Video and Transcript: Our Neuroscience Approach to Treating Chronic Pain | Pain Science Physical Therapy

Hi everyone! Doctor Orit Hickman here (physical therapist,) and I'm here to talk to you a little bit today about chronic pain. Chronic pain is a condition that we treat very often in our clinical setting and we use a very unique approach in the treatment of patients with pain.

For many of you who are watching this video, you've had pain for many months, maybe even many years. You've probably tried many different types of treatment, including physical therapy, and maybe you've seen varied results. Sometimes it helps. Sometimes it doesn't. Usually, it's all temporary.

Often times when we're treating chronic pain, we miss the boat when you come into physical therapy. Our focus is very much on how is your body moving. We're looking for weak muscles, joints that maybe aren't functioning properly, and of course we want to be able to reproduce your pain as a way of noting that we can say, “Alright, we know what caused it. Now, we should be able to treat it.”

The fact is that the longer that you had pain, it's no longer the same thing as it once was. So, maybe when you first started experiencing pain it was due to an underlying musculoskeletal problem. Maybe you developed low back pain after doing a lot of heavy lifting or a lot of gardening. Maybe you developed ankle pain after you sprained your ankle. Maybe, some of the most common is you develop low back and neck pain after being in a car accident or some other sort of physical trauma, such as a work injury.

The reality is we know a lot more about pain than we ever did before, and because of that our treatment of chronic pain has to change. It has to shift. So, no longer do we just simply say, “Okay, let's see how your joints are moving. Let's see how your muscles are working.” But, we want to know more about your history. We want to understand:
How long have you had this pain?
How many treatments have you had for it?
For how many of those have been successful?
How many of those have flared you up?

In our clinical setting, we utilize a technique called Graded Motor Imagery, along with a lot of Pain Neuroscience education or Therapeutic Neuroscience education. These are very, very well-researched techniques that help us be able to treat your chronic pain.

Regarding pain education, what we utilize is a lot of Neuroscience. So, what does that mean? That means that when you come in for your PT session, at your initial visit we take a very, very, very long history. Usually, it takes the full hour. At the end of that time, we start to talk to you a little bit about pain.

We tell you that pain is created in the brain. It's not that it's in your head. That’s very, very important. All pain is 100% real. But, if you're experiencing pain in your physical body, that’s not necessarily happening because you have physical damage or tissue injury. And that's a very, very important distinction to understand about pain.

By the time that a patient sees us, if you've been experiencing pain for many months or many years, often times there's something new and different that's happening in the body. Even if the pain feels exactly the same.

So, all pain that you experience in your body 100% of the time happens because your brain determines that something dangerous is happening and it needs to protect you. So, it's important to know all pain is protection.

So, let's give you an example. Let's say your walking and you step on a nail. We would hope that that would be painful. It's important to note that it is not the nail going through the foot that causes pain. In fact, you have receptors in your foot and all over your body that are danger receptors or potential danger receptors. So, these receptors feel the fact that you’ve stepped on the nail. That message travels from your foot, all the way up to your brain, and your brain has to take a fraction of a millisecond to decide:
What just happened to my foot?
What is happening all around me when I'm experiencing this?
What’s my past sensory experience like with something similar to this?
And, is this dangerous?

If at the end of that your brain decides something dangerous has just happened at your foot, it is only then that you will experience pain. If your brain doesn't think it's dangerous, you will not feel it.

And, I have had countless patients who've told me stories in which they’ve experienced really severe physical trauma, including stepping on a nail and not feeling pain. So, the most common answer that patients will say is it’s adrenaline, it's some sort of shock. However, the research shows that adrenaline doesn't make it that quickly through the body at least not fast enough for it to be the response and for it to affect how the foot responds to what's happening in terms of stepping on the nail.

So, one of the very first things that we do is we educate patients. And, we spend sometimes four to six sessions just educating on Neuroscience. The research has shown that if we educate you on pain, on why we experience pain in the body, the system starts to treat that pain. And, you get better and better. And, your pain is less and less.

If you have any more questions -- if you have any more thoughts on this -- please feel free to comment below. If you like this video, definitely give me a thumbs-up. Contact the clinic if you have anymore questions. And, of course I'm going to keep bringing videos all along. Some of them are going to be a bit longer. Some will be a bit shorter. All kind of talking about this idea of pain and how pain is produced in the brain in response to a perceived threat. Thanks for watching!