Pain Science Education: Physical Therapy for Chronic Pain

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What is pain science education?

Pain science education is used by physical therapists to teach people with pain – especially those with chronic pain – self-empowerment that helps them manage their own symptoms. It focuses on the components of each individual’s pain experience and how it affects their daily lives. Research shows that when people have a better understanding of the processes of how pain works in the body, it can ease fears and create hope.

What is pain and how does it work in the body?

Pain is a normal part of the human experience. Without the ability to experience pain, people would not survive. When you experience pain, think of it as a message your body and nervous system is trying to communicate with you brain. Pain research has shifted away from studying solely anatomical explanations of chronic pain and towards studying the functions of the nervous system and brain, which are main contributors to pain.

Historically, the anatomical model was used to describe pain caused by tissue damage. This is often the mechanism of pain in an acute phase of an injury, where damage to the body structures leads to immediate pain. But damage of this kind this is not the cause of chronic pain. With pain science education, the focus is to understand how the nervous system works, and what you can do to understand your symptoms.

In many cases of chronic pain, symptoms are produced due to the sensitivity of a person’s nervous system and how the brain processes that information, rather than by the tissue damage associated with pain.

You can think of your nervous system like an alarm. When the alarm goes off, your brain sends a signal for pain in the body. When you have an injury, your nerves increase their sensitivity to protect you. This is normal. One example is the way that a sunburn works. Normally, when you touch your arm, it does not hurt. After a bad sunburn, your arm hurts to the touch, due to the increased sensitivity. This alarm is a warning signal from your nervous system to let you know that you have a sunburn. This in turn, is a reminder to protect your skin from sunburn by using sunscreen in the future. As your sunburn heals, the pain when touching your skin decreases, as your nerves reduce their sensitivity.

In the case of chronic pain, your nerves get stuck in this “sensitive” mode. Your body processes this as a threat and sounds the alarm. When the alarm goes off, your brain processes pain. There are a number of things you can do to help lower sensitivity.

How can physical therapy help me with chronic pain?

A physical therapist will perform an evaluation to assess how your body is moving and what may be contributing to your pain. When working with a physical therapist, it is important to address what in your everyday life triggers your pain or symptoms. Your physical therapist will create an individualized plan to help you with different areas of your day-to-day activities which pain interferes with. Physical therapists will prescribe exercises for your strength, flexibility, and cardiovascular system, as well as suggest modifications to your activities of daily living.

What can I do to manage my chronic pain?

Exercise

Research has shown that getting your heart rate up pumps blood and oxygen through your body to help “calm down” your nerves. Brisk walking for 10 to 20 minutes is all you need. Remember to gradually build up your walking time and pace. Other forms of beneficial aerobic exercise include bicycling, using the elliptical, swimming, and even Zumba classes. Talk to your physical therapist to discuss which form of aerobic exercise would best meet your needs. Your physical therapist may also suggest different types of strengthening and flexibility exercises. These exercises are designed to help restore function in the body so you can achieve your goals. It is important to know that some exercises may cause muscle soreness. This is a normal part of exercise and is to be expected. Talk to your physical therapist to discuss the amount, as well as frequency, of exercise that you should be performing.

Sleep

Research has shown that sleep has a significant effect on our health, especially for those with chronic pain. Most adults require anywhere from six to eight hours of sleep each day. It is important to have set sleep times to help get your body used to a regular schedule. This means going to bed and waking up at consistent times. Try to limit screen time (television, smartphone, computers) 30 minutes before you go to sleep. Discuss with your physical therapist different sleep hygiene suggestions.

Goals/pacing

It is important to set goals and expectations when dealing with chronic pain. If you have pain for multiple years, you should not expect to be symptom-free within the first several weeks of physical therapy and making some adjustments to your daily life. Break down your big goals into smaller obtainable goals. Go in knowing that setbacks are a normal part of the healing process. For example, you have pain following a day of chores, start off only doing 10 minutes of chores. As you build endurance, start increasing your time doing chores by five minutes each week. The eventual goal is to have you return to performing a whole day of chores again with less symptoms.

Key takeaways

• Pain is a normal human experience.
• Pain does not necessarily equal harm or tissue damage. Chronic pain is often driven by nervous system sensitivity, not ongoing tissue damage.
• Your body has the ability to heal itself.
• Pain science education empowers people with chronic pain to understand their symptoms and manage them more effectively.
• Physical therapists can help identify triggers, evaluate movement, and create individualized plans to reduce symptoms and improve function.
• It is okay to move. You need to find what is right for you. Exercise, especially low-impact aerobic activity, can help “calm” sensitive nerves and support healing.
• Sleep habits, pacing, and goal-setting play major roles in managing chronic pain and making steady, realistic progress.