The Biology of Chronic Pain and Its Implications for Pain Neuroscience Education: State of the Art

Abstract

Pain is an individualized experience for the person suffering from chronic pain. Significant strides have been made in the last few decades in understanding various biological changes that coincide with chronic pain. This state-of-the-art overview looks at the current evidence related to the biology of chronic pain and the implications these findings have on the delivery of pain neuroscience education (PNE). The paper summarizes the various (epi)genetic, neural, endocrine, and immune factors discovered and explored in the scientific literature concerning chronic pain. Each of these biological factors has various implications for the content and delivery of PNE. We discuss the future directions these biological factors have for the clinical implementation of PNE by linking the importance of behavior change, optimizing the learning environment, and using an individualized multimodal treatment approach with PNE. In addition, future directions for research of PNE based on these biological factors are provided with importance placed on individualized patient-centered care and how PNE can be used with traditional modes of care and growing trends with other care methods. PNE was originally and continues to be rooted in understanding chronic pain biology and how that understanding can improve patient care and outcomes.

Pain Neuroscience Education for Acute Pain

“… 3 Nociceptors are stimulated (mechanically, chemically, or thermally), initiating an electrochemical impulse into the central nervous system (CNS), passed onto the brain for processing, and typically a pain experience ensues, which garners the attention of the individual. 1 Most pain experiences in life, including those that occur during sport participation, fit within this category and are referred to as a nociceptive driven pain experience. In fact, epidemiological research data from outpatient physical therapy (PT) indicates that approximately 55% of patients attending PT fit into this category.…”

“…In the dorsal horn of the spinal cord, information from the periphery is received with the intent to pass that information on to the brain for processing. 1 Inhibitory and excitatory neurotransmitters interact with receptors, allowing the information to be blocked (gating) or continue on to second-order neurons to pass the information on to the brain. In acute, sub-acute, and postoperative pain experiences, the dorsal horn becomes bombarded with nociceptive information from the target tissue; the dorsal horn plays an essential role in the acute pain experience and then reverts back to a normal state as tissues heal.…”

“…The concluding stage of the mature organism model is output, encompassing diverse biological and physiological reactions to the input and processing of information, including motor, immune, linguistic, sympathetic, and other responses. 1 For example, for a soccer player who sustains an ankle sprain, information is sent to the CNS and brain for processing, and if the brain perceives a threat, pain will be produced by the brain to protect the ankle, and ultimately the athlete. Pain is an output of the brain to get a person to stop, pay attention to the situation, and seek help.…”

“…Pain is an everyday human experience designed to warn an individual in the case of danger and ultimately have them take action to reduce or eliminate the threat. 1 For example, suppose a football player hurts their knee in a tackle. In that case, pain is a critical warning sign to reduce the threat by stopping what they’re doing (running on the leg) and take action by getting it further evaluated by the medical team.…”

“… 3 Persistent pain does not follow this trajectory, and often, despite tissue healing, the pain experience continues. 1 This not only significantly impacts the person dealing with pain but also increases challenges faced by medical providers when seeking ways to address persistent pain. 4 …”