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 
  
  
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Learn more with the Canadian Physiotherapy Association