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How Pain Education Can Be a Game Changer in Your Patient's Lives
By: Nataliya Zlotnikov | Blog Writer, editor: Meghan Zhu, MSc PT student

Introduction

With the growing research and support for pain education, it is becoming one of the most essential components of a patient’s treatment plan. Registered physiotherapists Debbie Patterson and Geoff Bostick provide several online physiotherapy courses that address the important gaps in knowledge surrounding the theory and practice of pain education.

Maladaptive beliefs and thoughts about pain are substantial barriers to recovery. Pain education can help address these thoughts by providing current and relevant science specifically targeted to the individual patient's needs and level of understanding. Appropriate education can be a core intervention for changing pain and quality of life.

 

What is Pain Education? 

Pain education is a type of intervention to help people cope with their pain by understanding how pain is processed neurophysiologically. By improving a patient's understanding of the pain system it may lead to:

  • Reduced worries and anxiety around the pain they are experiencing 
  • Improve one’s feelings to cope
  • Reduced pain cataphrasizing 
  • Positively modifies psychological factors
  • Enhances movement and function

When providing pain education, it is essential that we adopt a biopsychosocial approach when educating our patients about pain science, as research suggests there are long term clinical improvements in pain when doing so. Furthermore, by applying a biopsychosocial approach, there are a variety of different factors that we can address to help cope with their pain besides the damaged tissue or perceived damaged tissue. 

There are two main parts of pain education: short interventions and discrete interventions. Short intervention refers to strategies that permeate through all treatment sessions and often provided to all patients, such as reassurance. Discrete interventions are more specific in helping people understand how pain is processed neurophysiologically by providing a different point of view on how pain works and challenging some traditional views on pain.

Learn more about Pain Education


Key Messages:

In the online physiotherapy course on pain education, Dr. Bostick highlights some key messages to pain education theory and practice

Although many students and clinicians know theoretically what the biopsychosocial approach is, when it comes to doing it, we revert  back to the biomedical model 

This may lead to problems as some of the messages for pain education contradict the biomedical model:

1. As health care providers, we need to personally reflect on our perspectives and beliefs on pain

  • Often times, therapists fear-avoidance beliefs may rub-off on patients

2. The patient is the expert, physiotherapists assist them 

  • Patients bring a lot of expertise about their pain and we need to acknowledge it and give them space to discuss it

3. Take a biopsychosocial approach 

  • Although many students and clinicians know theoretically what the biopsychosocial approach is, when it comes to doing it, we revert  back to the biomedical model 
  • This may lead to problems as some of the messages for pain education contradict the biomedical model

4. Pain is normal, personal, and always real 

  • Almost everyone needs to hear this

5. Pain and tissue damage rarely relate 

  • Pain is a response from your nervous system to what it judges to be threatening
  • Evidence suggests persistent pain is a wiring problem, and not a tissue damage problem 

 

Does Everyone Need Pain Education? 

Yes and no. Remember that pain education has both short and discrete interventions. Most patients will benefit from short interventions, whereas not everyone may need discrete pain education intervention. Conducting a thorough subjective and objective assessment will be your best strategy in determining if your patient needs discrete pain education intervention.

Patients who may not require in-depth pain education:

  • Patients with non-complex pain 
  • Patients with adaptive thinking, coping, and behaviour 

Patients who WILL benefit from in-depth pain education: 

  • Patients who demonstrate:
    • Low self-efficacy: 
      • Do not believe they have the resources to cope with their pain 
      • Demonstrate a lack of understanding of the factors that influence the pain and how to address them
    • Fear-avoidance: 
      • Patients who are fearful to move and re-engage inactivity
      • May believe pain is a sign of tissue damage and do not want to further harm themselves
    • Misdirected problem solving: 
      • Patients who keep using the same strategy over and over again even when it does not help with their pain 
    • Biomedically or biomechanically focussed 
      • Pain education can inform them that their emotional and psychological state influences their pain

