The four most important things we can learn from modern pain science research
Pain science is the study of pain.
You’re probably thinking…wow, I couldn’t have figured that out myself!
It begins with the seemingly obvious assumption that when, for example, you burn your finger, your experience of pain is an accurate indicator of what is happening at the biological level.
This falls in-line with the structural-pathological understanding of pain where the assumption is that pain and damage neatly correlate with each other.
However, in the case of chronic pain, pain science gets more complicated…
If you tore your ACL three months ago, should the pain you experience now be the same as what you experienced when the injury first happened?
What does it mean if the pain is better, worse, or hasn’t changed?
How do we understand these fluctuations in our experience of pain?
Modern pain science explores the variability of our perception of pain.
There are 4 key points to be drawn from current science:
1.) Pain is not an accurate measure of tissue damage.
When we get injured and experience pain, our behavior changes. This behavior change influences our experience of pain whether for better or worse, depending on your response.
Furthermore, studies have found that pain does not provide a measure of the state of tissues.
2.) Pain is influenced by various factors across somatic, psychological, and social domains.
Beliefs heavily influence our perception of pain. As a general rule, those who have a catastrophic interpretation of their pain (“I’m broken,” “I will never get better,” etc.) will have a much higher pain rating.
Believing pain to be an accurate representation of disuse damage is also associated with higher pain ratings in research studies. The opposite of this thinking is the belief that pain is just one of many protective outputs from our brain.
3.) The correlation between pain and tissue condition diminishes as pain becomes chronic.
As pain becomes chronic, the nervous system undergoes changes that increase its sensitivity. This heightened sensitivity means that pain signals can be amplified without new or worsening tissue damage.
Over time, this leads to a scenario where even minor stimuli or no apparent physical cause can trigger intense pain responses.
Consequently, the correlation between the actual condition of the tissues and the experience of pain weakens, making the pain less predictable and often more difficult to manage.
4.) Pain can be seen as a conscious reflection of an underlying perception that tissue is at risk.
When there is a threat to tissue, the brain releases numerous outputs in response. These outputs can include inflammatory responses, increased blood flow, and neurons whose job is to collect information on the threat and send information to the brain. This means that pain will not become a response until the threat has been evaluated by the brain.
The brain must interpret and decide the pain response, so the experience of pain is dependent on the conscious and unconscious perception of the threat posed.
Clinicians make use of modern pain science by working with patients to help them answer the question:
How dangerous is this really?
This is where working with a physical therapist can be valuable. Your PT may work with you on managing sensitivity and flare-ups while providing the education needed to make mindset shifts that can also help decrease your experience of pain.
If you have any questions or are interested in working with one of our physical therapists to help manage your chronic pain, our team can help.
Schedule your first session with our team here
Citations:
Moseley, G. L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), 169–178. https://doi.org/10.1179/108331907X223010