Let’s start with clarifying some terms:

Nociception: the signaling of noxious (painful) stimulation

Pain experience: result of the brain’s neural processing of nociception

Chronic Pain: pain lasting greater than 3 months

With research now, it is outdated to only seek “which tissues are to blame” when someone is experiencing chronic pain. Only focusing on that idea may actually be a significant contributor to the increased epidemic of chronic pain worldwide. In treating chronic pain, the brain should be the primary target for directing treatment, not finding which exact tissue is the problem.

Here’s why:

There are changes within the brain and spinal cord when someone has pain. Certain brain regions (ex. anterior cingulate cortex, amygdala, etc.) demonstrate increased activity during a person’s pain experience.When doing something painful, these increasingly active brain regions communicate with each other, developing a pain “neurotag” or pain map. 

There is a phrase “Neurons that fire together, wire together” for strength training, however this occurs at the spinal and supraspinal levels as well, which can exacerbate our feelings of pain.Therefore, the brain of a person with chronic pain may become more proficient in running its pain map.

What does this mean?

The main idea is that less pain/stimulation is then needed to activate that pain map and therefore cause the person to feel pain more easily over time. Imagine that you have a cup filled to the brim at baseline, and this represents your pain. One little drop to the cup could cause your cup to overflow and therefore send you into feeling pain. If the cup was only half full, that drop would not have normally bugged you. This nearly overflowing cup at baseline is a characteristic of a topic called central sensitization.

Our pain map and how the brain processes it can also impact our emotions, motivation, movement control, focus, body temperature, sleep and even short term memory. Don’t let that get you down though, because PT can help turn this all around.

The pain map can be modulated, or changed, based on the patient’s knowledge, understanding, beliefs and experiences which makes pain more complicated and individualized. Modification of these areas can be rapid (for better or for worse), which is a good reason to address pain science asap! The brain has a two-way path that allows the brain to enhance or damper the info being transmitted. Certain things we do can facilitate or inhibit your pain. That’s where we come in.

Clinicians tend to underestimate the patient’s ability to understand complex pain science, however, empowering you with this information can begin the process of changing the perception of threat from your pain. In physical therapy, pain is both physical and psychological and both must be addressed.

Studies have shown that pain neuroscience education can decrease fear, improve perception of pain, and can have immediate effects on improvements in the patient’s attitude about pain. It can additionally improve cognition, physical performance, outcomes of therapy, improve pain thresholds and reduced widespread brain activity related to your pain experience.

In conclusion,

Studying and acknowledging the neuroscientific view of chronic pain allows for improved patient outcomes. It is important to know that pain felt during movement is not necessarily due to injury, but from an extra-sensitive nervous system. Our goal is to aim to restructure the threat and meaning of pain.

Try talking about pain science with your PT before pursuing the pharmacological and surgical approach. It is extremely helpful to understand the true nature of your pain and that the brain is capable of neuroplastic chance.

— Kristin Belfiore, DPT