The Pain IS In Our Heads. But This New Treatment Can Help.
by The Candidly Team
“Maybe it’s in your head.”
We’ve all heard this maddening phrase before.
Whether it’s endometriosis or stomach pain or hideous menstrual cramps, our pain has been dismissed. Belittled.
But as we learn more about pain, we’re learning that pain actually IS in our heads, yet that doesn’t mean it’s not real. In fact, it’s still very real, and shouldn’t be ignored.
And actually, it can be properly treated, using this new, emerging modality that’s approaching pain from an entirely fresh perspective-- a mental health perspective.
1. What is pain neuroscience education, or “PNE”?
PNE—pain neuroscience education, also known as “TNE,” or “therapeutic neuroscience education”—is a new, emerging method that seeks to validate, understand, and treat pain, especially chronic types, by addressing mental health.
PNE teaches patients about their pain, the mental and emotional reasons for it, then helps develop a customized treatment plan based on their individual needs. For some, this entails cognitive therapies; for others, it could include worksheets or support groups.
“Pain neuroscience education (PNE) has taken the most amazing, new findings in neuroscience (how nerves and the brain work) to explain to people in pain why they still hurt. It teaches people why pain spreads, how pain can get worse with cold temperature or stress, problems with fatigue and sleep, etc,” says Adriaan Louw, PT, PHD, physical therapist and teacher of pain science. “Once people understand that what they are experiencing can be explained— that it’s normal and there is something you can do about it— the nervous system calms down, pain eases, fear decreases, and hope ensues.”
2. So our pain actually IS in our heads?
“Pain is 100% produced by our brain,” says Louw. While injuries might start with other parts of the body, “the brain decides when we experience pain,” he says.
It turns out, approaching pain as easily explained by only physical symptoms or injury— a stubbed toe, a broken bone, a pulled muscle— actually isn’t always a holistic way to treat our symptoms.
And even these physical symptoms of pain still come from the brain. For example, “if you sprain your ankle, the injured tissue activates the nerves in and around the ankle to send danger messages to the brain, then various areas of the brain start discussing it (a ‘pain meeting’), and it produces pain to protect you,” Louw says.
So while an injury might have triggered the messages your body sends to the brain, ultimately, the brain itself is responsible for deciding when you do, and do not, feel pain.
3. How is pain connected to our mental health?
When we have pain that isn’t easily explained away by a clear injury or event, that pain could actually be coming from mental or emotional sources, not a physical source.
In fact, in a 2017 study that looked at a group of men who received back surgery, the biggest predictor of chronic pain was their anxiety about their pain.
According to Louw, “emotional pain is as real as physical pain and society, and medicine should understand that. Our body’s nervous system monitors our stress levels and when we experience a lot of stress or emotional overload, especially for long periods, it can trip the nervous system to send danger messages to the brain, a pain meeting ensues, and it creates pain for protection. In this case – scans and imaging of tissues are normal, yet someone really hurts.”
4. How exactly does PNE work? What makes it different?
It can be hugely discouraging to be told there’s nothing “wrong” with us because all of our tests come back “normal,” yet we’re still writhing from back pain all night. And that’s because “most of the tests we have in medicine scan and test tissues, and not pain,” says Louw.
Instead of just scanning tissue, PNE looks past just the physical self to the connections between pain and our mental health. Patients may be struggling with not just the pain itself, but the fear, uncertainty, and questions that come with pain. Questions like, “why do I still hurt? The injury/surgery/trauma was months or years ago,” and “why is my pain spreading?”
And according to Louw, “as long as a person's brain has these (underlying) questions, the central and peripheral nervous system will remain on high-alert, increase sensitization and pain will continue.”
So PNE treats pain by answering these questions, and calms the nervous system using psychological and neuroscience-based modalities like:
Guided meditation
Guided visualization
Cognitive Behavioral Therapy
Expressive writing
Brain-centric physical therapy
Social/peer support
Here’s an infographic, courtesy of the Curable app, that explains some of those modalities, and a patient’s pain journey, in more depth:
5. What’s an example of how PNE can help?
According to Louw, “people in pain are often afraid to move because they worry about their future (catastrophizing),” and worry that their pain will get worse with movement. “PNE can help decrease this fear and catastrophizing, which in turn allows people to move more, experience less pain and get back to tasks they like to do,” says Louw.
For many, PNE helps them dial down the anxiety that comes with pain, and studies have shown perceptible long-term improvements in perceptions of pain from patients of PNE.
And don’t forget—with pain, perception is everything.
6. What are some actionable ways to take charge of our own pain management?
After decades of being told that treating pain means MRI’s and shots of cortisone and years of physical therapy (and, to be clear, we recommend all of that when needed), the idea of suddenly trying to treat our pain by just being less “anxious” feels a bit…vague and amorphous.
Also, PNE is still a very emerging modality, and it’s hard to find PNE-focused providers and experts. So here’s a convenient list of a few PNE-focused ideas for managing pain:
Try Curable: Curable uses custom treatment plans focused on psychology and neuroscience to help users heal from chronic pain. According to their founder, Laura Seago, they “offer a wide range of science-backed techniques to experiment with. Not every technique will resonate with everyone, but it’s nice to have access to a wider range when you are learning about what works for you.”
Find a chronic-pain specialist with these focus areas: We’re big advocates of therapy, but not every therapist will be the right fit. Louw recommends finding a provider “that is well trained in current updated cognitive therapies, i.e., cognitive behavioral therapy, pain neuroscience education, motivational interviewing, acceptance and commitment therapy, or positive psychology.” Louw’s company, Evidence In Motion, has a curated list of neuroscience and psychology-focused pain specialists.
Try searching “pain psychologist” or “pain neuroscience specialist” and your location: You might be surprised by how much comes up.
Mindfulness, meditation, and stress management: We know—these are suggested as cure-alls for virtually everything these days. But in this case, reducing stress and anxiety have been shown to be important psychological treatments for chronic pain. Headspace even has meditations specifically devoted to pain.
NARM & trauma-informed therapy: There’s a lot of literature on the long-term effects of trauma in the body, including its role in pain. NARM is a trauma-informed therapy that specifically focuses on biological and somatic symptoms of trauma.
Advocate for yourself: “Own your pain – the provider does not own your pain. If you feel they are not listening to you or minimizing your pain experience, feel free to ‘fire’ them and find someone who listens to you and believe you,” says Louw.
This article is for informational purposes only. It is not intended to be used in place of professional advice, medical treatment, or professional care in any way. This article is not intended to be and should not be a substitute for professional care, advice or treatment. Please consult with your physician or healthcare provider before changing any health regimen. This article is not intended to diagnose, treat, or prevent disease of any kind. Read our Terms & Conditions and Privacy Policy.
