Bold claim, I know.
But recent research has provided compelling evidence to back it up.
Learning how pain works can actually reduce pain. It’s even been shown to prevent low back pain better than specialized core stability exercises!
Talk about “knowledge is power” hey? Pretty cool.
Pain science might sound complicated and hard to understand. But it’s not – researchers have also shown that regular people (not just health professionals and scientists) can understand this stuff when taught properly.
So how would learning about pain science actually help relieve and prevent pain?
- Pain Science Education
There are many names for it: ‘Neurophysiology of Pain Education’, ‘Pain Physiology Education’, ‘Pain Biology Education’, ‘Pain Neurophysiology Education’.
Educating someone on pain definitely involves explaining the biology, neuroscience, and physiology of pain.
But it goes beyond the lab bench.
There’s also psychology, sociology, and even some philosophy that needs to be explained. Then, there are the clinical trials (probably the most important part of healthcare science) – research that tests what actually works in the real world.
Therefore, I just call it ‘Pain Science Education’.
- Pain Science can (and should) be Understood by Everyone
Recently, the health care community has learned a lot about the science of pain. There has been an explosion of new research on the topic – especially from neuroscience.
Neuroscience sounds complicated. Doctors and therapists often think their patients wouldn’t understand this information… however, a research study in 2002 tested this assumption 1.
They took professionals as well as patients and tested them on their pain knowledge before and after some pain education. They also surveyed the professionals on how well they thought the patients would do.
Turns out that after a short education session, patients performed much better on the test than professionals had estimated. Furthermore, after education, the patients improved their scores on the test from an average of 29% to an average of 61% (and up to 80%). So there it is: anyone can learn and understand this stuff.
It should be noted that the professionals improved from 55% to 78%… yup, without the updated education on current pain science, professionals knew less than the educated patients! That’s why I often say at the end of my articles: “now you probably know more than your doctor or therapist!” (unless they are up to date on the subject, and you would be disappointed to know how many are not)
- How Can Learning About Pain Actually Decrease It?!
Now that we have that out of the way, let’s discuss the cool part!
By now, a bit of research has accumulated looking at the effect of pain science education on patients with chronic pain.
In 2011, researchers did a systematic review huh? titled: The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain 2. This review looked at 8 studies with a total of 401 patients and assessed their results from a pain science education. The results were synthesized (to my joy) based on effect sizes wha?, and generally showed positive results! Here’s their conclusion:
“For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.”
But wait, there’s more!
- Learning about Pain can Actually Prevent / Lower Incidence of Pain
We now know that learning how pain works can reduce it. Furthermore, a recent study provided evidence that it can even reduce the incidence of pain in the future.
A study was published in 2011 (now you can see how new a lot of this research is) titled: Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. 3
This was a big study; the researchers enrolled 4,325 soldiers with no previous history of low back pain. There were four treatment groups: traditional lumbar (low back) exercise alone, traditional lumbar exercise with psychosocial (stuff we talked about above) education, core stabilization exercise alone, or core stabilization with psychosocial education.
The education occurred during just one session, and the exercises for each group were performed in five minutes every day for three months straight. Traditional lumbar exercises were simple abdominal and oblique exercises, while core stability exercises were specialized exercises designed to target the deeper core muscles.
The participants were followed up two years later, and surveyed for incidence of low back pain that resulted in seeking health care (going to a doctor or therapist). Keep that in mind: they probably all had the same amount of back injuries during work and training. But what we’re looking at is whether these injuries lead to low back pain requiring health care.
Results: No difference between traditional low back exercise vs. core stability exercise. Perhaps they both worked, but note the specialized core stuff was no better.
However, the one session of ‘psycho-social’ education reduced incidence of low back pain by up to 5%.
Okay, finally, let’s talk about how this might be working:
- How Learning About Pain Can Reduce And Prevent Pain
When people are in pain, especially chronic pain, it’s usually confusing and scary. This uncertainty causes stress, anxiety, and fear of movement – all of which can make the pain more severe. Learning how pain works can make it less scary.
Being overly worried about pain is called ‘catastrophization‘.
This is actually quite understandable, and probably our (health care professionals) fault. We have spent decades telling people their back is ‘out’ (whatever that means) and they need to stop bending over or lifting things. Most of this is nonsense and I plan to write more about it soon.
Learning that pain is a perception of the brain, not simply a sensation from damaged or injured tissues, can be very effective in reducing this catastrophization. Simply learning that pain is not ’caused’ by damage can reduce that perception of threat. This will allow someone to move more freely, improving function and reducing pain and disability.
Learning how the nervous system can change with persistent pain can help one appreciate why their pain is being so stubborn. This can also help people devise strategies to reduce their pain while staying active – by using graded exposure for example.
Finally, learning that these changes in the nervous system – namely the brain – can be reversed, is tremendously encouraging! This will lift a persons spirits, which relieves stress and fear of movement, and ultimately can reduce pain.
All of this just from learning how it works.
Currently, most people think a low back injury is a death sentence to your ability to move comfortably. This -and I don’t think I’m being too dramatic here- culture of fear has greatly exacerbated the amount of health care people seek for low back pain.
But for the same reasons stated above, learning how pain works can prevent you from suffering from it. If you understand why things hurt, the next time you hurt your back, you won’t automatically panic, catastrophize, and freeze in fear.
This doesn’t mean things won’t hurt. Injuries hurt. We’re not talking about shrugging pain off like it’s nothing. But we are talking about preventing unnecessary stress, and fostering constructive practices towards recovery.
- First of all, everyone can understand how pain works. The basic points people need to learn are not too complicated.
- Learning how pain works reduces the threat you perceive from pain. Since pain is basically a ‘survival threat detector’, reducing threat will reduce pain.
- Pain science education will reduce confusion about pain, and reduce worrying. By reducing this ‘catastrophization’, you lower stress and anxiety, which will lower pain.
- Learning about pain science can reduce fear of movement (‘kinesiophobia’), leading to improved movement, aiding recovery and reducing disability.
For more info on how pain works, check out the pain section of this site!