pain neuroscience education Flashcards
complexity of pain and central sensitisation
Pain is often present in the absence of tissue damage
People sometimes don’t experience pain when they have major tissue damage
Pain is affected by emotions: stress, sadness, happiness
Culture, race, language, religion, discrimination all have an impact on how someone experiences pain
Central sensitization refers to the amplification of pain by central nervous system mechanisms. Classically described as a consequence of ongoing nociceptive input, it is increasingly recognized that central sensitization also occurs independent of peripheral injury or inflammation
persisting pain
Heightened sensitivity of nervous system
Functional, structural and chemical changes (plasticity)
Reduction in inhibition (descending)
Changes in how areas of the brain talk to each other
Cortical reorganization
Pain no longer linked to peripheral nociceptive input
Pain no longer protective
clinically seen by pain mgmt physios
Pain hypersensitivity
Symptoms spreading around
Small movements hurt
Touch hurts
Any activity results in a big increase in pain
Pain becomes unpredictable
Sleep, mood, quality of life all become affected
biopsychosocial model
Pioneering model George Engel 1977
Challenged the medical model
Humanistic approach to care
Looks at the interconnection between biology, psychology, and socio-environmental factors
Framework for understanding the complexity of pain conditions
Factors all interact with each other
Bringing the mind and body together
impact of pain
Loss of independence, role, identity
Relationships
Work, financial pressures
Social life
Caring roles
Adults who attend pain clinics report high levels of distress, disability and loss of social role (Froud 2014)
Chronic pain is associated with poor quality of life (Maniadakis & Gray 2000)
history of explaining pain
Education has long been used in the management of pain
Educational models traditionally used anatomic or biomechanical models
Limited efficacy and may have increased patient fears anxiety and stress (Maier-Riehle 2001)
Neuroscience education:
Butler and Moseley ‘Explain Pain’
pain neurophysiology education
Education about pain
Aims to help people shift from a tissue injury model of understanding to a biopsychosocial model of understanding of pain
Change people’s understanding and beliefs about pain
Ultimately the hope is that they become less worried, less fearful- can move more and engage in meaningful life activities
reconceptualisation
Pain does not provide a measure of the state of the tissues
Pain is modulated by many factors from across somatic, psychological and social domains
The relationship between pain and the state of the tissues becomes less predictable as pain persists
Pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger (Moseley, 2007)
need to know about patient
The impact pain is having on their life How is pain affecting life right now? How they are managing/coping now Understanding and beliefs about condition and prognosis What do you think is going on? Why do you think you have the pain? What do people around you think? Have people told you different things? Worries about pain What worries you about the pain? Expectations and hopes Their individual context Family, work, support, current stressors,
subjective history
previous treatments and effects
patterns of activity
thoughts and feelings
values and goals
key concepts
Pain is normal and protective
The difference between acute and chronic pain
Nociception Vs pain- pain doesn’t always mean tissue damage. Pain is not proportional to the presence or degree of injury
Real biological changes happen when pain persists
Context is important
Thoughts, beliefs, memories, past experiences all have a role to play in our experience of pain
functions of pain
Pain is a critical protective device
Pain is a conscious experience that depends on the brain evaluating many inputs, not just those from your tissues
Pain motivates you to do something to protect your body
It hurts where your brain thinks the problem is, not where it really is
Pain depends on how much danger your brain thinks you are in, not how much danger you are really in
The brain’s tendency to look out for a vulnerable body part comes at a cost
patient centred care
Compassion, empathy and respect
Consider how people learn
Remember the person’s background and context- individualise the information
Ask ‘do you want to know more about that?’
Consider giving little bits of information
Explore beliefs rather than ‘challenge’- remember there is a reason behind these beliefs and they are widespread
Try things out and allow people to come to their own conclusions ‘should we see what happens?’ ‘should we give it a go?’
movement and exercise for chronic pain
Beneficial in chronic pain
We don’t actually know the mechanisms
A wide variety of proposed mechanisms given in literature
Increased confidence in body
Relate differently to body
Reduce fear
Enjoyment
Social support
Exercise as a form of self compassion
Address deconditioning- Improved strength, endurance, fitness
General benefits: reduce depression (Finan 2013)
Exercise provides modest improvements in pain and function for CLBP (Hayden et al 2020)
No clear recommendation for one type of exercise over another (Oliviera et al 2018)
Exercise should be prescribed based on patient preference (Oliveira et al 2018)
Minimal adverse effects (in comparison to medications etc)
Simply giving someone advice to exercise is insufficient to bring about significant change (SIGN 2013)
Often people with chronic pain will have flare ups when trying to exercise
Need to educate about pacing and gradual progression
PNE and exercise
Best practice supports the combination of pain education alongside movement and exercise
PNE can be seen as an ongoing process during treatment
The words you use are important
Be careful not to introduce vulnerability or fear
Don’t over correct when doing exercises
Give patients choice about what type of exercise they do
‘Thoughtless fearless movement’ Louis Gifford 2005
