Translating pain neuroscience into clinical practice

Pain is presented through a multidimensional biopsychosocial model, with the person at the centre and contributing factors including peripheral and central nociceptive processes, psychology, social influences, lifestyle, and genetics. The main focus is pain neuroscience and how it informs assessment and clinical reasoning, using back pain as an example while applying the same principles to broader musculoskeletal conditions. The explanation covers peripheral sensitisation, such as inflammation increasing nociceptor sensitivity, and central sensitisation within the dorsal horn, where increased neurotransmission, altered ion channel activity, and reduced inhibition amplify pain signals. It also outlines why pain can spread, why touch can become painful, and how findings such as hyperalgesia, allodynia, and temporal summation appear in practice. Broader influences from the brain are also examined, especially how anxiety, threat, expectations, and difficulty making sense of pain can enhance descending facilitation. Learners can expect practical guidance on classifying pain, recognising nociplastic mechanisms, and using clinical tools such as sensory testing and questionnaires to assess pain sensitivity, psychological factors, and recovery risk.