The Tao of Pain with Dr. Adriaan Louw PT, PhD


I have for some time, been reading pain science studies and viewing lectures by Dr. Adriaan Louw.  Some of these quotes are from lectures and others are from papers and presentations. Dr. Adriaan Louw earned both an undergraduate as well as a master’s degree in research and spinal surgery rehabilitation from the University of Stellenbosch in Cape Town, South Africa. Dr. Louw recently completed his Ph.D. which centers on therapeutic neuroscience education and spinal disorders. He is a guest lecturer at Rockhurst University, St. Ambrose University and the University of Las Vegas Nevada.

I highly recommend his book Therapeutic Neuroscience Education that he has done together with fellow pain researcher Dr. Emilio Puentedura PT, DPT, PhD.

Without further ado, here are thirty quotes from Dr. Louw.

“Pain is a protective mechanism developed by the brain based on how it interprets information” Adriaan Louw PT, PhD

“Pain is complex and interesting to patients. New paradigms of pain (i.e. neuromatrix, nerve sensitivity, endocrine and immune responses to pain) and neuroplasticity have pushed physical therapy to the foreground in the treatment of pain. This course aims to show, via a modern understanding of pain, how physical therapy can help patients afflicted with various seemingly disabling pain states. This course will not only teach attendees the evidence of neuroscience education, but a step-by-step clinical application of teaching patients more about pain.” Adriaan Louw PT, PhD

“The nervous system works like an alarm system. It activates to inform us of danger, like stepping on a nail, and calms down when the threat is removed. In some people, the alarm system remains extra sensitive, which creates less space for exercise, work, etc. Your sophisticated alarm system contains various sensors to tell you how cold it is outside or how stressed you are. Thus, increased feeling in an arm or leg is just that … not necessarily that something is wrong.” Adriaan Louw PT, PhD

“People in pain want to know more about pain…NOT anatomy, biomechanics or patho-anatomy. It can not explain complex pain states” Adriaan Louw PT, PhD

“First, let’s discuss the assumption that pain comes from tissues. The Cartesian model that correlates tissue issues (nociception) to pain is over 350 years old, and it’s still doctrine in medicine and various therapies. The model is false. You can have tissue injury and no pain. For too long, practitioners and patients have sought answers to their pain by exploring the various tissues, including joints, muscles, ligaments and more. Pain is leading reason that people seek care, and when they do seek help for pain, they are presented a tissue-based model to explain their pain.”  Adriaan Louw PT, PhD

“If your alarm system keeps ‘buzzing’ for long periods, it will wake the neighbours. You hurt your back three months ago; the alarm went off and is still ‘buzzing’. The low back’s neighbours are the hips, upper back, etc. Increased awareness of these areas doesn’t mean an injury, but an extra-sensitive alarm system.” Adriaan Louw PT, PhD

“We spend a lot of time trying to “fix” things that may not matter. And, likely may be normal. Who has one leg shorter than the other? All of you. Who has one foot that pronates more than the other? All of you. Need to be careful. It’s your job to decide if something is important and contributing. But, be careful.” Adriaan Louw PT, PhD

“With persistent pain and altered processing, the brain develops a “poorer” view of the tissues. The map of the affected area is “fuzzy.” The more the map is messed up, the more the pain.” Adriaan Louw PT, PhD

“Nociception is neither necessary or sufficient for pain” Adriaan Louw PT, PhD

“Think about it: A patient comes to you seeking help for pain, and you teach the patient anatomy! No wonder pain rates in the US have doubled in the last 15 years alone. Never before have we performed as much surgery or prescribed as much medicine for pain in the history of mankind, and pain rates are ever increasing.” Adriaan Louw PT, PhD

“The sad reality is that the cognitive approaches, such as therapeutic neuroscience education and altering a patient’s beliefs, may be far superior in their outcomes compared to traditional bottom-up treatment models.” Adriaan Louw PT, PhD

“We need to change how we view pain. PT’s what we’ve learned about pain is blatantly wrong. Totally false. Need to be more complex.” Adriaan Louw PT, PhD

“30% of the patients we treat will have pain, but never had an injury.” Adriaan Louw PT, PhD

“We have been teaching people about pain for years, in various countries, to different age groups, in different languages, to various ethnicities, etc. The end result? They all get it. The best part is they experience less pain and disability; move and function better despite no hands-on interventions; catastrophize less; are less afraid and are able and willing to move further into pain during exercise and functional tasks. Healthcare education has simply become a display of knowledge. “ Adriaan Louw PT, PhD

