Why do I keep hurting?

Pain is a normal human experience, and without the ability to experience pain, people would not survive.(1) Living in constant pain, however, is not normal.(2)
I have been treating people in my physical therapy clinic for 30 years and some have been struggling with pain for extended periods of time. Frequently pain is complex, it’s 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) We call this Pain Science Education.

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)

The goal of Pain Science Education 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. Pain Science Education should be combined with manual therapy and exercise therapy to break down movement-related pain memories with graded exposure to exercise and decrease sensitivity of the nervous system.(8)

See next blog post for a pain science education example.

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.