Why should you learn about the neuroscience behind pain?

Pain neuroscience education (PNE), while not a standalone treatment for chronic pain, has demonstrated its efficacy as an important component of the overall chronic pain treatment process. When used in combination with other types of treatments, it has been proven to significantly decrease pain levels. Studies continue to be done on the benefits of pain neuroscience education and continue to indicate that it does have a positive impact on pain reduction. 

Pain neuroscience education is meant to decrease activity avoidance responses and correct misconceptions regarding chronic pain. It is also meant to foster feelings of safety while engaging in physical activity and improving exercise endurance (Casana et al., 2023). This multidisciplinary approach places emphasis on addressing the pain experience and how cognition and emotions impact that experience (Kim et al., 2023). Ultimately, pain neuroscience education can put you on the path to significantly reducing and potentially eliminating your chronic pain.

What Is Pain?

To put it simply, pain is a message within the body that signals danger. It instigates the fight or flight response to take over with the primary objective being to escape the danger. This process starts with nociceptors (nerves that sense pain) sending a pain signal to the spinal cord. These signals are then dispersed throughout the central nervous system. This includes the portions of the brain that process sensations and emotional responses. In an ideal scenario, pain alerts a person to danger or injury,  and upon recovery the pain discontinues.

If pain is still present after an injury has occurred, it is a sign that central sensitization has occurred which means the nervous system has been modified to be more sensitive to pain (Furlan, 2023, p.32). Parts of the nervous system are now dysfunctional and this can cause pain to become chronic. The injury has healed but the nervous system is still sending pain signals. This can also happen without an injury. People can develop chronic pain due to stress, anxiety, depression, insomnia, PTSD, and autoimmune disorders. 

The nervous system processes pain the same way it processes memories. The more you think about and focus on pain, the stronger the memory of pain becomes, and the pain becomes increasingly worse (Furlan, 2023, p.33). It is important to clarify that this information does not mean that the pain is all in your head or that you’re imagining pain. Your pain is real and it can be treated (Furlan, 2023, p.35).

What Pain is Not

Pain is not an accurate measure of how much damage there is within the body. No matter how intense pain is, it does not determine the severity of injury or damage (Furlan, 2023, p.20). Pain does not indicate the presence or absence of an underlying condition. For example, someone could be having a heart attack and have no pain. Or someone with an amputated limb could be experiencing severe phantom limb pain despite the fact that it is impossible for the absent limb to have experienced an injury (Furlan, 2023, p.20).

Fear Increases Pain

Pain often leads to fear and apprehension towards engaging in certain activities. The development of this fear is due to the perception that these activities may cause or exacerbate pain. In this sense, fear is a protective mechanism meant to discourage actions that could potentially cause further harm. For instance, after a leg has been fractured, it is best to avoid putting weight on the injured limb.

When pain is chronic, activity avoidance can have damaging effects. Prolonged activity avoidance can lead to physical de-conditioning, a decrease in flexibility, muscle atrophy, and an increase in pain sensitivity. Ultimately, this fear-driven process has the potential to delay or prevent healing (Barad et al., 2021).  

The Psychosocial Approach

The following paragraphs are different methods on how to understand and treat chronic pain.

Pain Reprocessing Therapy

Pain reprocessing therapy (PRT) is based on the idea that the brain actively constructs chronic pain in the absence of tissue damage. It suggests that understanding the underlying causes and the perceived threat of harm or damage may lead to substantial reductions or even elimination of chronic pain. This therapeutic approach begins with pain neuroscience education, helping individuals comprehend how their pain has altered their nervous system (Asher et al., 2022)..

PRT includes interventions such as engaging in movements and activities that are often accompanied by fear, addressing complex emotional responses, encouraging techniques that foster positive emotions and self-compassion, and learning to observe the pain without judgment or negative emotions (Asher et al., 2022).

A study was done in 2017 on 151 participants from the ages of 21 to 70. All of the participants had suffered from lower back pain for at least 6 months and consistently had at least 4 out of 10 pain. The participants received eight PRT sessions over the course of four weeks. At the end of the study 73% of participants were either pain free or nearly pain free. The researchers followed up with these participants a year later and the effects of PRT were still evident (Ashar et al., 2022).

