Inservice on current concepts of pain and how it relates to treating patients from a physical therapist perspective.

1. PAIN EDUCATION AND CONCEPTS
Tyler Luke, SPT

2. WHAT IS PAIN?
 Many, many theories
 Gate-control previously most popular
 One theory doesn’t cover all aspects of pain
 More than just sensory experience
 Does pain come from periphery or brain?

3. PAIN NEUROMATRIX
 First described by Melzack (Melzack 2001)
 Incorporates many aspects of patient’s self and
care
 Pain as a homeostatic response (Craig 2003)
 Important aspects of Neuromatrix concept
 Pain does not equal physical damage
 Protective mechanism
 Emotional component
 Sensitization

4. Melzack 2001

5. ACUTE VS CHRONIC PAIN
 Evidence showing those with chronic pain have
sustained high levels of cortisol, leading to
heightened stress response and sensitivity to pain
(Henderson 2013)
 The “deal with it” group
 Chronic pain has a huge emotional piece
 Attitude and mood can negatively impact pain (Vachon-
Presseau 2013)
 Stress raises cortisol levels, just being in a hospital can
(and often is) very stressful

6. MOSELEY
 “Many therapies attempt to restore movement in the
hope that pain will automatically get better as
movement improves” (Moseley 2003)
 Is pain caused by abnormal movement, or is
abnormal movement caused by pain?
 Explain Pain by Butler and Moseley
 Evidence-based perspective on pain education with
patients
 Can be a great tool for longer-term patients or those
who you anticipate will be in hospital several weeks

7. PAIN AND PAIN EDUCATION
 Is education a necessary PT intervention?
 Pain neurophysiological education can cause
physical AND cognitive changes (Bushnell 2013, Nijs 2011)
 Moseley has focused pain education research on
changing attitude toward pain rather than just
physiological knowledge (Moseley 2004)
 Patients have better approach to pain, and understand it
is not necessarily something to be feared or even
avoided in some cases

8. BARRIERS TO PAIN EDUCATION
 Time
 Especially in acute care, very limited time to spend with each
patient
 Can incorporate pain education during interventions
 Complex physiology
 Pain is very complex, we assume patients cannot understand
the pain process
 Studies show patients actually learn about pain more when it
is not “sugar-coated,” and retain it when you personalize it to
them (Moseley 2004, Nijs 2011)
 Education alone can be more effective than education plus
exercise, at least in short-term settings (Ryan 2010)
 Research is greatly focused on outpatient settings, but
results can be adapted to acute settings

9. PUTTING EDUCATION INTO PRACTICE
 If patient is refusing PT due to pain, this is a great
opportunity for pain education
 Validate pain, find out its characteristics
 What is this person’s learning style? Visual? Tactile?
 Can guide how you educate them on pain
 Patients with neurological conditions (MS, fibromyalgia, ALS,
diabetes) may have neuropathic pain, great groups of people
to educate on mechanisms of pain
 Patients might have anxiety with interventions if they
have pain
 May think exercise/ambulation/manual therapy will cause
“more” injury – PAIN does not equal DAMAGE
 Pain education can help change attitude toward pain, and
alter their perception of “debilitating pain”

10. QUESTIONS?

11. REFERENCES
 1. Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65(12):1378-1382.
 2. Craig AD. Pain mechanisms: labeled lines versus convergence in central processing. Annu
Rev Neurosci. 2003;26:1-30.
 3. Henderson LA, Peck CC, Petersen ET, et al. Chronic pain: lost inhibition? J Neurosci.
2013;33(17):7574-7582.
 4. Vachon-Presseau E, Roy M, Martel MO, et al. The stress model of chronic pain: evidence
from basal cortisol and hippocampal structure and function in humans. Brain. 2013;136(Pt
3):815-827.
 5. Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther.
2003;8(3):130-140.
 6. Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in
chronic pain. Nat Rev Neurosci. 2013;14(7):502-511.
 7. Van Oosterwijck J, Nijs J, Meeus M, et al. Pain neurophysiology education improves
cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot
study. J Rehabil Res Dev. 2011;48(1):43-58.
 8. Moseley GL. Evidence for a direct relationship between cognitive and physical change during
an education intervention in people with chronic low back pain. Eur J Pain. 2004;8(1):39-45.
 9. Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes
compared to pain biology education alone for individuals with chronic low back pain: a pilot
randomised controlled trial. Man Ther. 2010;15(4):382-387.