Adding education about pain for physiotherapy treatment?

cropped-before-after-louw-2013-pain.jpgI have always been interested in pain ever since watching Dr Allan Basbaum’s Youtube video “Pain and the Brain” in 2009. Dr Allan Basbaum is a professor of University of California San Francisco and an expert in the field of pain. In this video, he attempts to explain to a lay audience, what pain is about, the current understanding about pain and what are the factors that can determine the painful experience. This is a huge paradigm shift away from the traditional medical model, where pain is explained using a‘bio-medical’ model that pain equates to structural damage. Pain is more complicated than that!

What is pain neuroscience education?

Pain neuroscience education is the transfer of current knowledge about pain from the healthcare provider (doctor/physiotherapist/psychologist) to the receiver (patient/client). This allows them to understand their pain, creates adaptive perceptions, improves their ability to cope with their pain. This involves teaching people about the underlying mechanisms of pain, including how the brain produces pain. Much attention is paid to the fact that pain is not always the consequence of damage and that, definitely in the case of persistent pain, the pain is due to enhanced central pain processing rather than structural damage (Pain Science Division – Canadian Physiotherapy Association).

What can we learn from the use of pain education in dealing with people with pain?

We now know that there is a growing body of evidence that demonstrates, by adding pain neuroscience education to current physiotherapy intervention, it results in better outcomes. Up till today, research have been done on subjects with chronic low back pain, pre-operation for lumbar nerve root decompression, complex regional pain syndrome, persistent pain, fibromyalgia, whiplash associated disorders (neck strains from motor vehicle accidents), showing promising results.

Why is there a strong urge to apply Pain Neuroscience Education to people in pain?

People in pain often have their own beliefs of their pain:

  • They fear that something is wrong despite all the scans have proven negative, because the pain is still there
  • They were previously told to do less, as doing more physical activity will do further damage to themselves.
  • They might have been told that there is serious damage already done, and they should not be as active as before.
  • Some may develop fear of movement/re-injury because in the early stage of injury, movement is almost always accompanied with pain. Even after the injury has healed, they may have lingering pain memories or irrational thoughts that certain activities or movements can induce a re-injury.
  • They should not take medication for their pain because the symptoms would then be masked, side effects, addiction risks, etc.

By changing their beliefs about pain, they develop a positive mindset that they can get better, have higher motivation for a better quality of life. Although in many cases, the pain does not get better, research demonstrates that these people feel better about themselves, cope better, spend less money on treatment and have better quality of life! What doesn’t want all these?

What can I suggest that we do differently to benefit our patients/clients:

“Empower them with knowledge, reduce their fears or beliefs about their painful disorders, increase their self-efficacy, give them options and pick the best ones to rehabilitate them.”

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