New Course Release: APTEI Pain Truth Certification by Bahram Jam
In the new online course, the Pain Truth Certification Training by Bahram Jam, we will discuss the interventions for persistent pain.
First and foremost it is important to determine if and what physical therapy intervention is most appropriate for a patient. In order to do this, the possible source of a patients' pain must first be hypothesized.
The possible sources of pain are:
- Nocioceptive pain (NP)
- Peripheral neurogenic pain (PNP)
- Central sensitization pain (CSP)
- Visceral pain, which we won't discuss, which includes things like kidney stones and abdominal pain related to GI issues
Look at the following pictures and guess which type of pain you think is presenting:
You may guess that the above body diagram looks like somebody with nocioceptive pain (NP).
You may guess that the above body diagram looks like somebody with peripheral neurogenic pain (PNP).
You may guess that the above body diagram looks like somebody with central sensitization pain (CSP) - for example, fibromyalgia.
However, it's not as simple as it sounds. All three types of pain are influenced by emotions such as fear avoidance, beliefs, catastrophization, depression, anxiety, stress, anger, job dis-satisfaction, reduced hopefulness, and there's evidence to back up every one of those factors. However, this is not what we will focus on in this blog - we will discuss this throughout the online training program which you can take by clicking below:
Let's discuss the three types of pain we've outlined above.
Nociceptive pain is the type of pain that's associated with any anatomical structure that has a nerve supply. It's localized to the area of injury, it's predictable, and has aggravating and relieving factors.
Someone with this type of pain will say for example: "When I sit it feels worse. When I walk it feels better. When I bend backwards it feels worse and when I go forward it feels better."
This type of pain is influenced by movements or postures. The typical pattern is very local and they respond favorably to physical therapy, manual therapy, and exercise interventions.
These are the types of patients that I get excited for because they are easy to treat. And when I graduated from scholl, I just assumed everybody had nocicpetive pain.
Peripheral Neurogenic Pain:
This is pain related to neural tissue inflammation, compression, and/or pathology. Pain is deep, often described as knife-like, and follows a line pattern. There's objective neurological signs of weakness and parasthesia, meaning positive myotomal or dermatomal signs.
Peripheral neurogenic pain is typically pain that goes down the arm or leg in a line. These patients have positive neurodynamic tests such as the straight leg test or femoral nerve neurodynamic test.
Central Sensitization Pain:
This is the focus of my new online course - the APTEI Pain Truth Certification Program. Central sensitization pain is associated with chronic pain states and is due to the sensitization of the central neurons leading to a decreased threshhold to all normal afferent input. Examples of coniditions that centrally sensitized include fibromyalgia, phantom limb pain, chronic spinal pain, chronic whiplash associated disorder (WAD).
Some common things that patients with CSP say are:
- "It hurts even when I just think about moving."
- "The pain seems to move around my body."
- "I've developed similar pain on the other side of my body." (this is called mirror pain)
- "My whole leg/arm is numb."
- "My pain increased for no particular reason."
- "My pain has a mind of its own."
- "My pain is increased by stress."
Basic identifying features of CSP are:
- Increased pain by small movements (ex: slightly bending or turning)
- Inconsistent or non-changing centralization/peripheralization phenomenon with repeated movements and sustained posture
- Several failed past treatments (i.e. they've seen many healthcare professionals and tried a variety of treatments)
- They may have a pain pattern that's vague and all over the body
Why Is It Essential to Identify CSP?
It is essential for physiotherapists (physical therapists) to identify CSP as management focusing on treating specific anatomical structures is likely futile. In fact, treatments such as pain relieving modalities, pain medication, specific manual therapy, and specific localized exercises, may all exacerbate the cerebral cortex's focus on pain and even further contribute to chronicity.
In summary, consider the three classifications of pain on every patient, which includes nociceptive pain, peripheral neurogenic pain, and central sensitization pain.
If you are interested in learning the latest evidence, treatment management strategies, and the use of mindful movements in patients with CSP, take the APTEI: Pain Truth Certification Training which is now available online. You can take this course on your own time and schedule. Come back to the content as frequently as you like. I also provide the relevant outcome measures and resources that I use with my patients.
This online physiotherapy course is for all healthcare providers who wish to have the ability to more effectively assist their patients in their recovery. The program will not teach healthcare providers any magic bullet techniques and it will not focus on futile attempts to reduce pain for patients who so desperately seek it.
The Pain Truth program content is based on hundreds of research studies and systematic reviews; ensuring clinicians learn the most up to date interventions for their patients with central sensitization.
Learn More About the APTEI Pain Truth Certifcation Training by Watching the Short Video Below:
Dr Bahram Jam, MPhty, BScPT, Cred. MDT, FCAM
Bahram is a physiotherapist and founder of the Advanced Physical Therapy Education Institute (APTEI). He's taught 1000+ continuing education courses to healthcare professionals across Canada & internationally.
He has instructed over one thousand post-graduate orthopaedic and pain science courses and has been a guest presenter at several physiotherapy and medical conferences across Canada and internationally.
Bahram's primary clinical approach is to identify relevant functional impairments and determine the best self-management strategy to maximize patient independence.