Pain Education Is Stuck — And We Know It

Pain Education Is Stuck — And We Know It

There’s a new paper out from Moseley and team.
They’ve renamed Pain Neuroscience Education (PNE) to Pain Science Education (PSE).
Same message, but now with comics, VR, and some storytelling added in.

They’re trying to freshen it up.
But anyone paying attention knows… it’s still the same old stuff.

Pain is a brain output.
Pain doesn’t mean damage.
If you change how you think about pain, your pain might go away.

That’s the pitch. It always has been.

But Let’s Be Real

The model hasn’t changed. Just the wrapping paper.
Still focused on explaining.
Still preaching from the top down.
Still acting like pain is a belief problem — and they’ve got the belief correction manual.

But does it actually work for most people?

The research says... not really.
And in clinic? It misses the mark more often than it hits.

The Neuromatrix: Useful Once. Now Just in the Way.

The whole thing is built on the neuromatrix model.
That pain comes from the brain, and we just need to update the software.

It sounded smart 20 years ago. But now?
It feels more like a belief system than actual science.

And yet, it’s treated as fact.
Taught in courses. Sold to patients. Backed by authority.
And if it doesn’t help someone? That’s their fault.
“They didn’t get it.” “They weren’t ready.” “You didn’t teach it well enough.”

But no one stops to ask:
What if the model itself is the problem?

A Different View

Bud Craig’s work shows us something deeper.
Pain isn’t just a brain trick.

It’s a homeostatic emotion — like hunger or thirst.
It comes from the body when things are out of balance.

• Inflammation

• Acidic tissue

• Nervous system overload

• Fatigue

• Low energy

• Disconnection

You don’t fix those things with metaphors.
You fix them with movement, rhythm, breath, food, recovery, trust.

You don’t talk the body out of pain.
You help it feel safe again.

It’s Time to Say It Plainly

The problem with PNE isn’t just the method.
It’s the mindset.

It’s the attitude that “we know better.”
That the brain is the answer to everything.
That patients need to be re-educated.

And that if the education fails — it’s on them.

That’s not science.
That’s sales.

And the worst part? It’s delivered with a smile, a TED Talk, and a research grant.

The Brain Took Over the Room

Let’s call it what it is.

Neuroscience didn’t just join the conversation — it took over.
The conductor became the soloist.
And now everything revolves around the brain.

Pain is no longer in the tissue. Not in the immune system. Not in the gut.
Nope — just a misfiring prediction machine that we need to talk into calmness.

We’ve lost the whole person by obsessing over one organ.

Taleb Saw This Coming

As Nassim Taleb wrote in Antifragile:

“When it comes to narratives, the brain seems to be the last province of the theoretician-charlatan... Add neurosomething to a field, and it suddenly sounds scientific — even when it’s just psycho-neuro-babble.”

The brain-based model gives the illusion of control.
But it hasn’t delivered the outcomes it promised.

So Here’s the Truth

We don’t need more education.
We don’t need another metaphor.
We don’t need another cartoon or animation explaining how pain is a brain output.

We need a new path. One that starts in the body.

One that:

• Builds real capacity

• Resets balance

• Teaches through experience, not slideshows

• Trusts the body's signals, not overrides them

Thanks for the Input. We’ll Take It From Here.

Neuroscience had its moment. It gave us some tools.
But it’s not the whole answer.

It’s time physios, coaches, patients, and people doing the real work reclaimed the space.

We’re not here to be educated.
We’re here to heal.
And that starts by turning down the noise — and tuning back into the body.

Let’s move forward.
With honesty. With humility. With both feet on the ground.

What If Pain Was Just Your Body Asking for Balance?

Have you ever felt pain creep in after a stressful day or tough workout, even when nothing was technically “wrong”?
No injury. No big trauma. No obvious cause.
Just… pain.

That experience might seem mysterious — or frustrating — but it’s not a glitch.

It’s your body doing exactly what it’s designed to do.

Let’s unpack a game-changing idea that could help you understand your pain differently — and manage it more gently, wisely, and effectively.

