Understanding the Science of Pain
"All pain is real. All suffering is real." --Dr. Adriaan Louw, PT, PhD
Last week I attended an interesting and surprisingly engaging lecture on pain, "Understanding the Science of Pain," put on by the Courage Kenny Foundation and the Courage Kenny Rehabilitation Institute. The speaker was Dr. Adriaan Louw, PT, PhD, co-founder and CEO of the International Spine and Pain Institute (ISPI).
Here's a little bit of background information about Dr. Louw:
Dr. Louw earned both an undergraduate and master's degree in physiotherapy from the University of Stellenbosch in Cape Town, South Africa. He is an adjunct faculty member at St. Ambrose University, South College and the University of Nevada Las Vegas, teaching pain science. Dr. Louw has also taught throughout the U.S. and internationally for 20 years at numerous national and international manual therapy, pain science and medical conferences. He is a Certified Spinal Manual Therapist, Therapeutic Pain Specialist and has authored and co-authored over 50 peer-reviewed articles, books and book chapters related to spinal disorders and pain science. Dr. Louw completed his Ph.D. on therapeutic neuroscience education and is the Director of the Therapeutic Neuroscience Research Group–an independent collaborative initiative studying pain neuroscience. He is also the Program Director of the Therapeutic Pain Specialist and Pain Science Fellowship post-graduate program for Evidence In Motion.
What is "pain science," exactly?
According to Dr. Louw, pain neuroscience education (PNE) is an educational strategy used by physical therapists that focuses on teaching people in pain more about the biological and physiological processes involved in their pain experience. Funnily enough, you've probably heard an exasperated patient say to his or her unsupportive doctor (or anybody who will listen): "This pain isn't just in my head!" Well, actually, yes it is. The brain controls pain and the perception of pain and in profound and complex ways. For us RA patients, it feels like the pain throbs and burns in our joints, but it's actually in the brain where all the action is happening.
While doing a bit of googling just now, I came across this recent article from The New Yorker: "The Neuroscience of Pain" by Nicola Twilley. In the piece, Twilley meets with a scientist at the John Radcliffe hospital in Oxford, England where she then undergoes a series of MRI scans to see how her brain responds to pain inflicted on her body. These pain "experiments" include sharp needle pricks into her ankle and calf and a hot water bottle placed against the capsaicin (the chemical responsible for the burn of chili peppers) patch on her shin--mimicking a third-degree burn.
The article gives a fascinating and detailed glimpse into the type of research that's being done on pain and pain neuroscience. Traditional pain treatments (often opioid drugs) are mostly inadequate for chronic pain patients, and a new and effective form of pain care is needed right now as people all over the world succumb to an ever-growing pain crisis. Pain science is researching new ways to help people find the relief they need without the negative or harmful side effects of drugs.
During Dr. Louw's lecture, I was furiously jotting down notes the whole time because so much of what he said applied to my own pain, and I wanted to remember it. Unfortunately, I wasn't able to catch everything; I wanted to give my full attention to his presentation and that was difficult to do while scribbling down notes. But, there are a few that I made sure to write down.
"Pain is normal. But living in pain is not normal."
"Pain is normal," said Louw. "But living in pain is not normal."He also went on to give the staggering statistic that 1 out of 4 people in the world is struggling with pain. Twenty-five percent of the world's population is living with pain? Incredible. That really does seem like a pain "epidemic." But why? Why are so many people suffering from untreatable pain?
Dr. Louw points a finger at the "tissue health" model of pain, also known as the Cartesian model of pain (which is over 350 years old). According to Dr. Louw, as stated on the Institute for Chronic Pain's website, traditional medicine is strongly rooted in a biomedical model. The biomedical model assumes that injury and pain are the same issues; therefore, an increase in pain means increased tissue injury and increased tissue issues lead to more pain. The model claims that if you treat the faulty tissue or movement then the pain will go away.1 Dr. Louw says this is a wrong and ineffective method of treating pain.
According to Dr. Louw and the Institute of Chronic Pain (ICP):
This approach of teaching people about joints when they have pain does not make sense, and in fact does not answer the big question: Why do I hurt? This is especially true when pain persists for long periods; we know most tissues in the human body heal between 3-6 months. It is now well established that ongoing pain is more due to a sensitive nervous system. In other words, the body’s alarm system stays in alarm mode after tissues have healed.1
I find this metaphor of an alarm system stuck in alarm mode a very fitting way to also describe RA. For unknown reasons, our immune systems are constantly in an alarm-like state of "on." They're in continual attack mode, unable to quiet down and return to a normal state. Likewise, our pain is unable to shut itself off. Having tried years of unsuccessful medications and surgeries to try to "fix" my "bad" tissues, I'm curious and eager to learn more about pain science and how it can help me.
According to Dr. Louw, research has shown that people in pain are interested in pain, especially in regard to how pain works. Based on a large number of studies, it has been shown that teaching people with pain more about the neuroscience of their pain produces some impressive immediate and long-term changes1:
- Pain decreases
- Function improves
- Fear diminishes
- Thoughts about pain are more positive
- Knowledge of pain increases
- Movement improves
- Muscles work better
- Patients spend less money on medical tests and treatments
- The brain calms down, as seen on brain scans
- People are more willing to do much-needed exercise
During the lecture Dr. Louw also stressed the importance of four specific things to practice in order to help relieve pain: pain education, aerobic exercise, sleep hygiene, and goal setting. The first three sounded pretty understandable to me, but goal setting? What do goals have to do with pain? Apparently most people in pain have no goals or else poorly-defined goals.
"There's got to be something, a reason to get out of bed in the morning," Louw urged. Having well-defined goals helps improve your mental health and thus your pain, too. Well, I hate to admit it but I need to do some serious work improving all four of those things in my life. I rarely get any aerobic exercise, the quality of my sleep is horribly poor, my goals are unorganized and unfocused, and I'm sure that I could use some quality pain education.
At the lecture, Dr. Louw went on to speak more about the science of pain and how it's being used as a part of physical therapy to help patients. His presentation was also honest, passionate, and a delight to listen to for the hour that he spoke, I noticed. An hour wasn't long enough for this topic and I could have sat there much longer. His enthusiasm and the compassion he has for patients was also clearly evident. Dr. Louw made me want to learn more about pain, the science behind it, and how to help myself and others who are trapped and disabled by it.
"YOU own your pain!" Dr. Louw exclaimed to all of us in the auditorium. He's right, I do. We all do.
Quiz: Which is NOT a common risk factor for osteoporosis?