“Our models of pain are outdated and wrong” Adriaan Louw PT, PhD

“We need to take pain to the clinic…This is the biggest challenge we face. This stuff [education, pain science] works. We have to bring it to the patient. Don’t ever think this is easy. It’s hard. It’s the hardest thing we do in all of medicine…” Adriaan Louw PT, PhD

“Whenever I make the statement “every patient has a brain,” I hear the same joke: you haven’t met my patient. Of course, they’re kidding, but there’s a dangerous assumption in their joke. What’s more concerning is that many clinicians have seemingly forgotten that every patient has a brain.” Adriaan Louw PT, PhD

“Pain does not correlate to injury, but the perception of threat to the body” Adriaan Louw PT, PhD

“The only thing tissues can tell us is information. Information comes in many forms. The brain makes decision. Pain is decision regarding threat. Pain education is about taking away threat and decreasing fear/anxiety.” Adriaan Louw PT, PhD

“Pain is 100% produced by the brain based on the perception of threat. What a patient thinks and believes contributes to their pain experience considerably. Altering what a patient thinks or believes can alter the patient’s pain experience, hence the “top-down” approach. It is suggested this approach could be far superior to the typical bottom-up approach. “ Adriaan Louw PT, PhD

“Time is running out. With healthcare reform and new reimbursement models being introduced, the stakes have never been higher to learn how to treat chronic pain patients. New reimbursement models propose a fixed fee per diagnosis and disability, and how a clinic or system treats the patient is up to them. The only caveat? There is no more money. Chronic pain patients will cause a significant clinical threat to practitioners who cannot effectively treat chronic pain.” Adriaan Louw PT, PhD

“Turner and Whitfield showed 97% of what a PT uses in his/her practice is based on what PT school taught them. If that paradigm embraces the Cartesian model of pain (pain and tissue injury is synonymous) you’re screwed. If your school has updated to the Pain Gate – you’ll be good at putting TENS units on patients, but Ron Melzack who designed the Pain Gate with Patrick Wall has taken us to the brain and The Neuromatrix, which is where we need to be; but don’t camp out there too long – people like Mick Thacker is taking PT to the immune world….and more.” Adriaan Louw PT, PhD

“The fear of pain is likely worse than the pain itself. Need to reduce fear.” Adriaan Louw PT, PhD

“Orthopedic-based professions such physical therapy commonly use anatomy and patho-anatomy based models to explain pain to their patients. Not only have these models shown limited efficacy in decreasing pain and disability, but they may increase fear in patients, which in turn, may increase their pain.” Adriaan Louw PT, PhD

“There is nothing easy to treating people with persistent pain. In manual therapy wherever you poke and they say “ow” that is the problem. Well, it doesn’t work. It’s much more complicated.” Adriaan Louw PT, PhD

“Therapists may encounter barriers in regards to time constraints, reimbursement issues for cognitive therapy, and challenges from colleagues and other healthcare providers (the biomedical model is so ingrained in society). As for the patient, we hear so many ‘You think it’s in my head?’, ‘My MRI shows …’, ‘You don’t believe me’, ‘This is too simple.’ Patients are afraid and angry. They’ve been let down so many times. They’ve lost hope and are truly suffering. Some identify themselves by their pain; losing it is losing a part of themselves. Add to this the perception that if pain doesn’t show up on a scan or test, it’s just ‘in your head’ and not real.” Adriaan Louw PT, PhD

“At least 1 in 5 people in the US (likely 1 in 4) suffer from persistent, chronic pain and the numbers are increasing. This means – 75 million!” Adriaan Louw PT, PhD


“Pain is a multiple system output, activated by an individual’s specific pain neural signature.The neural signature is activated whenever the brain perceives a threat.” Adriaan Louw PT, PhD

“Tissues contain DANGER receptors (not pain receptors).” Adriaan Louw PT, PhD

“We have all examined someone and thought how the hell can they hurt this much? Pain and NO pathology… And the opposite. Horrible posture, horrible mechanics, horrible pathology. Life is good! What is the correlation? My pet peeve is posture. What is the correlation between posture and pain? Beautiful posture and disabling pain. Horrible posture and no pain.” Adriaan Louw PT, PhD