Important Components of Pain Education

1. Initial assessment 

  • A thorough history including the opportunity for the patient to disclose their pain
  • Red flag screening 
  • A thorough examination of their neurological status 
  • A thorough examination of their movement 


2. Pain Outcome Measures 

  • Important to utilize pain outcome measure to be able to track and document any changes throughout the treatment plan
  • A few Pain Outcome Measures mentioned in the courses:
    • McGill Pain Questionnaire:
        • A self-reported measure of pain that assess both the quality and intensity of pain
        • Can be used to monitor pain over time in a number of diagnoses, including Musculoskeletal Conditions, Chronic Pain, Cancer, Back Pain, Arthritis and Non-Specific Patient Population
      • Pain Catastrophizing Scale
        • The self-reported measure used to quantify a patient’s pain experience about their thoughts on pain and how they feel when they are in pain
        • Can be completed even when the patient is not in pain 
      • Fear Avoidance Beliefs Questionnaire
        • A self-reported measure of how a patient’s fear-avoidance beliefs about physical activity and work may impact their pain 


3. Information delivery on pain looks different for everyone

  • Some people may want to have a lot of the content knowledge, whereas other people may want it to be more contextualized specific to them
  • Information can be sprinkled throughout treatment or can be a whole treatment session itself 

    •  

Learn more with the Canadian Physiotherapy Association

Debbie Patterson
Registered Physiotherapist

Debbie Patterson is an orthopaedic physiotherapist with a special interest in the treatment of persistent pain. Early in her career she recognized that the medical model of physiotherapy treatment often failed people with persistent pain. This led her on a career path of learning about the current science of pain, and searching for clinical relevance in the treatment of pain.

Debbie Patterson is a registered physiotherapist in the provinces of Ontario and Alberta. She is a founding member of the Pain Science Division of the Canadian Physiotherapy Association.

Debbie has a clinical practice treating people whose lives are affected by persistent and complex pain conditions. She has worked within the Biopsychosocial model of pain for over 35 years. She sees herself as a physiotherapy coach to help patients relieve suffering, pain and distress and improve their quality of life.

Debbie has used Telerehab to assess and treat patients for over 10 years. She is a trained and certified Progressive Goal Attainment Programme (PGAP) clinician and is trained in Cognitive Behavioural Therapy and Motivational Interviewing. Debbie has a passion for teaching patients and health care providers about the science of pain in the Biopsychosocial model. She has taught courses in pain science and appropriate assessment and treatment approaches. Now she provides live and recorded webinars. She also mentors other physiotherapists in developing their knowledge and skills to better meet the needs of their patients with persistent pain.

Geoff Bostick
PT, PhD

Geoff obtained his BScPT from the University of Saskatchewan in 2001. He then worked in private practice in Saskatoon, Edmonton and Victoria. In 2005, he completed the Diploma of Advanced Manual and Manipulative Physiotherapy. By 2006, Geoff had developed a fervent interest for pain sciences; particularly the cognitive and social aspects of pain. He then began his PhD in Rehabilitation Science at the University of Alberta, completing the program in 2011. Currently, Geoff works as an Assistant Professor at the University of Alberta (U of A) in the Department of Physical Therapy (PT). He teaches primarily in the orthopaedic portion of the program, but incorporates as much pain education as possible into other courses in the MScPT program. His research interests include neuropathic pain in OA, cognitive factors in chronic pain and various teaching-related initiatives. He also runs a student-led physiotherapy clinic within the Department of Physiotherapy at the U of A, and a modest not-for-profit PT pain program in conjunction with the U of A Multidisciplinary Pain Centre.

Geoff’s current role with the Pain Science Division is the Division Research Representative Committee (DRRC) representative, promoting pain-related research to its members. He is also co-chair of DRRC. The DRRC rep is broadly charged with promoting pain-related research to its members. Geoff is particularly excited about a new initiative called Paincasts – short podcasts discussing pain with some bright people.

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