Pain neuroscience education or pain science communication? A Course Dedicated to Clinical Reasoning & Skills Training 4 Clinicians

DOCENTI:

Jo Nijs^1,2,3  Pain in Motion International Research Group, www.paininmotion.be

¹ Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium

² Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium

³ Department of Neuroscience and Physiology, University of Gothenburg, Sweden

Learning objectives:

At the completion of this course, learners will be able to:

1. Explain pain to patients with persistent pain;
2. Identify barriers for exercise therapy and self-management in patients with chronic pain;
3. Individually-tailor pain neuroscience education to the relevant barriers for engaging in active interventions;

Combine pain neuroscience education with motivational interviewing to engage patients with chronic pain into a lifestyle approach

Content:

Chronic pain has a tremendous personal and socioeconomic impact. Lifestyle factors such as physical (in)activity, sedentary behaviour, stress, poor sleep, unhealthy diet and smoking are associated with chronic pain severity and sustainment^1-5. This applies to all age categories, i.e., chronic pain across the lifespan. However, clinicians often struggle engaging patients in such a lifestyle approach for managing chronic pain. For instance, how can clinicians motivate patients to continue their exercise program when it increases their pain? How can clinicians motive patients to self-manage their sleep problem, poor diet, or stress intolerance, when they don’t understand the importance of these lifestyle factors in relation to their pain condition? This course addresses this lacuna by teaching clinicians to explain the complexity of their pain problem in an easy but comprehensive and individually-tailored manner.

Pain neuroscience education (PNE) uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients’ pain beliefs/perceptions to facilitate the acquisition of adaptive pain coping strategies. Course participants will learn how to provide PNE in the clinic, including how to combine PNE with motivational interviewing, a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the client away from a state of indecision or uncertainty. The combination of PNE with motivational interviewing upgrades PNE to pain neuroscience communication, and makes it lots of fun for clinicians, especially when to succeed in engaging their patients into the treatment program⁶. This course is dedicated to learning clinicians to enjoy their work with pain patients more. Ultimately, this should lead to a higher clinical impact with higher effect sizes and subsequently decreasing the psychological and socio-economic burden of chronic pain in the Western world.  

“I recall being nervous the first time I tried explaining pain in the clinic, but the patient was so grateful and excited to finally understand her medical problem. By that time, she had received multiple explanations for her chronic pain, but this was the first to capture everything, including her full range of symptoms and comorbidities. Finally all pieces of the puzzle fell into place. Explaining pain allowed her to remove the barriers for a more active approach (i.e., behavioural graded activity, exposure in vivo, cognition-targeted exercise therapy, stress management, etc.). Explaining pain is the fundament of a multimodal approach to managing chronic pain.”

Educational modes:

The course content will be delivered through a mixture of methods, including:

- interactive lectures

- demonstrations

- practical skills training

- illustrations

- case studies

Key references

1.         Nijs J, D'Hondt E, Clarys P, et al. Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth? PM & R : the journal of injury, function, and rehabilitation 2020; 12(4): 410-9.

2.         Malfliet A, Marnef AQ, Nijs J, et al. Obesity Hurts: The why and how of Integrating Weight Reduction with Chronic Pain Management. Physical therapy 2021.

3.         Vitiello MV, McCurry SM, Shortreed SM, et al. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. Journal of the American Geriatrics Society 2013; 61(6): 947-56.

4.         Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of pain research 2015; 8: 399-408.

5.         Torres-Ferrus M, Vila-Sala C, Quintana M, et al. Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study). Cephalalgia : an international journal of headache 2018: 333102418777509.

6.         Nijs J, Wijma AJ, Willaert W, et al. Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Physical therapy 2020; 100(5): 846-59.