Integration of Pain Neuroscience into Clinical Practice/Pain Neuroscience

Integration of pain neuroscience into clinical practice

Chair(s): Brona Fullen (University College Dublin, Ireland)

Relevance to physiotherapy

Basic science is a necessary and integral part of physiotherapy within entry to practice programmes across Europe. As pain assessment and management is now seen through the lens of the biopsychosocial model the need for basic neuroscience education to supplement and integrate human, social and natural sciences is essential. To advance as a profession, physiotherapy must be able to inform basic science as well as continuing to be informed by it in a bidirectional approach.

Target audience

Physiotherapists: academics, clinicians, researchers as well as undergraduate and postgraduate students

Summary of the session focus and structure that will be followed

Four presentations on pain neuroscience will review the:

Evidence on pain neuroscience education and how physiotherapists inform and are informed by it in clinical practice.
Knowledge and skills required by physiotherapists to identify pain mechanisms contributing to the generation and maintenance of pain in clinical assessments which can inform the physiotherapist to best tailor neuroscience education.
How treatment approaches are informed by the evidence from scientific literature.
Challenges faced by patients with low health literacy to understand pain neuroscience messages and how the results of inter-professional research on this topic have been icorporated into bachelor and masters physiotherapy curricula.
The completed abstract for the symposium

i. Title: INTEGRATION OF PAIN NEUROSCIENCE INTO CLINIAL PRACTICE

ii. Authors (chair first, followed by all presenters)

Chair: Brona Fullen
Presenters: Morten Hoegh, Catherine Doody, Catherine Blake, Harriet Wittink
iii. Learning objectives

Review current perspectives in relation to basic pain neuroscience and education
Explore how pain neuroscience informs patient care (assessment and management)
Discuss how interprofessional research on the challenges faced by patients with low health has been incorporated into physiotherapy curricula
iv. description

Four presentations will focus on the topic of pain neuroscience.

Speaker 1 Pain Neuroscience
Basic science is a necessary and integral part of physiotherapy that is reflected within the entry to practice programmes across Europe. As pain is now seen through the lens of the biopsychosocial model as opposed to the pathoanatomical model of disease the need for basic neuroscience education to supplement and tie together human, social and natural sciences is increasingly seen as a way forward1. In order to advance as a profession, physiotherapy must be able to inform basic science as well as continuing to be informed by it in a bidirectional approach. This session will a) discuss how neuroscience informs physiotherapy practice in the management of acute and chronic pain2 and b) try to identify basic neuroscience-based principles that could be implemented into graduate and post-graduate education of physiotherapists.

Speaker 2 Pain neuroscience informing the biopsychosocial assessment
The evidence suggests that Physiotherapists should use a biopsychosocial approach for the assessment of people with chronic pain to best capture the multidimensional aspects of pain, which can inform the therapists’ management strategies. This session will discuss the assessment of the multiple domains of pain, including intensity, quality and temporal aspects of pain in addition to physical sensory and affective dimensions using valid and reliable methods3. Assessment of pain will also focus onidentifying the underlying pathophysiological pain mechanisms that may contribute to the generation and maintenance of chronic pain4. It is important for Physiotherapists to be equipped with the knowledge and skills to carry out an optimal evidence-based clinical assessment of people with chronic pain based on current knowledge of pain neuroscience, which can inform a tailored approach to treatment.

Speaker 3 Applying pain neuroscience evidence into practice
Evidence based practice requires the integration of best research evidence with clinical expertise and patient values. There can however be a mismatch between the perspectives of patients and the public compared to clinicians, so Physiotherapists need to consider how best to implement pain neuroscience in practice. This session will explore the evidence for Pain Neuroscience Education (PNE). Practical applications of a PNE programme in academic and clinic settings will be discussed.

Speaker 4 The challenge of pain neuroscience messages for patients with low health literacy
Increasingly, the “soft (social) sciences”, such as communication studies and psychology are gaining importance within the field of physiotherapy as it is recognized that a therapeutic alliance is an important contributor to beneficial outcomes5-8. Part of forming a therapeutic alliance is the ability to communicate and to focus on the client's needs and goals. In order to be able to communicate effectively therapists should have a thorough understanding of health literacy. Health literacy has traditionally been defined as the “ability of the individual to access, understand, and use health-related information and services to make appropriate health decisions” As people are increasingly being asked to assume more responsibility for self-care in an increasingly complex delivery system filled with health information and technology, health literacy skills become increasingly important. Formulating research questions that examine whether physiotherapy interventions support client health literacy is essential. In this session we will relate the results of an interprofessional study, including a physiotherapist, an anthropologist and a psychoanalyst on whether low health literate patients are able to comprehend the pain neuroscience message through qualitative research. We will further relate how we implemented the findings into our bachelor and master curricula.

v. Implications/ Conclusions

In order to advance as a profession, physiotherapy must be able to inform basic science as well as continuing to be informed by it in a bidirectional approach to effectively manage patients.

vi. Funding acknowledgements

Grants of the Dutch government- NWO- 023.004.121 and SIA Raak 2012-14-12P.

vii. Supporting references

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. 2019;20(10):1140
Nicholas M, Vlaeyen JWS, Rief W, et al. The IASP classification of chronic pain for ICD-11. PAIN. 2019;160(1):28-37
Wijma AJ, van Wilgen CP, Meeus M, Nijs J. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiotherapy theory and practice. 2016 Jul 3;32(5):368-84.
Smart KM, Blake C, Staines A, Doody C. The discriminative validity of “nociceptive,”“peripheral neuropathic,” and “central sensitization” as mechanisms-based classifications of musculoskeletal pain. The Clinical journal of pain. 2011 Oct 1;27(8):655-63.