Pain Isn’t Just a Warning — It’s a Message from Inside

We’ve been taught to think pain equals damage.

Twist an ankle → pain.
Throw out your back → pain.
Easy, right?

But what if pain could happen without damage?

What if pain sometimes comes from your internal chemistry being off balance — like when you’re inflamed, overly acidic, exhausted, or just run down?

That’s exactly what a fascinating study by Kelly et al. (2013) showed — and it lines up perfectly with the work of neuroscientist Bud Craig, who describes pain as a “homeostatic emotion.”

Translation?

Pain is your body’s way of saying: “Hey — things inside aren’t okay. Help me find balance.”

This Chart Sums It Up Perfectly 👇

In the study, researchers injected a mix of chemicals into people’s muscles — things your body naturally makes during exercise, like:

• Lactate (produced when things get anaerobic)

• ATP (your body’s energy currency)

• Hydrogen ions (acid), which lower pH and increase acidity

Each mix mimicked what happens inside your body under increasing stress — from light movement to intense exercise or ischemic conditions (like blood flow restriction).

And here’s what happened:

• At low doses (near normal pH), people felt non-pain sensations — stuff like heaviness, fullness, warmth, twitching, or fatigue.

• As the chemical levels increased and acidity rose, people started reporting pain — often described as dull, hot, or aching.

• At the most acidic condition (pH 6.6), 100% of participants reported pain, even though there was no injury.

In other words:
Chemistry alone was enough to make people feel pain.

Why This Is Such a Big Deal

This study proves something many people with persistent pain already feel deep down:

You don’t need a torn ligament or disc bulge to feel pain.
You just need your internal system to be under pressure — physically, chemically, emotionally — and your brain will signal pain as a way to get your attention.

Bud Craig’s research puts it beautifully:

Pain is a homeostatic emotion — a feeling that motivates you to restore balance, just like thirst or hunger.

That means pain isn’t just an “alarm system” or a brain misfire.
It’s your body’s way of saying,

“I’m out of rhythm. Please slow down, adjust, and support me.”

🧪 What This Graph Really Shows (in Plain Language)

At the most intense level (similar to blood flow restriction or overtraining), everyone felt pain — even though there was no damage, no injury, and no emotional context.

💡 Why this matters:
It proves that your body alone — without needing an injury or a psychological trigger — can send signals up to the brain that are strong enough to cause real pain.

🚨 Bottom-Up Pain, No Damage Required

This graph breaks the myth that pain only happens when:

1. You’re hurt

2. Your brain “misinterprets” safe signals as dangerous (which is the focus of many modern pain education models)

Instead, it shows:

Sometimes your body chemistry alone can push the system into pain — even if there’s nothing structurally wrong.

Your muscles and tissues have sensors that detect acidity, fatigue, and other signs of internal stress. When those sensors are triggered enough, they fire pain signals straight up the spinal cord to your brain.

No story. No emotion. Just raw, bottom-up input.

🧭 So What’s the Takeaway?

If you're in pain and nothing seems “wrong” on your scans, you’re not imagining it.
Your body might just be in a state of imbalance, and the signals are getting loud.

This is why recovery often needs more than mindset work — it needs real support for your physiology:
hydration, breathing, rest, movement, and rhythm.

So… What Do You Do With This?

If pain is your body’s call for balance, then managing pain becomes less about “fixing” and more about listening + supporting.

Here’s how that might look in real life:

1. Zoom Out from the “Injury” Narrative

If your pain isn’t linked to a fresh injury, consider:

• Am I underslept?

• Stressed or emotionally stretched?

• Under-recovered from training or work?

• Eating or drinking in ways that support or stress me?

Sometimes, it’s not about the area that hurts — it’s about the system being overloaded.

2. Respect Your Chemistry

That graph didn’t lie:
Your pain may just be your body saying,

“Hey, it’s getting acidic and inflamed in here. Can we chill?”

