"My neck hurts all the time, I can hardly drive, work, and my sleep is bad. I am discouraged by the lack of solutions, feel helpless and sad."
These are very common statements of patients who are severely impacted by their pain. While sometimes the root cause is identified and treated, or pain resolves because of a healing process, many individuals do not find a solution. In such situations, one underrated and frequently neglected way to improve is "pain neuroscience education".
What is pain neuroscience education?
Pain neuroscience education includes educational programs that aim to improve the patient's understanding of how pain is generated, elaborated and perceived, and the associations between pain, physical and psychosocial functioning. This intervention helps patients to build insight into factors that influence awareness of and attention to pain, which may lead to improved self-management of symptoms.
How is pain neuroscience education delivered?
It is delivered by educational sessions, either on an individual face-to-face basis or as group sessions, possibly supplemented by online tools. The trainer explains aspects of the pain experience that are not commonly known by patients but are crucial to understand the suffering and impairments associated with pain.
One notion is that pain is caused not only by a damaged tissue, such as an arthritic knee joint or shoulder. Rather, it is the result of multiple processes that happen also at nerves, the spinal cord, and the brain. Read here about amplification of pain signals at different sites of the nervous system, leading to strong pain with minimal injuries at the site of pain.
In the brain, areas responsible for pain perception are connected with brain areas that process emotions, sleep, and other functions that are disrupted in patients with chronic pain; these areas communicate bi-directionally. While it is commonly believed that physical inactivity, mood or sleep disorders are obvious consequences of the pain, it has been demonstrated that the opposite is also true: namely that inactivity, insomnia and depression can enhance pain. This explains why treatment of sleep disorder, psychological distress and physical disability may promote pain reduction, as you can read here.
Pain neuroscience education involves many other topics, which I am not reviewing here.
Does pain neuroscience have demonstrated efficacy?
Yes, several studies have shown improvements. A good example is a recent systematic review on neck pain. The investigators have identified 7 studies that met quality criteria. Pooling the results of the studies showed that pain neuroscience education reduced pain and fear of movement ("kinesiophobia").
The latter is considered a substantial barrier to improve physical function in chronic pain. In acute pain, such as after a fracture, the pain with movement is a signal that tells the injured person not to move in order to protect themselves from worsening the injury. Conversely, physical activity is encouraged in chronic pain, as it is generally associated with better long-term outcome, even if it causes short-term pain. Therefore, reducing kinesiophobia with pain neuroscience education can lead to better physical functioning and, in the long-term, to less pain in some patients. Read here about physical therapy in chronic pain.
Summary
Pain neuroscience education is not enough considered in the treatment of chronic pain and can lead to improvements.
Ideally, patients are referred to health professionals familiar with pain neuroscience education.
If not available, any health professional that manages chronic pain can deliver education on the pathophysiology of pain.
Please find below online resources.
Online Resources
We recommend:
Video for patients and health professionals: "The mysterious science of pain - Joshua W. Pate"
NOI Group for health professionals.
Flippin' Pain for patients.
Pain Revolution for patients.
Retrain Pain for patients and health professionals
Books
Painful Yarns: Metaphors and Stories to Help Understand the Biology of Pain for patients and health professionals.
Explain Pain for patients and health professionals.
Apps
Curable for patients.
Written in collaboration with Eric W. Wanzel and Kaitlin Touza
Center For Pain Relief, Department of Anesthesiology and Pain Medicine, University of Washington