Why does learning about pain make it better?

By Dershnee Devan

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In the words of pain neuroscience guru David Butler “Knowledge is the Greatest Pain Liberator of all” (Butler, 2013). This is something I have personally experienced with my patients. I guess the question really is how and why does it work?

Well… the how is all about targeting the brain, the most important player in the physiology of pain. The brain is in charge and takes control of whether the volume of pain is turned up or down.

This is often a difficult concept for patients and clinicians to take on and understand. This is mostly because the majority of us receive a purely biomedical education about pain in our medical studies. Although we know the brain is involved in pain physiology, we often look no further than the peripheral mechanisms for generators of pain. Pain – specifically chronic pain – is far more complex than what happens in the periphery or tissues.

Neuroplasticity has shown us that our nervous system, specifically our brain, does in fact change when persistent pain occurs. When chronic pain becomes a reality for our patients, it is usually at a point where the entire central nervous system attunes to creating a pain experience. Yes that’s right….it is now creating the pain experience often with limited or no peripheral input.

What makes this even more distressing for our patients is the biopsychosocial nature of pain. The context, the support, the psychological distress such as fear and anxiety together with the physical contributors make chronic pain an overwhelming experience. If we add to this the loss of control we experience when we feel persistent pain, we start to understand that chronic pain is indeed a complex beast. In Lorimer Moseley’s words we have to “tame the beast”(Moseley, 2017)!!!

Now for the why… knowledge about pain and its mechanisms helps to indeed “”tame the beast” and regain some control over the pain experience. It helps patients see more clearly the reasons for their symptoms and weird sensations they experience like zings and zaps. If you can understand why pain is happening in your body you will feel less fear and anxiety about the “why do I have pain?” question.

Simplistically on a physiological level this helps our brain to make sense of the input it receives which ultimately results in a calming down of the brain and sensitised nervous system. (More on this in a later blog)

Knowledge really is power in this scenario. Teaching our patients and ourselves more about chronic pain and its mechanisms is a truly liberating tool. It allows us to empower our patients to take steps towards self-management of chronic pain ultimately leading more fulfilled lives.

I believe if I can help people understand chronic pain, it will open the door to brighter futures for our patients.

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