How Pain Neuroscience Education Changes the Brain

Pain

Aug 29

Many treatments for chronic pain fail because the treatments focus on the wrong thing. Chronic pain isn’t caused by tissue injuries; it is the result of the brain and nervous system becoming sensitized over time.

As a result, MRIs and X-Rays are often inconclusive, causing you to get second (and third, fourth, or fifth) opinions. The more conflicting information you receive about what is causing your pain, the greater the fear response and the more sensitive your nervous system will become.

If you are living with chronic pain, you may have heard some of these inaccurate and unhelpful messages:

“It’s all in your head.”
“Just push through it.”
“If it hurts, don’t do it.”
“You’ll just have to learn to live with it.”
“If you did your exercises, you’d be better.”
“If you lost weight, you wouldn’t have so much pain.”

Your pain is REAL. If your treatments haven’t worked, it is because your providers are likely treating the wrong thing. When you have chronic pain, you don’t need treatments for your body, you need treatments for your nervous system.

Pain is the nervous system’s reaction to perceived threat. To heal from chronic pain, you have to convince your nervous system that there isn’t any threat and teach it to be less reactive.

The good news is that because the brain is malleable, you can rewire your nervous system and decrease its sensitivity. That’s where Pain Neuroscience Education (PNE) comes in.

What is Pain Neuroscience Education (PNE)?

Pain Neuroscience Education is an evidence-based therapeutic method for reducing chronic pain that was developed by some of the leading physical therapists and clinical researchers in the study of pain, including Adriaan Louw, Lorimer Moseley, Louie Puentedura, David Butler, and Kory Zimney.

Pain Neuroscience Education teaches patients how pain is generated in the body to change the story from viewing pain as being caused by damage to understanding that it is a protective response from a hypersensitive nervous system.

When you think that pain is caused by damage, two things will likely happen:

You will go searching for a physiological cause and get test after test trying to understand why you hurt.
You will fear that every time you feel the sensation of pain you are doing more damage and making things worse, increasing the fear and further limiting your tolerance to pain and your functional capacity.

When patients learn that their pain is due primarily to a hypersensitive nervous system rather than repeated or ongoing injury, they can begin to:

Experience less fear
Move with more confidence
Learn to take care of their nervous system so that it is less reactive
Rewire the nervous system and increase function
Interrupt the vicious cycle of pain
Develop hope that healing will be possible.

How Does Chronic Pain Change the Brain?

When pain persists over time, your nervous system becomes more efficient at producing pain, keeping you stuck in a pain cycle. This is due to neuroplasticity, which is the brain’s remarkable ability to change and adapt.

Neuroplasticity is the reason you’re still in pain — but it’s also the key to healing.

When you learn a new skill, have a new experience, or repeat a task or pattern over and over again, the brain builds new neural pathways to support learning and memory.

There is an old saying that says, “Neurons that fire together wire together.” Essentially what that means is the parts of your brain that activate during a task form a strong connection, and over time, those parts of the brain will synchronize to make that task more efficient.

The more often that neural pathway is used, the easier it will be to activate. I think of this as akin to carving a walking path through the grass. If one person walks across the grass one time, it won’t leave a trail. But, if many people walk across the grass in the same pathway over and over again, it will erode the grass and leave a clear path, enticing others to follow in those footsteps..

In other words, the brain rewires itself based on the patterns that are used most frequently.

Neuroplasticity can be a really positive trait. It is because of neuroplasticity that you can learn a dance routine, solve a puzzle with increasing speed and efficiency each time you play, remember what you study, recover from a brain injury, and learn a new language.

However, neuroplasticity can also create maladaptive patterns, including chronic pain. For example, if you have pain when you walk up and down the stairs, your nervous system will reorganize its structure to create a neural pathway that associates stairs with pain. The heightened fear of stairs can create a negative feedback loop called central sensitization that amplifies the pain signals and makes the pain easier to activate.

The good news is that although neuroplasticity is responsible for creating central sensitization pain pathways, it is also the solution.

How does PNE Rewire the Nervous System?

