How Pain Works: Understanding Chronic Pain
A pain neuroscience education handout explaining pain as a protective brain output, sensitization, volume-up and volume-down factors and personal reflections.
1-page fillable PDF · US Letter (prints on A4) · Psychoeducation · Pain neuroscience
- Approach / concern
- Chronic Pain
- Technique
- Psychoeducation · Pain neuroscience
- Format
- Fillable PDF, 1 page (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the How Pain Works: Understanding Chronic Pain?
Pain neuroscience education (PNE) teaches people about the biology of pain, including that pain is an output of the brain influenced by many factors and that chronic pain often involves nervous system sensitization rather than ongoing tissue damage.
Why it works
Explaining pain has developed over fifteen years into an evidence-based approach (Moseley & Butler, 2015). A systematic review found PNE reduces pain, disability, fear-avoidance and pain catastrophizing in musculoskeletal pain (Louw et al., 2016).
When to use it
- Chronic pain conditions
- Fear-avoidance and catastrophizing
- Start of pain management programs
- Family education
How to use it in session
- Validate that pain is real.
- Explain the alarm system metaphor.
- Identify personal volume factors.
- Link to pacing and graded activity.
- Revisit understanding over time.
Clinician tips
- Never imply pain is ‘in your head’.
- Use metaphors that fit the client.
- Coordinate with medical and physio care.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Does this mean my pain is imaginary?
No. All pain is real. This explains how the nervous system can keep producing pain.
Can understanding pain actually reduce it?
Research shows pain education can reduce pain and disability, especially combined with movement.
References
Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and future. Journal of Pain, 16(9), 807-813.
Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332-355.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
