Oregon has the fourth-highest rate of prescription pain killer abuse in the nation, so the state is implementing new guidelines that will require doctors to give lower doses and shorter prescriptions.

That's a challenge for patients who've relied on opioids to deal with their pain. Alternative treatments such as massage and acupuncture don't always work. So Providence Health is also offering to re-educate patients about pain to help them deal with pain by learning to think about it differently.

Nora Stern, a physical therapist and manager of the "Persistent Pain Project," spoke to about a dozen patients about the re-education. "This class was designed to help us all start to talk about pain differently. There’s a lot of new information about pain that leads us now to understand what pain is differently and what the options are for treatment.”

We think of pain as pretty simple, she told them. Johnny rides his bike, falls off, scratches his knee and feels pain. But scientists say how we perceive pain is much more complex.  If Johnny’s mother isn’t around, for example, he might not burst into tears. Stern says soldiers in battle, who’ve suffered massive injuries, sometimes don’t register the pain from their wounds until much later. They're too busy trying to stay alive or complete their mission.

“It’s possible because the threat value of what’s going on around them is much greater than the threat value of what happened even in that injury," she said. "They can’t afford to assign pain to that part at that time, because there’s something much greater going on ”

 So, Stern said, pain isn’t just a result of tissue damage. Pain is what the brain says it is.

“The brain produces a pain response as a result of putting together information from the body and information from all these other parts of the system in general," she said. "To decide how threatening that information is and based on the threat value it assigns more pain or less pain.”  The threat doesn’t have to be physical. A painter who falls off a ladder and injures himself may suffer worse pain because he’s worried his injury means he won’t be able to work any longer, to pay his bills and support his family.

“You’re likely to feel more pain if you’re having a hard time in your life and people have that happen all the time,” Stern said.

After Stern’s class, people filed out quietly. People in pain don’t tend to be very chatty.

But Sherry Swafford, who has suffered from neck pain for 30 years, says the class was illuminating. She especially liked Stern's suggestion to think more deeply about daily activities and less about pain.

“I thought about the walking and noticing all the different colors of greens," she said. "I’ve noticed the different colors of things and the smells, just the visual feast there is. But I never really thought about how many different differences there are.”

As a nation, we're used to taking pills for our pain. So patients can turn skeptical when someone suggests they should think differently about their pain as an alternative to painkillers. 

But Oregon Health & Science University neurologist Dr. Eve Klein said there's research behind the suggestion.

“You know there’s as much science behind behavioral therapy and physical therapy as there is behind opioids," she said. "The efficacy actually looks better when we look at what data there is available.”

Back at the pain class, Stern tells her students that sometimes they need to understand that, as she puts it, "motion is lotion." 

“Sometimes, (pain is a) warning us that we just injured ourselves. Sometimes it’s warning us about something else, like we haven’t been up and moving our bodies enough to have a healthy resilient nervous system," she said.