Pain Neuroscience Education works by interrupting the pain pathways and rewiring the brain to extinguish those pain pathways by creating new neural connections.

As I described at the start of this article, central sensitization is a nervous system condition, not a body tissue injury. Understanding the science of pain has been shown to dramatically reduce the fear of pain. Once you understand that the pain is not caused by reinjury or prolonged damage, but rather by nervous system sensitivity, you can start to unwind the pain pathways keeping you stuck in the chronic pain cycle (Moseley et al., 2018; Watson et al., 2023).

In other words, learning about pain actually changes the brain.

What the Research Shows

Clinical research has shown that PNE is actually more effective at reducing pain and improving function than medications like SSRIs and gabapentin, especially when PNE is combined with movement and/or physical therapy, and mindfulness and self-compassion practices (Watson et al., 2023).

PNE works because it focuses on the root causes of pain in the nervous system, rather than focusing solely on the body structure(s) that hurt.

🔹 Reduced Pain & Disability

A 2023 meta-analysis of 17 randomized controlled trials (RCTs) found that integrating pain neuroscience education into exercise-based rehab programs resulted in significant improvements in pain and disability compared to standard physical therapy. (Louw et al., 2023).

🔹 Improved Fear of Movement & Catastrophizing

Fear of movement (kinesiophobia) and catastrophic thinking are two of the biggest barriers to recovery. A study published in JAMA Neurology found that PNE combined with motor control training significantly reduced these psychological factors and led to long-term pain reduction (Malfliet et al., 2018).

🔹 Better Function in Older Adults

Even among adults over 65, PNE has been shown to improve gait speed, reduce disability, and help patients feel more empowered and less fearful about their pain (Louw et al., 2018).

What to Expect from a PNE-Based Program

In a typical PNE program, you will:

Learn about pain pathways and about the role the nervous system plays in pain.
Learn how and why the nervous system becomes sensitized and be able to identify signs of central sensitization in your own pain experience.
Explore the mind-body pain connection.
Learn how to be present with sensation without activating a fear-based pain response.
Teach your nervous system how to feel safe.
Replace pain sensations with positive sensations.
Engage in gentle movement or graded activity to reinforce new neural patterns, reduce sensitivity, build tolerance to pain activators, and improve function.

PNE is typically offered in a 1:1 or small group setting. Having a relationship with your provider and an opportunity to ask questions, apply pain science to your own life, and explore mind-body sensory reintegration techniques that are specific to your experience are important components of successful PNE experiences.

Why It Matters

When you understand that your pain is real, but that hurt does not equal harm and you can be sore but safe, you begin to move differently. You gain confidence. You break the cycle of fear and avoidance. And most importantly, you open the door to real, lasting change.

You are not broken. Your nervous system has just been doing its best to protect you (maybe a little too well!). With the right knowledge and support, you can teach it a new way.

Break the Pain Cycle

I am passionate about helping people like you rewire their nervous system and break free from chronic pain.

Join the next cohort of my Break the Pain Cycle Course and Nervous System Coaching Program to harness the power of Pain Neuroscience Education and neuroplasticity, and finally break free from chronic pain.

Need Personalized Support?

Schedule a Free Discovery Call to talk about your needs and goals and how you can begin to rewrite your pain story.

Schedule a Free Discovery Call Today

Dr. Rachel de Simone

Dr. Rachel de Simone is a Doctor of Physical Therapy and a certified chronic pain specialist on a mission to transform the treatment of chronic pain and depletion by restoring nervous system resilience.

Chronic pain, stress, burnout, emotional overwhelm, and chronic tension are signals from your nervous system that it's time for change. Imagine having the tools to calm your body, clear your mind, and stay steady through life’s storms. That’s the power of nervous system resilience, and it’s something you can learn, strengthen, and embody.

When your nervous system feels safe, everything begins to shift. Whether you're navigating pain or high stress, healing from trauma, or simply seeking more ease and presence, this work can meet you where you are. Schedule a Free Discovery Call to learn more.

https://www.lotusvt.com

How Pain Neuroscience Education Changes the Brain

What is Pain Neuroscience Education (PNE)?

How Does Chronic Pain Change the Brain?