So…

• Hydrate well

• Prioritize sleep

• Breathe slowly, especially under pressure

• Move gently (to encourage circulation, not exhaustion)

3. Feel First, Fix Later

Instead of immediately chasing solutions, try noticing what your body is asking for.
Sometimes it’s rest.
Sometimes it’s gentle movement.
Sometimes it’s just a moment to breathe and regroup.

Pain is often louder when the system is overwhelmed and under-heard.

Final Thought

Pain is real. It can be awful, disorienting, exhausting.

But it’s not always damage.
It’s often information. And your job isn’t to silence it — it’s to tune in, understand it, and respond wisely.

As Lao Tzu said:
“Do you have the patience to wait until your mud settles and the water is clear?”

That’s what self-care can be when we treat pain as a guide, not a glitch.

So next time your body whispers (or yells),
Don’t just ask “What’s wrong with me?”
Ask:

“What is my body trying to say — and how can I support it today?”

🔗 Exogenously Applied Muscle Metabolites Synergistically Evoke Sensations of Muscle Fatigue and Pain in Human Subjects
Authors: Kelly, L.A., et al.
Journal: The Journal of Physiology (2013)

Want to learn more and see how this makes sense through a case study ? Read on…

🎯 Case Study: Mark’s Lower Back Flare-Up and the Model That Finally Made Sense

Mark, a 44-year-old graphic designer and father of two, has had on-and-off lower back pain for about five years. He’s fit, doesn’t sit too much, and has no major injuries in his history.

But one week, after a few late nights, some emotional stress at home, and pushing through a few intense gym sessions, he wakes up and…
BAM — his lower back locks up again. Sharp, aching pain. Muscle tightness. Fear floods in.

Here’s how three common pain models would explain what’s going on — and how only one of them actually helped Mark feel seen and supported.

🩻 1. The Biomedical Model

What it says:

“You probably strained something again. Maybe your disc or facet joint is irritated. Better stop lifting and get some scans.”

What Mark does:
He rests, pops anti-inflammatories, and stops training altogether. His scan shows a mild disc bulge (which he already knew about). Nothing new, but now he’s more afraid.

Result:
Frustration, fear of re-injury, and no real answers. The pain slowly fades, but the anxiety remains.

🧠 2. The Pain Neuroscience Education (PNE) Model

What it says:

“Pain doesn’t mean damage. Your brain is just interpreting signals as dangerous because of stress or past experiences. Try reframing your thoughts and keep moving.”

What Mark does:
He tries not to catastrophize. He tells himself “I’m safe.” He walks. He does a few gentle stretches and tries mindfulness. It helps… a little.

But deep down, he still feels like something in his body is off.
He’s told “trust the process,” but the pain lingers. He starts doubting himself.

Result:
Less fear, more confusion. He's doing “everything right,” yet still feels pain.

🌡 3. The Homeostatic Model (Bud Craig’s Approach)

What it says:

“Your pain is real. And your body is telling you something is out of balance — not broken, but dysregulated.”

It’s not just your thoughts. It’s your chemistry:

• Poor sleep

• Emotional stress

• High-intensity training without recovery

• Low-grade inflammation

These all impact your body’s internal signals — and when the system gets overwhelmed, your brain sends the message: PAIN.

What Mark does:
He reflects.
“Ah — I’ve been skipping sleep. Stress is high. I trained hard but didn’t recover.”
He doesn’t panic. He doesn’t stop moving. But he also doesn’t push through.

Instead, he:

• Adjusts his training for the week

• Prioritizes rest and hydration

• Focuses on steady breathing and slow walking

• Eats anti-inflammatory meals

• Lets his system settle

Result:
Within a few days, the pain eases without fear. He feels more confident, not because he ignored the pain — but because he listened to it.

✅ Takeaway: Pain as a Homeostatic Emotion

Mark’s back wasn’t “broken” — his body was overloaded.

The biomedical model told him he was fragile.
The PNE model told him it was just his brain.
The homeostatic model? It told him his body and brain were working together to send a useful signal.

And that changed everything.