If you read our blog on the anatomy of pain, you learned about how our understanding of pain has evolved over the past few decades. Research shows we often cannot link a specific tissue or structure to the source of pain. As the clinical understanding of pain evolved, so did our treatment approach. Many clinicians, including the clinical team at Aware Health, now integrate pain science education into treatment, which has been shown to improve patient outcomes and decrease pain. Today, we'll focus on how this modern research has changed the way we use education to treat pain and injury.
Why Have I Not Heard of Pain Science Education?
Traditional biomedical education for pain-related conditions focused on a structural pathological model to explain the patient's pain experience. This was often accompanied by antagonizing verbiage that formed negative expectations for recovery. The classic example being, "You have bone-on-bone in your knee, this is why your knee hurts, and you will not improve without surgery."
Studies showed that this type of provider behavior can dramatically influence pain perception in a variety of patient populations.1 Another previous barrier to pain science education was the provider belief that patients would not want or be able to understand the neurophysiology behind pain. A more recent study showed that patients could indeed understand pain accurately, but the provider underestimated the patient's ability to do so.2 These were just a few barriers in previous pain science models.
How has Pain Science Education Evolved?
Current evidence supports the use of pain neuroscience education for chronic musculoskeletal (MSK) disorders.
Incorporating evidence-based education has been shown to:
- Reduce pain
- Improve function
- Lower disability
- Improve patient knowledge of pain
- Enhance movement
- Minimize healthcare utilization3
This modern approach has been adopted by providers in all healthcare fields. Even better, most patients now want to understand their condition and be active participants in their recovery. As clinicians, we love to see more and more patients involved in this journey.
How Does Pain Education Work?
Pain science education is now grounded in the biopsychosocial model, which details the importance of psychosocial factors in the pain experience. Psychosocial factors are often related to your history and environment, and affect how you perceive pain. For example, are you stressed? Are you unhappy in your job? Have you experienced a traumatic injury or trauma? All of these factors can influence your daily pain perception.
For those new to this theory, it may come across as if the pain "is all in your head." Instead, this encourages the healthcare team, which includes the patient, to address and treat a multitude of factors that can significantly help decrease pain. In other words, you are not limited by perceived tissue or structural damage, but rather, outcomes improve when you better understand the biopsychosocial factors that contribute to your pain. As providers learn about their patients' history, patterns, and goals, these psychosocial factors help us individualize treatment.
Pain Education to Help Chronic Pain
Chronic pain is often accompanied by central sensitization, which refers to a pain experience not connected with tissue damage or structural injury.
Below are just a few behaviors caused by central sensitization:
- Poor concentration and short-term memory
- Increased fear and anxiety
- Pain catastrophizing
- Hypersensitivity to stimuli or sensations
- Pain sensation from non-harmful stimuli
- Increased pain in areas outside of the initial injury or pain region
Pain science aims to address these behaviors through education. Topics of education include:
- Hurt does not equal harm
- Pain does not provide an accurate measure of the state of the tissues
- The treatment effect of pain neuroscience education is clinically significant for kinesiophobia (fear of movement) and pain catastrophizing4
- If pain lasts longer than three months, though the tissues have likely healed (i.e ligaments, tendons, muscles), the pain experience is still quite real. In this case, addressing psychosocial factors is especially important
- Pain is modulated by many factors
- Movement and exercise therapy!
Pain Education Can Decrease Unnecessary Healthcare Spend
From a systematic review researching the effect of pain education on pain and function, three of the studies also explored changes in healthcare utilization following pain neuroscience education (PNE). The experimental group participants received PNE. The control groups received only passive or active treatment, such as manual therapy or stretching. In most studies, the experimental groups received PNE alongside active treatment such as mobility and strengthening exercises. For reference, a multi-modal approach is almost always recommended to provide comprehensive treatment.
- At 1-year follow-up, the experimental group made on average 3.6 healthcare visits compared to 13.2 average visits in the control group. This showed a clinically significant reduction in healthcare visits in the group who received pain science education.
- The experimental group took significantly fewer sick-leave days.
- Overall reduction in healthcare costs for medical treatment at 1-year follow-up in the experimental group. The healthcare cost in the experimental group was nearly 50% less than that of the control group.
In a pay-per-service healthcare system, healthcare costs can quickly become overwhelming, to say the least. Low back pain, specifically, is one of the highest cost, most debilitating, and most common conditions in the US. Pain science education is helpful in a wide variety of conditions, but research solidified that an even greater impact was seen for patients with low back pain and fibromyalgia.5 This demonstrates the importance of pain science education for the greater healthcare system, with the patient at the forefront.
Aware Health Approach
At Aware Health, our telehealth platform provides us the unique opportunity to see patients one-on-one, so we can properly learn more about our patients' background, psychosocial factors influencing pain, and goals. We utilize modern technology such as an in-depth anatomy app to explain diagnoses. Our patients have access to a personal dashboard where we provide treatment content specific to their diagnosis, such as video tracks and pain management strategies. This allows patients to reflect both during and outside of appointments without needing to remember every exercise and educational tip! Since our platform is available at no cost to users (covered by their insurance), we have the space and flexibility to incorporate pain science education, resulting in improved patient outcomes so our patient can live more with less pain.
Closing
If you are currently experiencing pain, it is understandable to be fearful, especially when unsure of the cause. It may seem that you need an x-ray, surgery, or injection before pain science education. We recommend the opposite. That said, overall, you may just not know where to start. Here are a few quick tips from the Aware Health clinical team on how to begin your recovery journey!
- Find a provider that will listen to your story
- Connect with a pain and movement specialist, such as a Doctor of Physical Therapy
- Begin treatment as soon as possible to create an individualized treatment plan that should, in most cases, include pain science education.
As you begin treatment with a pain science education component, you'll likely begin to reconceptualize pain and move more with less fear. This can lead to improvement in both current and future pain experiences. We hope this helped develop your understanding of pain and show how pain science education is one of the best tools in your journey towards living more.
References
1. Blasini M, Corsi N, Klinger R, Colloca L. Nocebo and pain: an overview of the psychoneurobiological mechanisms. Pain Rep. 2017 Mar; 2(2): e585. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621640/
2. Moseley L. Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain. 2003 May;4(4):184-9. doi: 10.1016/s1526-5900(03)00488-7. PMID: 14622702.
3. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiotherapy Theory Pract. 2016 Jul 3;32(5):332-55.
4. Watson JA, Ryan CG, Cooper L, et al. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain. 2019;20(10):1140.e1-1140.e22. doi:10.1016/j.jpain.2019.02.011
5. Lepri B, Romani D, Storari L, Barbari V. Effectiveness of Pain Neuroscience Education in Patients with Chronic Musculoskeletal Pain and Central Sensitization: A Systematic Review. Int J Environ Res Public Health. 2023;20(5):4098. Published 2023 Feb 24. doi:10.3390/ijerph20054098