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Let’s Talk PNE: Is Your Back Pain Really Just A Mental Trick?

PNE says back pain isn't real

What if we told you that back pain that’s making you miserable right now isn’t real? What if we told you your mind just thinks your back hurts, and all you have to do is, well, just learn how to think it away? That’s what one trend coursing through physical therapy circles is telling us—that we can create our own miracle pain relief simply by believing our back pain doesn’t really exist. Does it work? Not according to one high-level study using the pain neuroscience education (PNE). But before we dive into the study, let’s learn more about this theory that essentially says that pain is all in our head.

The Pain Neuroscience Education (PNE) Theory

At the basic level, the pain neuroscience education (PNE) theory is the belief that pain is really just our psychological response to overactive, or hyperexcitable, nerves. In other words, that the pain really is just all in our head, not really the result of any injured or damaged structure. So that pinched, irritated nerve your doctor found in your back…not really the problem. The real problem and what categorizes your pain is how you actually interpret the signals coming from the irritated nerve, and, perhaps, even what your doctor tells you about your irritated nerve feeds the raging fire of your conceptualization of your pain. In other words, what you’re told about your pain and how you process that information may actually be generating your pain and how much of it you believe you feel.

If you apply the PNE theory and are educated that your pain isn’t really there, or at least isn’t nearly as bad as what you imagine it to be, then this will relieve those overactive nerve responses and you’ve found the solution to your back pain—you can just learn it away. If you’ve ever suffered with back pain, you’re probably already defending your real physical pain just reading this. But is it true? Is your back pain only as real as what you imagine it to be? Let’s review the study.

No Relief of Back Pain Using PNE Theory

The new study randomized each participant with back pain into one of two groups: a PNE group that received pain education and a placebo (control) group that received no pain education. The PNE group was given pain management methods, such as pacing and other activities, and detailed biopsychosocial (biological, psychological, and social) info. explaining what contributes to pain. The placebo group received no educational methods for pain. Pain responses were compared between the two groups.

The study found that the neither group experienced a reduction in the intensity of their back pain. In addition, while the intensity of pain was unchanged in the PNE group, unfortunately, this group experienced less concern that their pain might be due to any serious back issues. This is not good as pain should be a red flag that something isn’t right; ignoring it is only likely to make the condition worse. Pain is absolutely real and should be treated as such.

More Concerns About PNE

PNE may be making a resurgence, but it isn’t new. Two to three decades ago this same type of pain-is-all-in-your-head concept was promoted by chronic-pain programs and failed. Another discredit to the PNE promoters: pain physically alters brain function, one study found, not just the psychological response to pain. In addition, brain shrinkage (or atrophy) has been associated specifically with back pain.

There’s also been a rebirth of the biopsychosocial supporters, whose focus is to talk patients out of their pain. If you have an injury to your SI joint in your lower back, for example, the biopsychosocial response is to talk you out of it because, according to them, this joint can’t be injured.

If you struggle with back pain, you know the title of today’s post is certainly tongue-in-cheek. You also know your back pain is real. In fact, we have to wonder if these PNE folks who think you can learn your back pain away have ever experienced any back pain. Are there patients out there who dwell so much on their pain it disrupts function? Certainly. But it’s important to not confuse these exceptions to the norm by generalizing it to the entire population of patients with back pain. The goal should be to focus on diagnosing and treating the problem, not on learning to ignore pain.

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