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Know Pain, Know Gain- Part 1

May 24

Today I ran into a previous patient whom I treated for 6 weeks for back pain and sciatica.  At the time he came to see me he had been having back pain and sciatica for years, he was using pain medications extensively and was considering back surgery.  His ability to function in his normal work and daily activities was very limited.  During the the course of our time together he improved and ultimately decided to not have surgery.  While he wasn’t “completely” better he was recovering and becoming more functional with less pain.  He was happy that he was continuing to progress and that he did not decide to have surgery.  He didn’t need the pain medications any more because he was able to manage any pain he had with ice or heat and exercise.  What happened to help him?  What was the key to his recovery? Well, it wasn’t just one thing but a major factor was his KNOWLEDGE of the pain system of the body, the neuroscience of pain if you will.  As he understood this more he gained more control over his pain and was able to start moving forward in his life.

Nearly 50 million American adults have significant chronic or severe pain, according to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH), which appeared in The Journal of Pain,, published by the American Pain Society.  Other groups estimate that up to 100 million Americans are suffering from Chronic pain.  There are more people with chronic pain than diabetes, cancer, and heart disease combined. Most of us don’t have to look very far to find someone who’s dealing with pain that won’t go away.  The number one reason for chronic pain is back pain followed by headaches and then joint pain.  A few other conditions that cause chronic pain are Fibromyalgia, Lupus, and Rheumatoid Arthritis.  Many people develop chronic pain after injuries or surgeries.  For example, according to Arts etal 2012 15 months after back fusion surgery 65% of patient were experiencing continued pain and functional limitation despite the fusion being fully healed.

Chronic pain is generally defined as pain that persists beyond 3-6 months.  Why 3-6 months?  Because in general we know that injured tissues heal withing 3-6 months.  When pain persists past this window of time we call it chronic pain, or pain that persists without a clear physiological reason.   If the tissues are healed, why do some people continue to have pain?  In the next few weeks I will answer this question.  I will discuss how the problem can actually lie in the nervous system not the tissues of the body.  New compelling research is showing that this is the case for most people with chronic pain. Essentially, the pain system in the brain has become extra sensitive or overprotective generating pain after the tissues have healed.

NOW HERE’S THE EXCITING NEWS!  Researchers in Australia have developed a way to teach people with chronic pain about their pain and as they do the people experience less pain almost immediately.  It’s called Therapeutic Neuroscience Education (TNE) or Pain Neuroscience Education (PNE).  Over the next few weeks I am going to introduce the concepts of TNE to you.  A growing body of research strongly supports TNE for reducing chronic pain when combined with other traditional treatment such as Physical Therapy.  Ultimately, if you KNOW PAIN (understand the neuroscience of pain) you can KNOW GAIN and see improvements in your pain and ability to function.

Dr. Greg Schroeder, Physical Therapist