Pain Neuroscience Education (PNE)

What is Pain Neuroscience Education (PNE)

What is Pain Neuroscience Education (PNE)? It is essentially a fancy way to relate to people what is going on when they feel pain. This is not a single piece of advice or specific intervention that is provided by Physical Therapy, but rather a way in which the clinician interacts with you as the patient. PNE is the words, body language, attitudes and overall disposition towards you as the patient and your condition. This has a profound effect on your rehab potential. 

Why CONTEXT Matters

When considering each patient's pain is it most vital to contextualize ALL of the parameters that may affect their pain response. This is why a good PT needs to look at persistent pain from a BROAD perspective. One that not only addresses the tissues you have injured, but rather a biopsychosocial model which encompasses the whole of the patient and their experience surrounding the event.

Diet, lifestyle, sleep, attitudes, beliefs, emotions, family events, finances, everyday stressors, environment and the trauma of the event which caused the pain are all very common examples of some things that can modify pain experience. This is why it is so important to have a decent grip on what influences pain and how PT can be so dynamic and effective when it is successfully integrated with quality PNE.

Example Time!

For example, think of a classic painful stimuli we ALL have experienced: a paper-cut. In this scenario we will compare a football player and a Guitarist. 

Football Player: A football player gets a paper-cut and doesn't care. He has minimal pain in the context of his daily activities, especially during his training. If he ever gets another paper-cut, it will continue to have virtually no effect on his daily living and is unlikely to be worse the second time around.

Guitarist: The guitarist swears this paper-cut will never go away. They got it a few days ago, but keep irritating it with more and more practice. It is really stressing them out too because they have a show on Thursday night and it is making practice exceptionally tough. They hope that they don't get another one because it could be the difference between getting another gig or having to find extra work to keep the cashflow coming.

Here you see a rather dramatic example of how the CONTEXT of each injury shaped the response from the character. Now if we extrapolate this to your life, your problems, your trauma, your unique life situation, is the outcome as tissue specific and neat as the cut itself? OR is it more nuanced? 

Active Approaches are Best

The patient having self-efficacy over their own condition, has the greatest ceiling for improvement. This means that the more control one has over their own therapy and recovery the more they will be able to do, pain free. The brain needs feedback that it can perform certain tasks in a pain-free manner and that requires that the patient expose themselves to those (possibly scary or fearful) movements, in order to overcome the fear. This active approach, along with correct education, allows the patient to take control over their recovery and see the greatest possible results from rehab!

Diet, lifestyle, sleep, attitudes, beliefs, emotions, family events, finances, everyday stressors, environment and the trauma of the event which caused the pain are all very common examples of some things that can modify pain experience. This is why it is so important to have a decent grip on what influences pain and how PT can be so dynamic and effective when it is successfully integrated with quality PNE.

So... What is pain?

"Pain is a distressing experience associated with actual or perceived tissue damage with sensory, emotional, cognitive and social components"

From one of the world's foremost leaders in PNE, Dr. Greg Lehman:

"...Pain doesn’t necessarily mean there is damage. Thus you can have pain with damage, no pain with lots of damage and lots of pain with minimal damage. The definition below is slightly expanded to show that pain is in uenced by a lot more than just body tissue. It is a ected by and in uences other areas of your life. Emotions, sensations, cognitions (beliefs about pain) and social aspects (social withdrawal is common with pain) are involved with persisting pain. We call this the Bio - Psycho - Social model of pain. Meaning all areas of your life can in uence pain. This is kind of a great thing because it means you have a lot of options to treat your pain. In the recovery strategies of this book you will perform a self-audit to nd out what factors might be related to your pain and maybe nd some factors that you can change to help with your pain and your recovery.