Review: Why Do I Hurt? A Patient Book About the Neuroscience of Pain | Modern Manual Therapy Blog

Review: Why Do I Hurt? A Patient Book About the Neuroscience of Pain

My regular readers know that I am a huge fan of David Butler and Lorimer Moseley. There is a lesser known alternative to Explain Pain, so I decided to review it!
I met Dr. Adriaan Louw at the one of the first Explain Pain courses ever in the US. Back then, he was just an assistant NOI Group instructor and seemed very quiet compared to David, who is probably one of he toughest acts in the world to follow (forget about Moseley, lucky for Adriaan he wasn't present). I am glad to see he has really come into his own with ISPI, and although I have not taken any of their courses, they are producing some great content and I know several clinicians who have nothing but great things to say. Without further ado....

A review of Why Do I Hurt? A Patient Book About The Neuroscience of Pain.


“Why Do I Hurt?” uses a very similar approach to Explain Pain, uses simple explanations and metaphors to educate the patient. It starts off with the hard to understand concept of pain being a normal human experience, but states that living in pain is not. Adriaan states this is for all pain, regardless of location and how modern neuroscience tells us the focus should be shifted away from issues in the tissues.

Key intro points
  • persistent pain is due to a sensitive nervous system 
  • injuries tend to heal within 3-6 months 
  • knowing about pain and how it works makes you better off, which improves 
    • abilities 
    • movement 
    • interest in doing the above 
  • anyone is able to understand the neuroscience of pain 
Section 1: Your tissue and your nerves

Key Points
  • nerves connect everything 
  • nerves monitor your body and inform you of anything going on in it 
  • some work like an alarm system
  • all nerves have a little bit of electricity going through them, which is normal and shows you’re alive 
  • stepping on a nail may cause alarm or the nerves to “wake up” 
  • the pain perception is necessary for survival 
  • in some cases nerves that “wake up” calm down slowly and remain elevated and “buzzing” or become extra sensitive 
In particular, there is a great graph showing the normal excited level as a wavy line that is vertically low, with the space above as “lots of room for activities.” The next pic is the same graph with the bar raised as “extra sensitive” and the space above, which is now quite small is “little room for activities.” This effectively demonstrates what the persistent alarm may do to a patient’s function.

Adriaan also answers the difficult question about why the alarm persists which could be anything from pain, to explanations to the pain, family, stress, and others.

Section 2 - Your nosy neighbors

Key points
  • once your house alarm sounds, the neighbors down the street wake up 
  • nerves work the same way and the tissue’s neighbors wake up with persistent alarms 
  • the police are also called (immune molecules) 
  • they check on all the neighbors and old aches/pains sometimes return but this is due to sensitivity not injury 
Section 3 - Your body’s CEO

Key Points 
  • with persistent pain, the brain analyzes the incoming message very closely 
  • i.e. - press “x” on your keyboard and four “x’s” show up instead 
  • if the CEO of “Body Inc” finds out there is a problem with a division (leg, arm, lower back), instead of monthly reports, the reports now come more frequently, and bypass the managers, vice president, etc.. 
I do not want to give away the entire text as there are several more sections, each building upon the last for focused and nonthreatening understanding of pain. It is absolutely a must read, and an affordable one at that compared to Explain Pain. I highly recommend both, but books tend to walk out of the clinic, this is an great option to let your patients borrow and to keep a few in the waiting room along with your Better Homes and Gardens, Golf and Car and Driver.

Click here to buy it from amazon!

1 comment:

  1. It's so hard to forget pain, but it's even harder to remember sweetness. We have no scar to show for happiness. We learn so little from peace.