Pain education is a widely used treatment tool in the management of a variety of painful conditions. Education can be used to address some of the commonly held misconceptions around pain and can also be a helpful tool to help someone in pain understand why therapies such as exercise are suitable and recommended for painful conditions.
I have touched on this subject in previous blogs however I have recently completed another course in pain management and thought I should spread the knowledge, because after all knowledge is power (and very important - see below)
Pain education has grown and changed and is becoming more frequently used. While pain education is an important tool to use to combat persistent pain conditions, a more important factor for recovery is the learning and understanding taking place.
Let me explain.
Lorimer mosley’s slides, master sessions, 2022
See the above graph. In this study a group of people with persistent pain underwent pain education. These people were split into two groups which were;
Blue - these people were able to understand the biology of pain in the first 2 weeks.
Red - These people were not able to.
Effectively the groups were people who were able to learn and understand pain and the people who weren't.
As you can see in the graph, at the 1 year follow up, the blue group ( people who were able to understand pain) significantly decreased their rating of pain. This tells us that even though both groups had the same pain education, it was the understanding and learning that was the critical factor in people reducing their pain.
I believe in my own experience with low back pain that learning and understanding pain while going through university helped me to recover from the chronic pain I was having.
What are the important things to learn to help improve this understanding?
To answer this question, it is important to get the perspective of those who have real life experience of persistent pain conditions and were able to recover. Those people were asked following recovery from persistent pain states;
“What do you think was the most important information for you to learn to help you recover?”
Based on the answers to this question 4 essential facts were created. I have another blog talking through separate facts which are essentially squeezed into these 4 concepts.
Fact 1: Pain protects us and promotes healing
Pain is fundamentally a mechanism used for protection of the body. Pain is used by the body to prevent injury or damage through behaviour change.
Think of pain as the body’s alarm system. If the body is in danger of injury or harm, pain will be used as a protective mechanism to stop whatever you are doing to prevent any harm. If an injury occurs, then the body will sensitise the area of injury to prevent further harm. This means pain will be felt long before there is any potential injury or harm and this allows the body to heal. Therefore pain is protecting us and promoting healing.
Once the body heals, it becomes less sensitive and we can go back to normal.
Pretty clever hey.
Follow the video for a short explanation for what we mean by, pain protects us and promotes healing.
Fact 2: Persistent pain overprotects us and prevents recovery
Although pain is there to protect and help recovery from injury, unfortunately like everything sometimes it does not work the way it was intended.
The sensitivity increases or remains after the injury has healed and the effectiveness of the way the body produces pain gets better during persistent pain states. This means that pain may continue after the tissue healing process has occurred.
The body learns how to produce pain by strengthening neural pathways and the body is still trying to protect itself even after the injury has recovered. Why the body is still trying to protect itself is different in each and every individual and could include multiple and many reasons.
Fact 3: Many factors influence pain
Pain originally was thought to be just neural pathways that responded to nerve endings in the tissues of the body. When in contrast we now know that pain is an output produced by the brain which is a result of multiple different influences. The slide below shows the old view vs the new view of pain which shows just how complex pain is!
Detection from the tissues in the body plays a vital role in the pain system but new research now tells us that it is neither essential nor necessary for pain to be produced.
This means that feeling down, believing you should be in pain or getting told a awful story of someone who had back pain like your own can change the way the pain feels.
Now. I'm not saying this is the reason for your pain but I am saying pain is individual and felt different by everyone because everyone has different contextual factors.
Things that influence pain can be broken down into 5 categories;
Facts 4: There are many ways to reduce pain and promote recovery.
Here is the great part. Now we know pain is influenced by a vast amount of factors, we have a larger amount of things we can target.
Of course tissue health plays an important role but potentially your current health is not promoting a great environment for your body, maybe you believe the pain is with you forever and there is nothing you can do about it, or perhaps you are dwelling on past injuries and you are trying to relate those injuries with your current pain.
Whatever may be influencing your pain we can target to try to promote recovery.
Pain is so very complex and individual to everyone. Learning and understanding this is an important part of not just recovery but any future painful problems.
To start, have an open mind, put in some effort to learn and understand, and seek advice from your trusted evidence based practitioner. Pain is very rarely a quick fix but a journey, more than likely there will be flare ups, but that does not mean you can't move forward again.
If you have any questions, please don't hesitate to ask.
Accredited Exercise Physiologist