Revisiting Pain Neuroscience Education: Adjunct or Focus?
Louw et al (2020)
Chronic pain is a growing problem. One component of overall management is patient and provider education about pain. The International Association for the Study of Pain (IASP) released guidelines on pain education for all healthcare professionals in 2012. The guidelines emphasize a multidisciplinary biopsychosocial model of pain for effective management.
What it Is
An intervention often used is pain neuroscience education (PNE). It explains the complex biological processes to patients in easy-to-understand metaphors, examples, and pictures. The goals are altering pain beliefs, and reducing threats, making patients more confident while exercising. This in turn would decrease fear-avoidance and pain catastrophizing, reducing pain and disability.
What it Does
However, PNE as a stand-alone treatment does not often result in clinically meaningful results for pain and disability. Yet, improvements in fear of movement and pain catastrophizing are seen in isolation. Knowing this, PNE should be seen as an adjunct for movement-based interventions.
Movement Based Interventions
The mechanistic evidence behind exercise in improving persistent pain is promising. A few mechanisms are known and proposed. Activation of endogenous inhibitory systems in the central nervous system, reduction in central excitability, altered ion channel expression of nociceptors, and many more have been extensively studied. The appropriate type of exercise and dosage remains elusive; not discounting the fact that movement is key.
Different passive interventions such as PNE, transcutaneous electrical nerve stimulation (TENS), and manual therapy, should be used with caution. This could strengthen faulty biomedical pain beliefs in the patient. When used appropriately, these interventions could facilitate movement-based interventions.
Physical therapists are in the front lines of pain management. Adequate education around pain should be mandatory in the curriculum. The clinician’s attitude and beliefs around pain could influence the patient implicitly.
“It is time for health care professionals to reach consensus to enhance the use of non-pharmacological and movement-based approaches to managing pain across a multidisciplinary network of healthcare providers.”
Louw et al (2020): https://pubmed.ncbi.nlm.nih.gov/33076759/