Pain Neuroscience Education

Pain neuroscience education (PNE) helps individuals in pain understand the underlying neurobiology and neurophysiology behind their pain experience. This education has been shown to reduce self-reported pain, decrease disability, alleviate fear and fear-avoidance behaviors, lessen pain catastrophizing, and improve movement.

Pain is a natural human experience designed to alert us to danger and motivate us to protect ourselves. However, persistent pain does not follow this typical pattern. Often, even after tissue healing, pain continues. Research now reveals that pain is a complex and unique experience, shaped by an intricate interplay of tissue-related factors, peripheral neuropathic processes, immune function, brain processing, psychosocial influences, sensitization of the peripheral and central nervous systems, neuroplasticity, and endogenous mechanisms.

Nearly twenty systematic reviews and meta-analyses examining PNE for various persistent pain conditions have consistently demonstrated its benefits in reducing pain, disability, fear-avoidance, and pain catastrophizing, while positively affecting physical movement and healthcare costs.

Recent research also clarifies that injury and pain are not the same—people can have injuries without pain, and pain can exist without tissue injury. Nociceptors in the tissues send nociceptive signals (danger messages) to the central nervous system (CNS), but they do not send pain messages. The brain processes this information, adds context from other sources, and ultimately produces the experience of pain (or not).

In persistent pain, continuous input from the periphery causes lasting changes in the spinal cord’s dorsal horn, including loss of inhibitory interneurons, expanded receptor fields, increased activity of second-order neurons, and reduced endogenous analgesia. This results in heightened central sensitization—manifesting as hyperalgesia (increased pain sensitivity) and allodynia (pain from normally non-painful stimuli). This is known as nociplastic pain, characterized by disproportionate pain, widespread tenderness, aggravating and easing factors that don’t align with tissue damage, and psychosocial challenges such as fear, avoidance, depression, and catastrophizing.

Pain involves widespread brain activation in areas like the amygdala (fear conditioning), anterior cingulate cortex (focus and attention), hippocampus (memory), and motor cortex (movement planning and execution). Dysfunction in these areas can lead to decreased motor control, concentration, and memory. The individual pain experience is also influenced by interactions with existing cognitive maps related to memory, beliefs, and past experiences.

Ask your therapist for further explanations or metaphors to help you better understand how your body may be processing pain. Studies show that improving patients’ knowledge about pain has positive effects on pain ratings, disability, fear, catastrophizing, willingness to move, and healthcare utilization.

Reference:
Louw, Adriaan. Pain Neuroscience Education for Acute Pain. International Journal of Sports Physical Therapy. 2024 Jun 2;19(6):758-767. doi: 10.26603/001c.118179