Persistent Pain & How Neuroscience Can Help:
Chronic pain isn’t always caused by an ongoing injury, sometimes, it’s due to the nervous system becoming overprotective. Pain is your brain’s way of trying to protect you, but it can continue sending pain signals even when your body has healed. Even after your GP or specialist confirms there’s no ongoing medical issue—like a fracture, infection, or major tissue damage—your brain can remain on high alert, leading to persistent pain.
Imagine there’s a construction zone on a road due to a pothole. Cones, barriers, and warning signs are set up to keep people safe while the pothole is being fixed. Once the pothole is repaired, in most cases, the cones and signs are taken away, and the road returns to normal. But sometimes, the cones and warning signs are left behind, even though the road is fixed. Drivers might still slow down or change lanes as if the pothole is still there, even though the danger is gone.
Here’s leading pain neuroscience expert Adriaan Louw, discussing the complexities of chronic pain. As a clinician, researcher, and educator, Louw has pioneered the understanding of how the brain and nervous system play a key role in pain perception, empowering patients to move beyond fear and begin their recovery.
https://www.bobandbrad.com/experts/adriaan--louw
Key concepts in Adriaan Louw's work:

All Pain is Real
Pain is always a real experience, even if there’s no visible tissue damage. It’s the brain’s way of protecting the body from perceived threats. Sometimes, the brain can misinterpret signals and send pain alerts when there’s no real danger. Just like a car alarm that goes off when there’s no intruder, pain can happen even when the body isn’t physically harmed. This doesn’t make the pain any less real—it just means that the nervous system has become overly cautious. 
Central Sensitization
When the nervous system becomes overly sensitive, it starts amplifying pain signals. This means that even non-threatening stimuli—like light touch or gentle movement—can feel painful. Imagine your nervous system as a sensitive microphone that picks up every sound, no matter how small, and makes it louder. In the same way, your nervous system can amplify even minor sensations, making them feel much worse than they are. This is known as central sensitization.
The Brain Can Change
The brain has an incredible ability to rewire itself—a concept known as neuroplasticity. Pain pathways in the brain can become well-worn, creating a habit of sending pain signals even when they’re no longer needed. But just like a road system, we can build new pathways that lead to less pain. With the right combination of education, movement, and mindset, we can retrain the brain to stop overreacting to pain signals.
Hurt Does Not Equal Harm
Pain isn’t always a sign that something is damaged. Sometimes, the brain acts like an overprotective guard dog—barking at anything that seems even slightly out of place, even if it’s harmless. Your brain can behave the same way, sending out pain signals even when there’s no real threat or damage. This overreaction is the nervous system trying to protect you, but it’s important to remember that just because it hurts, it doesn’t necessarily mean harm is happening.
Calming the Nervous System
The goal of treatment is to help calm an overactive nervous system that’s constantly on high alert. By using a combination of education, movement, and relaxation techniques, we can teach your nervous system to stay calm when there’s no real threat. Just like training a guard dog to sit peacefully instead of barking at everything, calming your overprotective nervous system can help reduce pain and restore balance.
Knowledge Reduces Fear
Pain is complex and is influenced by a combination of biological, psychological, and social factors, which means effective treatment must address all of these aspects. Think of pain as a puzzle made up of different pieces—your body, thoughts, emotions, and environment—all of which need to come together to complete the picture. Understanding how pain works is a powerful tool for managing it. When you learn how your brain and nervous system process pain, it reduces fear and gives you the confidence to take control of your recovery.
Bob & Brad discussing brain scans and pain from the book "Your Headache Isn't All In Your Head" by Adriaan Louw
Full Video: www.youtube.com/watch?v=uHvsX9z93dk
Movement is Medicine
One of the most effective ways to retrain the nervous system is through graded exposure to movement. This means slowly and gently reintroducing movement so that the nervous system can learn that it’s safe. Think of it like dipping your toe into cold water—at first, it feels uncomfortable, but the more you ease into it, the more your body adjusts. By starting small and gradually increasing movement, you help your brain realize that moving is not dangerous. Over time, this reduces pain and builds confidence in your body’s ability to move freely.
Think of your nervous system as a snow globe. When you’re stressed or in pain, it’s like someone has shaken the snow globe, and all the little flakes are swirling around, making everything cloudy and hard to see. As you calm down and start to move, the snowflakes begin to settle, and things become clearer. Our goal is to help settle your nervous system, so your body and brain stop sending out pain signals unnecessarily.

And you don’t have to do this alone—your clinician is part of your team, offering guidance, hands-on care for both your body and nervous system, and support as you work toward recovery.
Further Pain Science Insights: Lorimer Moseley
Watch this short talk by another prominent researcher in this field, Lorimer Moseley, discussing Why Things Hurt:
Lorimer Moseley DSc PhD FACP is Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy at the University of South Australia. He is Senior Principal Research Fellow at Neuroscience Research Australia and an NHMRC Principal Research Fellow.
Learn More:
Lorimer Moseley's Four Essential Pain Facts:

1. Pain Protects Us and Promotes Healing
Pain is a protective signal from the brain, prompting you to change behavior to avoid harm or allow healing. It’s a normal response designed to keep you safe, but it’s important to remember that pain is not an accurate measure of tissue damage.

2. Persistent Pain is Also a Protective Function
Chronic pain remains a protective response, but the nervous system can become overly sensitive, producing pain even when it’s no longer necessary. This occurs because the brain and spinal cord learn to generate pain more easily, maintaining unnecessary warning signals.

3. Many Factors Can Influence Pain
Pain is affected by various factors beyond physical damage, including thoughts, emotions, stress, and past experiences. These influences can make pain unpredictable, spread, or fluctuate without a clear cause.

4. Therefore, There Are Many Ways to Reduce Pain and Recover
Because pain is influenced by multiple factors, there are many approaches to managing it. Moseley highlights retraining the pain system through movement, bodywork, reframing beliefs, and gradually exposing the body to safe activities to reset the nervous system’s protective settings.
Key Resources:
Compiled by Joe Liguori