By Shauna Mazenes
For decades, Pauline Couture lived with a relentless ache in her knee — a constant reminder of a vacation gone horribly wrong.
A shard of glass pierced beneath her kneecap during an accident while on vacation in Seychelles, completely severing tendons in her right leg. At times, she struggled to walk and used mobility devices on and off.
Surgery, medication and numerous doctors failed to provide a solution for her chronic pain. It had a profound impact on her daily life.
"It was like having a personality transplant," says Pauline, a former news anchor and communications consultant. "The pain made me more irritable, less kind, less tolerant. I just couldn't give my best."
That's when she was referred to the Rehabilitation Pain Service at UHN's Toronto Rehab, where Pauline underwent pain reprocessing therapy — a structured approach that neurologically changes how people interpret pain.
She can now walk, move and live her life more freely.
"It's life-changing," says Pauline. "Your brain has the power to do amazing things you never realized."
Nociplastic pain is a type of chronic pain that arises despite no clear cause or tissue damage. Researchers believe it's caused by faulty pain processing in the central nervous system.
"It's the alarm system in the body malfunctioning," says Dr. Andrea Furlan, a world-renowned pain researcher and lead of UHN's Rehabilitation Pain Service. "That alarm system signals the sensation of pain to protect itself when there is no actual threat or injury."
Dr. Furlan helps patients treat their pain through a combination of physical and psychotherapy, ultimately restructuring neuropathways — called synapses — in the brain.
"The pain is real," Dr. Furlan says. "It's a matter of extinguishing those synapses and creating new ones."
Identifying the cause
Dr. Furlan suspected Pauline was likely experiencing nociplasticity when, after arriving at the clinic, she described how her pain would begin after walking 100 metres.
"I would get too ambitious, I would do too much, then boom," says Pauline. "I would be back in crutches or the wheelchair."
That detail helped Dr. Furlan identify what she believed to be a synapse in her brain — a type of neurological memory.
Because of her earlier injury, Dr. Furlan believed Pauline's brain was still triggering pain sensations to protect her from overexerting herself. The more Pauline limited herself, the more her pain intensified.
"Her brain was believing that she was in danger, and she was just reinforcing that belief," says Dr. Furlan.
"It made me think: This is a synapse we can undo. She can unlearn this."
Dr. Furlan says this is the essence of nociplastic pain. The fear of pain can be so intimidating that people begin to avoid the movements that can cause it, strengthening the relationship between the two.
"It's a vicious cycle," says Dr. Furlan.
Breaking that cycle — especially the fear — is the key to addressing it, she adds.
Reprocessing pain
Pauline began pain reprocessing therapy with Joyce Lee, a retired nurse practitioner trained in the treatment approach.
Alongside Dr. Furlan, they started with education about how pain works in the brain. Then, they used gentle movement to retrain the nervous system. Finally, they worked on cognitive strategies to reduce fear and reframe pain.
One of the first steps in Pauline's healing came through learning how to calm her nervous system. Joyce introduced her to breathing techniques that helped her feel more in control.
"She could feel her body relaxing and, from there on, we would go into the session," says Joyce. "For her, I think that was one of the biggest breakthroughs."
Dr. Furlan says the initial steps are often the most pivotal for patients.
"Once they experience in their own body how they can control their pain with their thoughts — that they can lose the fear and begin moving more without the pain returning — they get excited very quickly," says Dr. Furlan.
After only her second session, Pauline decided to walk home from Toronto Rehab on University Ave.
"It was only 1.7 kilometres," says Pauline, "I thought, 'I should be able to do this.'"
At the second streetlight, her knees began to tense. Worry crept in. But before she had the chance to call an Uber, she practiced the breathing exercises Joyce and Dr. Furlan taught her.
"I heard my own voice in my head saying, 'That's not pain, it's just weird. It is not dangerous,'" Pauline recalls.
"And that was the breakthrough moment for me."
That day, Pauline walked 12,000 steps — something she never could have imagined doing just six months earlier.
"I was so proud of her," says Joyce. "It reminded me why I'm in nursing — to make a difference in someone's life."
Return to regular life
Pauline's friends and family noticed her shift almost immediately. Her husband, Ian, remembers the day she returned home from that session.
"She came back and said, 'This is really, really good,'" he says.
Within seven weeks of working with Joyce, Pauline was walking long distances again.
"Her energy is higher, her ambition is higher," Ian smiles. "It's a life-changing thing, for which I'm profoundly grateful."
Today, Pauline goes to the gym multiple times a week, lifts weights and walks on the treadmill.
As for her professional life, she's taking on even bigger challenges — such as co-chairing a gala to raise money for women in sports and lending her support to a therapeutic technology startup company.
"I lost 28 years of my life and potential," says Pauline. "I felt a regained energy, a burning desire to really ramp up what I'm able to do.
"UHN's willingness to experiment, to hire people who are doing groundbreaking work, has made a huge difference in my life and I'll always be grateful."
