Your Brain on Pain: The Science of Pain Education

Here at the Miller-Dwan Foundation, we are anti-pain. We don’t like it and are totally against it. That, however, doesn’t mean we don’t need it. Pain is critical to us understanding when something is wrong – physically, mentally and spiritually. But chronic pain – that pain that just won’t go away – is associated with all manner of mental health problems including substance abuse. It’s the number reason people see doctors, it’s why research on pain management is a core National Institute of Health goal and it’s why, as much as we dislike pain, we support it.

Pain is one of those things. It affects nearly one third of the US population with the yearly cost of treating chronic pain estimated at more than $600 billion. That’s greater than the yearly cost of cancer, heart disease, and diabetes.

Nearly all of us have experienced significant pain at some time or other. When I popped a disc in my back, I would have done darn near anything to relieve the pain. Drink copious amounts of liquor, pray to the gods, pop a few pills and pay for whatever possible therapy was available. But nothing seemed to help.

Over the years, with the rise of opioid abuse, the medical community has come to support non-drug treatment options offered by a variety of medical providers.  Treatment strategies provided by physical therapists, have in fact, proven quite effective. One of those strategies, based on research, shows that when we help people understand exactly how pain works in our bodies, pain improves.

Think of it this way. When I injured my back, nerve cells sent a message to my brain, and my brain responded. It was my brain that said, “Oh holy cow, your back is hurt!” It was my brain that said, “You better collapse on the floor and moan for a while.” It was my brain that said, “Get help.”

You could be mad at your brain for making you feel the pain, or you could thank your brain for making you stop and stay still long enough to avoid further injury. Right? But there’s a problem.

Like someone who talks too much and likes to stir the pot, pain can take up a lot of space in your brain. That’s because it doesn’t limit its chatter the occasional water cooler conversation. It will wander over to chat with emotion. It will jump over to connect with movement, spend some time with concentration and even mess around with problem solving. If it hangs around long enough it will collaborate with fear, stress and memory and get better and more efficient at being irritating.  And then, the next time we get hurt ––we bang our elbow or scrape your knee –– even small owies can provoke significant pain responses. That’s a lot of time and energy spent listening to pain. Time and energy that would be better spent learning, playing, and being productive. But luckily, we are in charge of our brains. We can slow the brain’s barrage of unsolicited information.

Understanding the brain as the message carrier has allowed healthcare providers to devise new and interesting pain treatment strategies. This year, the Miller-Dwan Foundation funded one of those strategies.

With the  support of the foundation, 47 physical therapists, physical therapists assistants, and occupational therapists from all different areas throughout the East Region within Essentia Health including acute care, inpatient rehab, outpatient neurologic rehab, outpatient pediatrics, behavioral health, and orthopedics attended a Pain Neuroscience Education (PNE) course. PNE is a strategy, used primarily by physical therapists, to teach people about pain and how it works in our bodies. Research shows that teaching people about pain, helps decrease pain, increase movement and function and helps people keep up with exercises that can help them heal.

My back pain eventually led to surgery without the opportunity to use PNE. But if I knew then, what I know now about PNE, I am convinced I would have benefitted both before and after surgery. Here are some real stories about patients and the physical therapists who helped them:

A physical therapist was asked to see a patient on the inpatient behavioral health unit. This patient, saying they could no longer stand living with chronic back pain, had attempted a suicide. With information gleaned from the PNE course, the physical therapist was able to identify multiple factors contributing to the patient’s persistent pain.  The patient agreed to learn more about pain and was also given a few exercises. The physical therapist provided a significant amount of education. Together they discussed how the brain, pain and nerves work and how exercise would help, rather than exacerbate the pain.

A few days later, the physical therapist checked on the patient. In the meantime, another medical provider had documented in the patient’s chart that the patient reported a significant shift in the perception of their pain. They eventually reported improved pain and mobility. They were becoming holistically healthier and more able to participate in daily activities.

The incredible part of this story was that it only took one person to provide the right education at the right time to jump start a lifestyle transformation.

Another physical therapist saw a patient for the first time during the patient’s participation in the SpineX program. The SpineX Program is designed to help restore spine strength and mobility. And as it turns out, PNE is a great adjunct to SpineX. During this visit, the physical therapist described the anatomical changes taking place in the patient’s body based on MRI. These aging-related changes are common in all of us, he told her, and said we should think of them as “wrinkles on the inside.”  No one, the patient said, had every explained pain to her in this way, and she came to understand that she would lively always have some pain that physical therapy could ease. She found herself more willing to participate in SpineX and in other exercises that would improve her life.

“Chronic pain,” says one physical therapist, “is incredibly difficult to treat.  Although PNE is not the end all and be all, understanding pain is clearly an incredibly important aspect.”

The Miller-Dwan Foundation supports a wide variety of programs and departments at Essentia Health and in Community. For more information about what we do, go to To make your own difference in someone’s life, donate online to the focus area of your choice or contact us at (218) 786-5829.

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