Trying to Understand Chronic Pain: An Introduction to Pain Neuroscience Education
Written by Shannon Hall, DPT
Chronic pain is defined as pain lasting more than 3 months. In the United States alone, it is estimated that of the 255 million adults, nearly 126 million of them suffer from chronic pain. That means that almost half of the population suffers from some form of chronic pain. Put into a dollar amount, roughly $560 – $630 BILLION dollars are spent on chronic pain treatment in the United States EVERY YEAR.
So why is chronic pain such a hard problem to solve?
This is likely because pain is a complex, multi-factorial construct that is poorly understood by the medical community and the layperson alike. Traditional pain education models, such as the Biomedical Model (this is what most physicians and medical professionals use), directly relate pain to tissue injury. Think back to a time when you went to your doctor or physical therapist and he or she pulled out a model of the spine, ankle, shoulder, etc. to show you how YOUR faulty anatomy can explain YOUR pain. However, it has been proven many times over that there is not a direct correlation to tissue injury and chronic pain conditions.
For example, take two healthy 16 year old female soccer players, let’s call them Judy and Trudy. To make it easy, let’s say both Judy and Trudy have the same BMI, same years of experience in their sport, and same skill level. Both Judy and Trudy sustain bad ankle sprains on the same day. They both get MRIs that show Grade III sprains and are given the same treatment regiment – ice, rest from soccer, use crutches and a brace, and go to physical therapy. They are both compliant with their treatments. Judy is feeling good after 4 weeks and is returning to playing soccer. However, Trudy is still having pain after 3 months and is still relying on using a brace to walk. They both have follow-up MRIs at 3 months and both show normal tissue healing. So why is Judy fine, and Trudy is still having pain? Little did we know that Trudy has been struggling with her grades and has been under an enormous amount of stress to get a soccer scholarship in order to go to college, whereas Judy is only playing soccer for fun. Did I also mention that Trudy has to take care of her 7 year old sister after school every day because her mom is a single mom working two jobs? So now it seems reasonable that there are other factors at play than just anatomy and physiology in the pain experience.
So why do health professionals continue to use biomedical models to explain pain? Well, this can be a helpful tool to describe acute and sub-acute pain but has been disproven time and again to explain chronic pain. Research shows that past experiences, coping strategies, personal views, and education level are very important when it comes to explaining why someone is experiencing chronic pain. One of the best things we can do to combat pain is to educate ourselves on what pain is. This is where Pain Neuroscience Education (PNE) has come from and this is what I will be hoping to discuss over the next few blog posts. Stay tuned!