The Brain Behind Your Pain –
How understanding pain helps to claim victory over it.
By: Chrystin Schultz. PTA IINN
It’s a cold burn. Sharp and shooting. Dull and achy. Constant, nagging tightness. Pain affects every aspect of life, from the moment we wake up until we lay our heads back down and pray that we’ll eventually get comfortable enough to fall asleep. One-in-five American adults experience chronic pain. (1) It’s no wonder that we have been experiencing multiple waves of an opioid epidemic since the early ‘90s. (2)
Pain shouldn’t be a scary, depressing topic. Pain is actually a good thing! It’s our body’s natural way of letting us know that something is wrong. Without it, we as a species would not survive. However, living in pain every day is not normal.
In the last few years, there has been a shift in understanding the true nature of pain. For a long time, the main focus of pain has been on soft tissue structures such as muscles, tendons, and ligaments. These structures generally heal within three to six months. (3,4) Our bodies are designed to heal. All sorts of awesome stuff happens in our body to remodel, repair, and rebuild what has been damaged. Recently, we have come to learn that the majority of chronic pain (pain that does not go away within three to six months or even after the soft tissue structures are fully healed) is due to an oversensitive nervous system. (5,6) A newer field of study called pain neuroscience education (PNE), aims to help educate patients about the neuroscience behind pain. Research shows that the more people understand pain, the greater victory we will be able to claim over it. (7)
Taking a step back, let’s start with the question: What is pain? We know that the human body is covered in a crazy matrix of nerves. If we step on a Lego, we feel pain in our foot, grab the bottom of our foot, or hop around and shout a few words you may not be proud of later. Once the Lego is removed from our foot, generally the pain goes away within a few minutes. In this situation, the body has had a normal response to pain. When we feel pain, neurons called nociceptors respond by sending an electrical impulse from the peripheral nervous system to the spinal cord. The spinal cord receives the signal and sends the information up to the brain. Next, the somatosensory cortex and other areas of the brain identify the intensity and location of the pain. Now that the brain knows there is pain, it triggers an emotional response such as fear, anger, or anxiety. The brain then sends a signal back down the spinal cord to the peripheral nerves, telling them to act fast to get away from the source of pain. All of this happens within milliseconds.
In the case of chronic pain, the peripheral nerves that first alerted the brain to pain stay on guard and become extra sensitive to any new kind of stimulus or potential threat. (5-9) When this happens, normal activities such as sitting, driving, standing, or bending over trigger the nerves to send a warning message to the brain. (8,9) What you once were able to do for an hour without pain, you can now only do for thirty minutes or less before needing a break. There are many factors that come into play when dealing with chronic pain. Temperatures, stress, movement, immunity, and pressure all play a role in the continuation of chronic pain. (6) That means that cold weather, poor work/home life balance, lifting, having a cold or the flu, and sitting in a tight spot for a while can all make pain worse. Just like stepping on a Lego, when experiencing chronic pain, our nerves are continuing to send information to the spinal cord to be interpreted by the brain so action can be taken. (9) The longer the pain persists, more and more information will be sent to the brain for analysis, making the brain more aware of the painful area and then eventually the surrounding tissue structures. (6) This is what leads to muscle guarding and sensitivity in the peripheral nerves and surrounding soft tissue structures.
The good news and main take away is that studies show once people understand the neuroscience of pain, they understand how the brain processes and responds to the information it is receiving. In realizing that the majority of their pain is due to a heightened sensitivity in peripheral nerves, their nerve sensitivity is gradually reduced. (6,7) Adriaan Louw states in his book Why Do I Hurt? A Patient Book About the Neuroscience of Pain, “Education is therapy. Gaining an understanding of the neuroscience of your pain will undoubtedly ease some fears, explains some unknowns and provide some hope.” Simply understanding the root cause of pain immediately helps to calm down nerve sensitivity. (6)
Since the study of the neuroscience of pain is so new, implementation of pain neuroscience education is not common practice in most healthcare settings. Once pain neuroscience education is integrated into pain management and physical therapy practices, we may have a fighting chance of ending the opioid epidemic and significantly reduce the prevalence of chronic pain. In the meantime, for more information on the neuroscience of pain, turn to the many publications written by Adriaan Louw, PT, PhD, and check out the resources listed below.
- Brigham and Women’s Hospital. One in five American adults experience chronic pain. Science Daily. Published online April 20, 2021. Accessed July 25, 2021. https://www.sciencedaily.com/releases/2021/04/210420092901.htm
- Understanding the epidemic. Cdc.gov. Published June 17, 2021. Accessed July 25, 2021. https://www.cdc.gov/opioids/basics/epidemic.html
- Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. 2003;8(3):130-140.
- Moseley GL. Reconceptualising pain according to modern pain science. Phys Ther Rev. 2007;12(3):169-178.
- Butler DS. Sensitive Nervous System. Orthopedic Physical Therapy & Rehabilitation Produ; 2000.
- Louw A. Why Do I Hurt?: A Patient Book about the Neuroscience of Pain. Orthopedic Physical Therapy & Rehabilitation Produ; 2013.
- Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041-2056.
- Louw A. Your Nerves Are Having Back Surgery: Neuroscience Education for Patients Having Back Surgery. Orthopedic Physical Therapy & Rehabilitation Produ; 2012.
- Gifford L. Pain, the Tissues and the Nervous System: A conceptual model. Physiotherapy. 1998;84(1):27-36.
- Barker RA, Barasi S. Neuroscience at a Glance. 3rd ed. Wiley-Blackwell; 2008.