Cognitive Behavioral Therapy

There are several psychosocial therapies that are known to significantly decrease pain. One of these is cognitive behavioral therapy (CBT) (Baller, 2017). This therapy teaches patients that the automatic thoughts surrounding chronic pain can lead to depression, anxiety, hopelessness, and helplessness (Baller, 2017). These types of thoughts and cognitions may result in avoidant behaviors such as avoiding physical activity, staying in bed, calling out of work, and not participating in activities that had once brought joy (Baller, 2017). This type of behavior can increase pain overtime. CBT encourages exercise, behavioral activation, cognitive reframing, and relaxation (Baller, 2017). It breaks the cycle of negative reinforcement and helps patients decrease their fears surrounding pain (Baller, 2017).

Stress Reduction

It is well known among the medical community that stress can lead to a large variety of health complications, including chronic pain. That’s because our bodies are designed to have a physiological response to stress (Barad et al., 2021). Thousands of years ago, if we encountered stressors such as a dangerous predator our body would prepare to either fight or flight. Our fight or flight response is characterized by an increase in heart rate, respiration, blood pressure, and muscle tension. Our bodies still respond the same way to stress except instead of dealing with wild animals, we are dealing with modern problems such as getting stressed out over jobs, relationships, and busy schedules (Barad et al., 2021). Our bodies are designed for short term stress because that is what our ancestors experienced thousands of years ago. Today our bodies are still adapted for short term stress while long term stress is damaging and can lead to harm (Barad et al., 2021). 

That is why stress reduction is an integral part of chronic pain treatment. This doesn’t mean go sit on a couch and watch tv to relax, but actively working on reducing stress. Stress reduction techniques include, but are not limited to, relaxation, meditation, diaphragmatic breathing, mindfulness, guided imagery, biofeedback, hypnosis, and engagement with art and music therapy (Barad et al., 2021). 

Diaphragmatic Breathing

Learning to breathe deeply is a critical and basic stress-reducing intervention that can be done anywhere at any time (Barad et al., 2021). Diaphragmatic breathing, also known as belly-breathing, involves slowing down the breath so that our bodies can go into a relaxed state instead of a state of stress (Barad et al., 2021). This type of breathing involves actively engaging the diaphragm with every breath. Studies have shown that this type of breathing can help improve focus and mood, reduce stress and anxiety, and lead to a reduction in pain (Barad et al., 2021). This is a foundational stress reduction technique that plays a role in the reduction of pain.

To practice diaphragmatic breathing, start with taking deep and slow breaths through the nose (for some, using the mouth may be more appropriate). Allow the chest and shoulders to completely relax and not move during this breathing practice (Barad et al., 2021). Instead of moving the chest and shoulders, allow the stomach to gently expand outward on the inhale and inward on the exhale. A helpful visualization is to imagine a balloon that is slowly inflating and deflating inside of your stomach. That’s what you’re breathing should look like. For optimal practice and efficacy, it is recommended to do diaphragmatic breathing sitting or laying down (Barad et al., 2021). 

​

Mindfulness-Based Stress Reduction (MBSR) and Meditation

There have been numerous studies proving that MBSR and meditation can reduce medication usage in patients with chronic pain, increase physical activity, and increase self-esteem (Barad et al., 2021). MBSR works by decreasing attention to pain and pain-related stress which dampens pain processing within the central nervous system (Barad et al., 2021). The success of MBSR and meditation in the treatment of chronic pain highlights the relationship between cognitions and their impact on pain (Barad et al., 2021).

Guided Imagery

This exercise uses the imagination to take the mind to a relaxing place like a beach or meadow. It is helpful to engage all the senses by imagining what sounds you would hear, what the sand or breeze across your face feels like, and the smell of salt in the air (Barad et al., 2021). This exercise has been shown to reduce stress, improve mood, decrease anxiety and pain. Some people like to imagine themselves doing physical activities without experiencing pain. Or you can imagine yourself performing a task successfully.

Art and Music

Art and music have been used in psychotherapy to help people express their thoughts and feelings. This can help individuals maintain a sense of emotional stability. They also decrease stress and lead to the production of neurotransmitters known to decrease pain (Barad et al., 2021). 

