Less Pain, More Gain
One would believe that it’s the post-operative ACL, total knee replacement, and rotator cuff repair patients who are endeavoring the highest pain responses. Or even take the construction worker who accidentally stepped off the ledge of a six-story building and shattered his ribs or sustained spinal fractures. If we had a way to determine direct congruency between severity of injury and severity of pain, clinicians would most likely have greater algorithms developed on the best treatment regimen plans. As we know — this isn’t the case, and a lot of the acute injuries may lead to chronic pain down the line, influencing how medical management is progressed. While the opioid addiction crisis continues to be blooming, a question comes into play on whether a preventative based education program related to pain neuroscience education (PNE) could be beneficial in administration early on so that it helps reduce perceptual based pain driven by psychosocial influences (anxiety, stress, cultural barriers, etc) affecting the meaning of pain to the individual.
When I was a DPT student three years ago, I was fascinated by Adriaan Louw, who is a physical therapist, clinical neuroscience researcher, and the author of the Why Do I Hurt Book. The tool of pain neuroscience education has only been around for about 20 years, with high evidence favoring the use of it in chronic pain patients when worked in junction with movement based strategies. PNE’s goals are to help educate the patient on their pain experience, based on both a biological and physiological perspective in order to promote the biopsychosocial model.
While PNE is a huge breakthrough for helping manage the chronic pain population during physical therapy, more pain related education programs would be beneficial to administer from the time a patient steps into a physician’s office and discusses their first notable symptom of low back pain. What I’ve realized as a therapist is that if patients understand more about neural pain pathways and their body’s own pain alarm systems that may be constantly on overdrive, they would be more likely to learn self management strategies. One option could be if medical providers could make appropriate referrals to pain education specialists early on in the process such as during the initial evaluation, regardless of whether it is an acute or chronic based case. While I believe pain education needs to be communicated to the general public continuously throughout grade school years (K-12), it could start from the former idea. There are several barriers to this option related to insurance company approvals and scheduling conflicts, though if enough providers are hired to educate patients regarding this, it could allow for the patient to feel empowered of understanding their body’s way of processing pain and take greater initiative in addressing their care.
