Gepubliceerd op: 22 Apr 2025
Understanding Pain Neuroscience: A Physiotherapist's Guide to Smarter Pain Management
In the ever-evolving world of physiotherapy, staying ahead means embracing the latest in pain neuroscience education. Understanding pain mechanisms is not just an academic exercise; it's essential for effective physiotherapy pain management in daily clinical practice.
As musculoskeletal (MSK) pain continues to dominate patient caseloads, physiotherapists must deepen their grasp of how the nervous system interprets and modulates pain.
This blog, grounded in insights from the seminal work of Morten Hoegh (2022), unpacks the complexities of pain neuroscience and highlights its transformative impact on physiotherapy.
Pain is far more than a straightforward response to injury; it's a multifaceted experience shaped by an intricate dance between neural processes and personal perception. Hoegh (2022) reminds us that nociception — the neural encoding of potentially harmful stimuli — plays a central role but does not equate directly to pain. For physiotherapists, this distinction is critical. Patients often present with pain that lacks clear nociceptive input, particularly in chronic conditions. Recognising this empowers physiotherapists to explore beyond tissue damage, focusing on neurophysiological and psychological contributors to pain.
The nervous system, like an advanced alarm system, converts mechanical, thermal, and chemical stimuli into electrical signals through a process called transduction. This transformation ignites the journey of nociceptive signals via sensory neurons such as A-delta and C fibers. Yet, the story does not end here. These signals undergo transmission, travelling towards the spinal cord and brain, where complex networks of neurons and supportive glial cells refine the pain message (Hoegh, 2022). Understanding these pathways enables physiotherapists to better interpret clinical presentations and tailor interventions to modulate these signals effectively.
Transduction, transmission, and modulation are pivotal stages in the journey from stimulus to perception of pain. Transduction refers to the conversion of noxious stimuli—whether mechanical, chemical, or thermal—into electrical impulses by nociceptors, the body’s specialized nerve endings. This electrical impulse is then carried through transmission, where it travels along peripheral nerves to the spinal cord and ultimately to the brain for processing. Along this journey, modulation occurs at multiple levels of the nervous system, where the intensity of the pain signal can be amplified or diminished. Modulation is influenced by various factors including psychological states, previous pain experiences, and physiological conditions, all of which can either heighten or reduce the perception of pain (Hoegh, 2022). For physiotherapists, understanding these stages is critical to designing targeted interventions that can interrupt maladaptive pain signalling pathways and promote effective pain relief strategies.
What makes pain perception even more fascinating is modulation — the nervous system's dynamic ability to amplify or dampen pain signals, leading to phenomena like hyperalgesia (increased sensitivity to pain) or hypoesthesia (reduced sensation). Hoegh (2022) underscores the importance of appreciating modulation in physiotherapy, as it offers a gateway to understanding persistent pain conditions. Incorporating strategies like graded exposure, therapeutic exercise, and patient education about neuroplasticity can harness modulation for better outcomes.
Crucially, the subjective nature of pain means it cannot always be objectively measured in the clinic. Hoegh (2022) advises clinicians to remain vigilant in assessing sensory changes and to follow up with thorough neurological examinations. While nociception provides valuable insights, the patient's lived experience of pain remains the gold standard in clinical assessment. Physiotherapists, therefore, must adopt a biopsychosocial model, considering not only the physical but also emotional and cognitive aspects of pain.
Emerging research on voltage-gated ion channels, particularly NaV1.7, sheds light on the genetic underpinnings of pain perception. Mutations in the SCN9A gene, which encodes NaV1.7, can result in conditions ranging from congenital insensitivity to pain to erythromelalgia, a disorder causing intense burning pain (Hoegh, 2022). While this may seem like the realm of geneticists, understanding these mechanisms equips physiotherapists to appreciate the diversity of pain experiences and the potential for personalised pain management strategies.
For physiotherapists, this knowledge is not just theoretical. Applying pain neuroscience in practice transforms patient care. Pain neuroscience education (PNE) has emerged as a powerful tool in physiotherapy, helping patients reconceptualise their pain and reduce fear-avoidance behaviours. Integrating PNE into treatment plans fosters patient empowerment, improving adherence to rehabilitation protocols and enhancing clinical outcomes.
Moreover, physiotherapists must stay abreast of research advancements. Studies on nociceptive modulation and neural plasticity continue to refine our understanding of chronic pain mechanisms (Hoegh, 2022). By embracing continuous professional development in pain neuroscience, physiotherapists can lead the way in innovative, evidence-based pain management.
In conclusion, pain neuroscience offers invaluable insights for physiotherapists seeking to elevate their practice. By understanding the interplay between nociception, transmission, modulation, and perception, physiotherapists can deliver more precise and empathetic care. As Hoegh (2022) eloquently states, clinicians should respect the complexity of pain, recognising it as a subjective experience that transcends neural impulses. Integrating these principles into physiotherapy not only enriches clinical reasoning but also significantly enhances patient recovery journeys.
References
Hoegh, M. (2022). Pain Science in Practice: What Is Pain Neuroscience? Part 1. Journal of Orthopaedic & Sports Physical Therapy, 52(4), 163-165.