Engaging with creative activities can result in the release of endorphins which are the body’s natural pain killers, thereby leading to a reduction in pain. Some research even suggests that music can reduce anxiety and pain during medical and minor procedures (Barad et al., 2021).

Biofeedback

This form of therapy targets the biologic components of stress. Biofeedback works by attaching sensors to a person that sends messages about heart rate, respirations, blood pressure, etc to a computer. This visual feedback empowers the person to gain insights on how their body reacts to stress and how they can alter their body’s stress response (Barad et al., 2021). This may involve breathing more slowly, relaxing specific muscles, or taking a moment to meditate.

Hypnosis

Hypnosis can be defined as a state of deep relaxation. This is done through selective focusing, receptive concentration, and minimal motor functioning. Research supports that hypnosis can be used to decrease chronic pain. Individuals can be taught self-hypnosis or this can be done with the guidance of a trained therapist (Barad et al., 2021).

Conclusion: Is it possible to cure chronic pain?

For a lot of people, yes. People with all types of chronic pain have been able to put an end to the constant pain. It doesn’t matter how long you have had chronic pain. It’s hard to say if it is possible to completely cure chronic pain for all people with pain, but at the very least, pain can be significantly reduced. This is true for a spectrum of conditions including migraines, pelvic pain, back pain, joint pain, endometriosis, etc. 

Resources

Organizations

Pain Psychology Center: An organization that helps clients eliminate or significantly decrease their chronic pain through targeted psychotherapy techniques. These therapy techniques include pain reprocessing therapy, cognitive behavioral therapy, psychodynamic therapy, ISTDP, hypnotherapy, guided meditation, mindfulness training, and dual brain therapy.

Pogo Health: A virtual team that works together to treat your chronic pain. They offer a 12-week program that includes virtual sessions with a health coach, physician, and a therapist.  They also have an app called Pain Navigator that includes physical therapy exercises, medical education, wellness strategies, and mindfulness exercises.

American Chronic Pain Association: A non-profit organization that facilitates peer support, education, and hope for those with chronic pain and those treating chronic pain.

Websites

www.painreprocessingtherapy.com      

Provides education on pain reprocessing therapy and how it can be used to effectively treat chronic pain.

www.practicalpainmanagement.com    

An online resource that provides strategies for chronic pain management in a digestible, practical format.

Smart Phone Applications

Curable: Takes a biopsychosocial approach to treating chronic pain. Includes pain education, guided meditations, brain exercises, journaling prompts, and more. This is the #1 app for chronic pain.

Insight Timer: A meditation app that includes guided meditations, yoga, journaling, breathwork exercises, and daily affirmations.

Flowy: A platform for people with chronic pain, insomnia, and anxiety. It provides science-backed workshops, tools, and resources that help you manage your nervous system. It uses virtual reality to treat chronic pain and other conditions.

Calm: A meditation app that offers guided meditations, sleep stories for falling asleep, relaxing music, and masterclasses on mindfulness.

Books

“The Way Out” by Alan Gordon, LCSW

Alan Gordon is a psychotherapist who went through years of chronic pain. He used pain reprocessing therapy, a form of mind-body medicine rooted in neuroscience to significantly reduce his chronic pain. This form of therapy has transformed the lives of thousands of people. 

“8 Steps to Conquer Chronic Pain” by Andrea Furlan, MD, PhD, PM&R

Dr. Andrea Furlan uses this book to give advice on retraining your brain, controlling your emotions, recharging your body, and finding the medications that work best for you.

“Chronic Pain Rehabilitation: Active Pain Management that Helps You Get Back to the Life You Love” by Evan Parks, Psy.D.

This book has a step-by-step process for reducing pain and moving forward with your life. The treatment strategies are based on neuroscience and pain psychology.

Podcasts

Tell me About Your Pain

Alan Gordon (Founder of the Pain Psychology Center) and Alon Ziv talk about the experiences of real chronic pain sufferers and provide techniques for healing based on neuroscience.

Like Mind Like Body

Interviews with physicians, researchers, and ordinary people who talk about the power of the mind-body connection.

Pain Matters

Created by the American Academy of Pain Medicine. Each episode shares the latest innovations and practical applications for treating chronic pain.