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.
Therapist: “If you stepped on a rusted nail right now, would you want to know about it?”
Patient: “Of course.”
Therapist: “Why?”
Patient: “Well; to take the nail out of my foot and get a tetanus shot.”
Therapist: “Exactly. Now, how do you know there’s a nail in your foot? How does the nail get your attention?”
Therapist: “The human body contains over 400 nerves that, if strung together, would stretch 45 miles. All of these nerves have a little bit of electricity in them. This shows you’re alive. Does this make sense?”
Patient: “Yes.”
Therapist: “The nerves in your foot are always buzzing with a little bit of electricity in them. This is normal and shows….?”
Patient: “I’m alive.”
Therapist: “Yes. Now, once you step on the nail, the alarm system is activated. Once the alarm’s threshold is met, the alarm goes off, sending a danger message from your foot to your spinal cord and then on to the brain. Once the brain gets the danger message, the brain may produce pain. The pain stops you in your tracks, and you look at your foot to take care of the issue. Does this sound right?”
Patient: “Yes.”
Therapist: “Once we remove the nail, the alarm system should…?”
Patient: “Go down.”
Therapist: “Exactly. Over the next few days, the alarm system will calm down to its original level, so you will still feel your foot for a day or two. This is normal and expected.”
Therapist: “Here’s the important part. In one in four people, the alarm system will activate after an injury or stressful time, but never calm down to the original resting level. It remains extra sensitive. With the alarm system extra sensitive and close to the “firing level,” it does not take a lot of movement, stress or activity to activate the alarm system. When this happens, surely you think something MUST be wrong. Based on your examination today, I believe a large part of your pain is due to an extra-sensitive alarm system. So, instead of focusing of fixing tissues, we will work on a variety of strategies to help calm down your alarm system, which will steadily help you move more, experience less pain and return to previous function.”10
This example shows the shift in teaching about pain from a perspective that there is tissue damage to one that enables them to see pain from a sensitive nervous system perspective.
Do you have pain?