Don’t Be Afraid of Pain

Learning a bit of neuroscience may provide some relief from pain.

In a randomized clinical trial, researchers assigned 120 men and women with chronic back or neck pain to one of two treatments.

The first group received the commonly recommended program of physical therapy and general exercises.

The second received a program of “pain neuroscience education,” in which they learned about the function of neurons and synapses, the ways in which pain is transmitted along nerve fibers via the spinal cord to the brain, and how pain itself can modify central nervous system functions, producing pain with even the mildest stimulation. They also performed exercises, closely integrated with the education program, that gradually introduced increasingly difficult movements, concentrating on functionality rather than pain relief, and trying to continue exercising despite the pain.

Treatment in both groups lasted three months, and researchers re-examined the participants at six and 12 months afterward. Compared to the controls, the neuroscience education group had higher pain thresholds, a significant reduction in disability, and improved self-reported physical and mental health. The study is in JAMA Neurology.

“The main message is: Don’t be afraid of the pain,” said the lead author, Anneleen Malfliet, a doctoral candidate at the Free University of Brussels. “We know that worrying and giving attention to pain ultimately increases it. Staying active and moving is better than rest when it comes to chronic back and neck pain.”