Pain science education (PSE) is a treatment for pain that teaches people to think differently about their pain, and thereby reduce, or even cure, their pain. Pain Neuroscience education generally uses metaphors or stories to help people reconceptualise pain.
According to PSE chronic pain is NOT caused by tissue damage or injury but changes in the brain that make the central nervous system hyper-excitable and over sensitive to pain. This is called “central sensitisation”.
Central sensitisation is defined as “an increased responsiveness of nociceptors in the central nervous system to either normal or sub-threshold afferent input” which basically means you become hypersensitive to pain.
Pain science education is a way of reducing central sensitisation and thereby reducing pain.
It works by increasing pain thresholds during exercise by reducing fear of movement. The theory goes that when people reconceptualise pain and realise that movement is not doing them damage, then they will move more and their pain will reduce.
In practice, pain science education uses stories and metaphors to explain that pain is an output of the brain. That the nervous system has become sensitised to pain. That ‘hurt does not equal harm’. That it is safe to move. When people reduce their fear and anxiety around movement, their pain reduces.
There are many ‘brands’ of pain neuroscience education.
Explain Pain – Butler and Moseley
Explain Pain is by far the most popular, and it includes a book that has become the pseudo-text for all physiotherapists who a treat pain, and spawned seminars, webinars and range of supporting books. It is an industry unto itself. “Explain Pain” was written by David Butler and Lorimer Moseley and released by the NOIGroup. It is a very expensive book, and is a best seller. It has clearly made its authors a lot of money…
I was warned a very long time ago by a very astute GP that if someone is selling a book, don’t trust what they have to say. Chances are it’s full of shite. This has turned out to be exceptionally good advice, because a LOT of people are selling a LOT of books on chronic pain, and the evidence does NOT stack up. The most famous book is Explain Pain by David Butler and Lorimer Moseley.
Let’s look at the science.
Pain Neuroscience education