Pain Education Puts Patients on the Path to Successful Outcomes
In the “onion skin” model of pain modulation, each layer influences and is influenced by pain.
LAS VEGAS—Despite the known benefits of patient education in pain management, which include alleviation of fear and active engagement of patients in their treatment, this approach is not common practice.
The importance of pain education as “part of a comprehensive plan to improve function in people living with persistent pain” was stressed by Kathryn A. Schopmeyer, PT, DPT, CPE, physical therapy program coordinator at San Francisco's Veterans Affairs Medical Center, during a presentation given at the PAINWeek 2016 meeting.
An essential concept to convey to patients involves explaining that the pain experience is not solely mediated in the brain by nociceptors. Ms Schopmeyer cited a study in which contextual factors (visual cues) for both the evaluative context or “meaning” and warning of nociceptive stimuli were presented to participants.2
Results from this study indicated that pain intensity is modulated by “meaning,” and that “different dimensions of the stimulus' context can have differential effects on sensory-discriminative and affective-emotional components of pain.”
Context, experience, expectations, meaning, and beliefs all act as pain modulators. For example, the perception of being in imminent danger can promote a pain experience in patients. By clearly conveying the biopsychosocial model of pain, clinicians can explain the pain experience to their patients by integrating recent advances in science.
In this “onion skin” model, each layer—nociception, attitudes, beliefs, suffering, pain escape behaviors, and social environment—influences and is influenced by pain. According to Ms Schopmeyer, “tissue damage does not match pain most of the time.”
Several studies indicate that explaining the neurophysiological basis of pain has a positive impact on pain levels.3,4 When covering pain physiology with patients, physicians should detail basics principles of neuroscience, including peripheral and central sensitization and nerve plasticity and explain nociceptive pathways, but should avoid getting into structural anatomy.
She also recommends testing patients' knowledge using questions based on the Neurophysiology of Pain Questionnaire.5
In addition to pain education, alternative treatments (eg, spinal manipulation, soft tissue massage, or neural tissue manipulation) should be provided to patients. She also suggests using phrases such as “it is safe to move,” “the nervous system is wonderfully adaptable,” or “start low, go slow,” as well as employing metaphors to describe pain.
- Schopmeyer K. The neuroscience behind pain education. Presented at: PAINWeek 2016. Las Vegas, NV; September 6-10, 2016.
- Moseley GL, Arntz A. The context of a noxious stimulus affects the pain it evokes. Pain. 2007;133(1-3):64-71.
- Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041-2056.
- Zimney K, Louw A, Puentedura EJ. Use of therapeutic neuroscience education to address psychosocial factors associated with acute low back pain: a case report. Physiother Theory Pract. 2014;30(3):202-209.
- Catley MJ, O'connell NE, Moseley GL. How good is the neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties. J Pain. 2013;14(8):818-827.