/09593985.2016.1194653.

 

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