Pain Science

Joe Thilman, SPT

Pain Basics

• Pain is the brain’s response to a threatening

situation

• Pain is the interplay between peripheral

stimulation and central interpretation

• Pain experience is dependent on its perceived

cause

• Pain is NOT always directly related to the

amount of tissue damage

Importance of pain education

• The physiology of pain can be easily

understood by all members of the public

• Understanding pain physiology can change

the way an individual thinks about pain and

therefore reduce its threat value and improve

their pain management

Pain Relies on Context

• Previous Experiences

• Age, Gender, Culture

• Environment

• Education

Nociception

• Nociceptors are danger receptors

– We do not have “pain receptors” or “pain nerves”

• Nociceptors convey danger to the brain and

spinal cord

• Nociception does not guarantee pain, nor is it

a necessary precursor to pain

Homunculus

• Virtual representation of the body in the brain

• Exists at birth but is refined over time

• Size of the area represented by a body part

varies by use and amount of sensation

• With any chronic pain situation -- not just

phantom limb pain-- the affected area

becomes “smudged” on the virtual body

Pain Neurotags

A pain neurotag is the particular pattern of

activity that creates the perception of pain

– Once brain determines pain perception is

beneficial to survival, it activates other body

systems for aid:

• Sympathetic

• Endocrine

• Motor

• Immune

Changes in the brain

• Central Sensitization: Brain attempts to

increase its sensitivity by increasing the

number of sensors in the pain ignition nodes

• Smudging of the neurotag:

– Areas representative of different body parts or

functions begin to overlap

– Areas of repeated use get larger

Changes to other systems

• Sympathetic nervous system is in overdrive

• Parasympathetic nervous system is suppressed

• Endocrine System: Increased production of cortisol

• Immune System: Increased production of cytokines

• Motor System: Constant state of readiness, muscles become shortened and acidic

Thought Viruses

• In situations that remind you of painful

experiences or are perceived as dangerous,

you can now experience pain

• https://www.youtube.com/watch?v=gwd-

wLdIHjs

Common Activity Relationships with

Pain

• Gradual Decline Pattern: Stop activity at the

point of pain; over time, onset of pain is earlier

and earlier; become more and more disabled

• Boom-bust Pattern: Push through the pain

until you reach an unbearable pain level and

“bust”, stopping the activity for days or weeks

Major Components of Management

1. Medical management for any injury or disease

2. Prescribed treatment must make sense to the patient and fit their understanding of the problem

3. Answer all of the patient’s questions

4. Avoid total dependence on any one practitioner; patient must be in control

5. Determine quantifiable goals

Goal of Treatments

• Facilitate active coping strategies

– Learn about the problem

– Explore ways to move

– Explore edges of pain

– Stay positive

• Activate the virtual body without creating a

pain neurotag

• Return to prior level of function

Management Necessities

• Movement:

Re-establishes fine

functional sensory and

motor representation in

the brain

• Understanding:

Reduces the threat

associated with pain,

positively affecting all

input and response

systems

Additional Management Tools

• Medication

• Cognitive Behavioral Therapy

• Relaxation Strategies

Pacing and Graded Exposure

1. Identify an activity the patient would like to

do more of

2. Identify a baseline: Maximum amount of

said activity that the patient can do and

definitely not have a flare-up

3. Plan the patient’s progression

Training the Virtual Body

1. Imagined movements

2. Alter gravitational influences/improve movement security

– Activate movement neurotags in similar but novel ways

3. Add varying balance challenges

4. Vary visual input

5. Alter the environment of the activities

6. Do the movement in different emotional states

7. Add distractions

8. Plan functional activities which involve the movement

Takeaways

• Pain is an output of the brain designed to

protect you

• Pain does not necessarily mean harm

• Nociception is neither sufficient nor necessary

for pain

• Patient education plays a huge role in

recovery -- “know pain, no pain”

References

• Butler D, Moseley L. Explain Pain. 2003. NOI

group. Adelaide, Australia

• Noigroup.com