Understanding and Applying Pain Science in Physical Therapy

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Science has come a long way in helping individuals understand the experience of pain. Previously, pain was believed to be a result of a purely physical or anatomical issue, stemming from injury, illness or tissue damage.

Fortunately, a newer understanding of how pain works — pain science — takes a far more complex and nuanced view. Pain science moves away from the idea that tissue damage alone equates to pain. Rather, pain science suggests that the whole sum of a person — including biological, social and psychological factors — must be taken into account in order to fully understand their pain experience.

Conor O’Donovan, Doctor of Physical Therapy (DPT), in Shirley Ryan AbilityLab’s Pain Management Center, explains pain science and how physical therapy and exercise can help people living with pain.

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Pain serves a protective function. When we feel pain, we avoid using that area of our body. In the case of acute pain, this can help facilitate healing (for example, avoiding walking on a broken foot). Once healed, pain has served its function and dissipates.

In some cases, however, pain may continue beyond the usual recovery period from an injury or illness, or as part of a chronic condition like arthritis. Chronic pain can impact an individual’s ability to work, enjoy physical or social activities, or even activities like eating.

In some instances of chronic pain, we can think of pain as being the response of an overly protective nervous system. The nervous system is stuck in a state of high alert, and it has learned how to be in a continued state of pain.

Our goal with many interventions for chronic pain, therefore, is to calm, re-train and return the nervous system back to a more functional level of sensitivity or alertness.

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Pain can be extremely debilitating, frustrating and mysterious. Some days someone may feel relatively okay, but the next day their pain flares and they are bedbound. These fluctuations can lead to more frustration, more anxiety and more pain. 

However, understanding pain empowers individuals to manage their pain and is a critical part of chronic pain rehabilitation. Learning how pain works helps shed light on why flare-ups may occur and helps us learn how to decrease pain flare frequency, intensity, and duration. 

At Shirley Ryan Ability Lab’s Pain Management Center, patients participate in physical therapy, occupational therapy, psychology group classes and individual sessions. Many of these classes are educational in nature, which allows patients to see how pain science can be applied through different disciplines.

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In physical therapy, we educate our patients about trying to induce exercise-induced hypoalgesia (EIH). EIH is similar to a concept many people understand: the idea of a “runner’s high,” in which you feel good (and have less pain!) when you exercise. Many people dealing with chronic pain are unable to achieve this state because their experience with exercise makes their pain worse. 

Our goal with physical therapy is to unlock EIH by discovering — together — what type of exercise (cardiovascular, strength, stretching, etc.) and what dose and intensity feels good to the patient. No two people’s pain systems are the same and it takes time, trial and error, and collaboration to find which exercise is best suited for each person.

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As we have discussed, pain is incredibly complex and impacts many parts of the body. Therefore, it requires complex interventions. 

Thankfully, although we often move with little thought, movement and exercise are incredibly complex and require many parts of the body to work in concert with each other. This complexity is seen in the wide variety of benefits from exercise: improved strength and endurance; improved memory and cognition; enhanced mood; improved sleep; decreased risk of dementia, stroke, cardiovascular disease and metabolic disease; and improving your body’s ability to manage pain (strengthening your natural opiate systems)! 

So, while exercise may not cure your pain, it will help reduce it and make daily life easier — such as being able to walk farther and faster, going up and down more stairs, getting in and out of bed more easily or picking up that heavy bag of groceries with more ease. Exercise will help you feel better about your body, and help you feel more in control of your health.

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There are unfortunately no magic bullets, but working with a team of trusted clinicians who are well-versed in the science of chronic pain can have a large impact on your quality of life.

From a physical therapy perspective, I would encourage anyone dealing with chronic pain to find ways to move as much as they can. The benefits of transitioning from no exercise to a little bit of exercise can be massive. Here are a few tips:

• Do not stress about the optimal or perfect exercise or form. Do what you can and do what you enjoy.
• Listen to your body to differentiate your chronic pain from other sensations that occur during exercise.
• Try not to compare your current experience with what exercise may have looked like for you previously.
• As you start an exercise regimen, take it slowly. This can be as simple as starting to take a short daily walk, doing a chair yoga routine, doing a few air squats or minimizing housebound days. 

The hardest part is starting. It will get easier, and you may begin enjoying exercise!