Pain science education: why suffering matters in practice

Why good patient education must target not only pain, but also the life it begins to control

Pain science education is not simply about explaining nociception, sensitisation, and the nervous system. It is about helping the person in front of us make sense of their experience in a way that supports recovery and action (Louw & Riera-Gilley, 2024; Moseley et al., 2024). To do that well, clinicians need to recognise an important distinction: pain and suffering are closely related, but they are not the same thing (Noe-Steinmüller et al., 2024).

Pain is the unpleasant experience itself. Suffering is the wider distress that can grow around pain when it begins to affect a person’s sense of self, control, identity, and future. In that sense, suffering is not only about how much pain hurts, but about what pain comes to mean in a person’s life. It may show itself as isolation, loss of autonomy, difficulty coping, dissatisfaction with life, or the feeling of having lost one’s future (Noe-Steinmüller et al., 2024).

This distinction matters clinically. Education about pain helps patients understand their symptoms and can validate that pain is real, even when it cannot be explained only by tissue damage. Education about suffering addresses the broader impact pain has had on the person’s life. It helps clinicians focus not only on symptoms but also on confidence, participation, and meaningful re-engagement. If we explain pain well but fail to address suffering, we may inform the patient without truly helping them (Ciolan et al., 2025; Wijma et al., 2018).

A useful metaphor is that the patient remains the driver, while pain is the loud passenger in the bus or taxi. The passenger may warn, interrupt, and try to influence every decision. Over time, the journey becomes smaller: plans are cancelled, activities are avoided, and life begins to revolve around keeping the passenger quiet. Education is therefore not only about explaining why the passenger is loud, but about helping the person stay in the driver’s seat so that pain may still be present, but no longer controls where life is allowed to go.

How can we help patients stay in the driver’s seat? Not by arguing with the passenger, and not by pretending it is not there. We begin by acknowledging that the warnings feel real, listening carefully, and exploring what the pain has come to mean in the person’s life. From there, education can shift the relationship with pain: from “pain is deciding what I can do” to “pain is present, but I can still make choices.” This may involve clear explanations, meaningful movement, rebuilding confidence, and reconnecting with valued activities. In complex situations, this does not require having every answer immediately. What matters is being clear, calm, honest, and reassuring about what seems likely, what remains uncertain, and what the next steps will be..

For clinicians, this leads to an important shift in focus. The question is not only, “How do I explain pain?” but also, “What part of this person’s suffering is this explanation meant to address?” Sometimes the key message is that pain does not always equal damage. Sometimes it is that the body is not broken. Sometimes it is that movement and valued activity can gradually become possible again.

Good pain science education is not about saying more. It is about helping people feel understood and supporting them as they regain confidence, function, and participation in life.

This is also where the current IMTA curriculum fits naturally. The International Maitland Teachers Association places the Maitland® Concept within an evidence-informed, person-centred framework that integrates the biopsychosocial model, modern pain science, exercise and training principles, load management, skilled communication, and the continuous evaluation of evidence. In that sense, the current IMTA curriculum is well-designed to prepare clinicians not only to perform manual therapy skilfully but also to reason, communicate, and educate in ways that reflect contemporary pain science.

With best wishes for your clinical practice and learning journey with IMTA 
Gerti Bucher-Dollenz

MSc, IMTA Senior Teacher

References

Ciolan, F., Bertoni, G., Crestani, M., Falsiroli Maistrello, L., Coppola, I., Rossettini, G., & Battista, S. (2025). Perceived factors influencing the success of pain neuroscience education in chronic musculoskeletal pain: A meta-synthesis of qualitative studies. Disability and Rehabilitation, 47(10), 2459–2474. https://doi.org/10.1080/09638288.2024.2398141

Louw, A., & Riera-Gilley, V. (2024). Pain neuroscience education: Teaching people about pain. Journal of Pain & Palliative Care Pharmacotherapy, 38(3), 292–301. https://doi.org/10.1080/15360288.2024.2424853

Moseley, G. L., Leake, H. B., Beetsma, A. J., Watson, J. A., Butler, D. S., van der Mee, A., Stinson, J. N., Harvie, D., Palermo, T. M., Meeus, M., & Ryan, C. G. (2024). Teaching patients about pain: The emergence of Pain Science Education, its learning frameworks and delivery strategies. The Journal of Pain, 25(5): 104425. https://doi.org/10.1016/j.jpain.2023.11.008

Noe-Steinmüller, N., Scherbakov, D., Zhuravlyova, A., Wager, T. D., Goldstein, P., & Tesarz, J. (2024). Defining suffering in pain: A systematic review on pain-related suffering using natural language processing. Pain, 165(7), 1434–1449. https://doi.org/10.1097/j.pain.0000000000003195

Wijma, A. J., Speksnijder, C. M., Crom-Ottens, A. F., Knulst-Verlaan, J. M. C., Keizer, D., Nijs, J., & van Wilgen, C. P. (2018). What is important in transdisciplinary pain neuroscience education? A qualitative study. Disability and Rehabilitation, 40(18), 2181–2191. https://doi.org/10.1080/09638288.2017.1327990

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