The Explain Pain model is a conceptual framework that explains how pain works in the body and brain. Developed by Dr David Butler and Dr Lorimer Moseley, two Australian pain experts, the model is based on the premise that pain is an output of the brain that is influenced by various physical, emotional, and cognitive factors. In other words, pain is not simply a result of tissue damage, but is also influenced by how the environment and brain processes and interprets sensory information.

According to the Explain Pain model, pain is a protective mechanism designed to alert us to potential threats and encourage us to protect ourselves. When we experience pain, the brain evaluates the sensory information and determines whether it threatens our safety. If the brain determines that there is a threat, it will generate a pain response to encourage us to act. For example, if you touch a hot stove, your brain will respond to pain, encouraging you to remove your hand and avoid further injury. In contrast, a severe graze from sliding on a grass pitch might not be experienced as painful by an athlete focused on their performance.

The Explain Pain model helps to conceptualise how pain can become chronic and persistent, even when there is no ongoing tissue damage or threat to our safety. In these cases, the brain may become overly sensitised to sensory information and generate pain responses even when there is no threat. Pain that persists in the absence of ‘danger’ is often referred to as chronic pain and may not respond to medical interventions. This often results in avoiding the activities and movements associated with pain, decreasing a person’s level of function, strength, and mobility. This distressing and self-reinforcing cycle of pain and avoidance behaviour can be difficult to break.

Psychologists can use the Explain Pain model to help you with persistent or chronic pain conditions by educating you about the role of the brain in generating pain responses. This demystifies pain and reduces feelings of fear and anxiety. Your psychologist may begin by explaining that pain is not just a physical sensation but is also influenced by psychological and social factors. The psychologist will work with you to identify the factors contributing to your pain. For example, you may explore the thoughts, feelings, and behaviours related to pain and any environmental or social factors exacerbating your symptoms.
Next, your psychologist will help you develop coping strategies based on the principles of the Explain Pain model. This may include relaxation, mindfulness, cognitive restructuring, and graded exposure. You will also develop a self-management plan for pain, which could involve setting achievable goals, tracking symptoms, and engaging in regular physical activity.
Throughout the online therapy process, your psychologist will continue to help you understand the nature of pain and the strategies that can give you greater control over your pain and improve your quality of life.

One key component of managing persistent pain is recognising the role of emotions and thoughts in pain perception. Research has shown that emotions such as anxiety, depression, and stress can influence pain perception and increase pain sensitivity. Similarly, negative thoughts and beliefs about pain can amplify pain symptoms and make it more difficult to manage pain effectively. Your psychologist will help you identify and challenge negative thoughts and beliefs about pain. Reframing these thoughts and beliefs in a more positive and realistic light can reduce emotional distress, improve mental health, and develop adaptive pain-coping abilities.
The Explain Pain model also emphasises the importance of physical activity and movement in pain management. While it may seem counterintuitive to engage in physical activity when experiencing pain, research has shown that movement can help reduce pain symptoms and improve physical and mental health.

Overall, the Explain Pain model provides a valuable framework for psychologists working with people online to reclaim their lives from the cycle of chronic or persistent pain. If pain reduces your sense of freedom and quality of life, you may need guidance to change the beliefs, fears and behaviours that have held you back from a life beyond pain.