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Pain Science Education - Part Two

An Example of how you can use it

Posted on 01/29/2025 12:55
Tags: education | pain | pain management | physical therapy |
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The goal of this method is to change a patient’s perception of pain.

Many patients believe that damaged tissues are the main cause for their pain.
After a comprehensive evaluation to determine that damaged tissues are not the cause, education about pain neurophysiology helps the patient understand that pain may not correctly represent the health of the tissue but may be due to extra-sensitive nerves.
As a result, patients have been found to have a reduction in fear avoidance behaviors and are more able and willing to move.
PNE can be used with a combination of treatments, including exercise therapy that can be used to break down movement-related pain memories with graded exposure to exercise and decrease sensitivity of the nervous system. (8)

Here’s a brief example of therapeutic neuroscience education in practice taken from Louw et al., (2014).
Suzy is experiencing pain and believes her pain is due to a bad disc.
However, the pain has been there for 10 years. It is well established that discs reabsorb between 7-9 months and completely heal. (9)
So, why would it still hurt?
She believes (as she has been told by clinicians) that her pain is caused by a bad disc.
Now, we start explaining complex pain issues via a story/metaphor with the aim to change her beliefs, and then we set a treatment plan in place based on the new, more accurate neuroscience view of pain.

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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