Pain Neuroscience Education

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August 2, 2017
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Pain Neuroscience Education

Can simply educating you about pain resolve your pain?

Pain is a normal human experience and the inability to experience pain provides a significant risk to survival for any human being. However, living in consistent pain is not a normal human experience and can be a powerful motivating force to seek help.

Traditional musculoskeletal education models have focused heavily on biomedical education focusing on anatomy, biomechanics, and pathoanatomy (how anatomical issues can cause a pathological experience i.e. pain). In these educational models, clinicians aim to explain a pain experience to patients from a tissue perspective, be it contrasting healthy and injured tissues, or highlighting a mechanical deviance from normal expected patterns of movement or a disease state such as degenerated tissues i.e. discs or cartilage. Although these models may have clinical value in more acute phases of injury, surgical, or disease states, they lack the ability to explain complex issues associated with pain, including issues with the peripheral and central nervous system such as central sensitization, facilitation and inhibition (issues of pain that are coming from the brain, spinal cord or peripheral nerves that are not due to anatomical deviances), neuroplasticity (how the brains neuronal connections are always changing), immune and endocrine changes, all of which have been implicated in more complex and persistent pain states. Countless studies have shown that these biomedical educational models not only show limited efficacy in alleviating pain and disability, but may even increase patient fears, anxiety, and stress, negatively impacting patient treatment outcomes.

 

This traditional model of explaining pain and its attempts to alleviate pain and patient disability needed an upgrade. People in pain are always interested in learning more about their pain, and this educational model upgrade of teaching people about pain biology and physiology is called pain neuroscience education (PNE). PNE aims to explain to patients the biological and physiological processes involved in a pain experience and, more importantly, take the focus away from issues associated with anatomical structures such as muscles, cartilage, discs etc. PNE has been shown to provide compelling evidence in reducing pain, disability, pain catastrophization, and limited physical movement.

The question is, where does PNE fit in with manual therapies like Osteopathy, Physiotherapy and Chiropractic? Do they work better together, or is PNE alone enough to reduce peoples pain?

A number of studies utilizing PNE without any therapeutic intervention were shown to be ineffective at reducing peoples pain levels. However, 5 of 6 of the most competent studies showed that when PNE is combined with a therapeutic intervention, physiotherapy or other, they were able to produce a significant reduction in the pain experience of the patient.

To conclude, the old approach of tissue damage equals pain, or that evidence of degenerative changes through X-ray or MRI or any other form of imaging is the evidence of a person’s pain, is no longer the go to answer in the modern pain neuroscience world. In order to resolve a patients pain, any practitioner involved in the treatment of pain should include pain neuroscience education alongside any therapeutic intervention to fully inform the patient about how the human body creates pain and processes pain.

 

Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR 2008 Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine Journal 8: 948–958.

Butler DS, Moseley GL 2003 Explain Pain. Adelaide, Noigroup Publications

Gifford L 1998 Pain, the tissues and the nervous system: A coneptual model. Physiotherapy 84: 27–36.

Gifford L 2014 Aches and Pain. Cornwall, UK, Aches and Pain LTD.

Gifford L, Butler DS 1997 The integration of pain sciences into clinical practice. Journal of Hand Therapy 10: 86–95.

Gifford L, Muncey H 1999 Explaining Pain to Patients. Paper presented at the International Association on the Study of Pain, Vienna, Austria.

Louw A, Butler D 2011 Chronic pain. In Brotzman SB, Manske RC (Eds), Clinical Orthopaedic Rehabilitation: An Evidence-Based Approach. Philadelphia, PA, Elsevier Health Sciences.

Louw A, Diener I, Butler DS, Puentedura EJ 2011 The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation 92: 2041–2056.

Louw A, Diener I, Butler DS, Puentedura EJ 2013 Preoperative education addressing postoperative pain in total joint arthroplasty: Review of content and educational delivery methods. Physiotherapy Theory and Practice 29: 175–194.

Louw A, Diener I, Landers MR, Puentedura EJ 2014 Preoperative pain neuroscience education for lumbar radiculopathy: A multicenter randomized controlled trial with 1-year follow-up. Spine 39: 1449–1457.

Louw A, Louw Q, Crous LC 2009 Preoperative education for lumbar surgery for radiculopathy. South African Journal of Physiotherapy 65(2): 3–8.

Louw A, Puentedura EJ, Diener I, Peoples RR 2015 Preoperative therapeutic neuroscience education for lumbar radiculopathy: A single-case fMRI report. Physiotherapy Theory and Practice 31: 496–508.

Moseley GL 2002 Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy 48: 297–302.

Moseley GL 2003a A pain neuromatrix approach to patients with chronic pain. Manual Therapy 8: 130–140.

Moseley GL 2003b Unraveling the barriers to reconceptualization of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. Journal of Pain 4: 184–189.

Moseley GL 2003c Joining forces – Combining cognition – Targeted motor control training with group or individual painphysiology education: A successful tretment for chronic low back pain. Journal of Manual and Manipulative Therapy 11: 88–94.

Moseley GL 2004 Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain 8: 39–45.

Moseley GL 2007 Reconceptualising pain according to modern pain science. Physical Therapy Reviews 12: 169–178. Moseley GL, Butler D S 2015 Fifteen years of explaining pain: The past, present, and future. Journal of Pain 16: 807–813.

Moseley GL, Nicholas MK, Hodges PW 2004 A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain 20: 324–330.

Nijs J, Paul van Wilgen C, Van Oosterwijck J, van Ittersum M, Meeus M 2011 How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy 16: 413–418.

Nijs J, Roussel N, Paul van Wilgen C, Koke A, Smeets R 2013 Thinking beyond muscles and joints: Therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Manual Therapy 18: 96–102.

 

Kris Rai

Ostheopath

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