Physiotherapy and pain education, how important is it?
The neurobiological understanding of pain resulted in the Gate Control theory, which was proposed by Melzack in 1965. In the last 15 years, however, the focus in Physiotherapy has been on neuroscience education and changing pain behaviour.
Recent research provides new insights regarding central sensitization, peripheral sensitization, neuroplasticity, glial cell activation, cytokine signaling, endocrine changes et cetera. It has become abundantly clear, that psychological factors are need to be recognised in pain.
Biomedical models that are often used in Physiotherapy, such as Anatomy, Biomechanics and Pathoanatomy fall short in explaining some of the complex issues of pain, such as central sensitization.
The aim of Pain Neuroscience Education (PNE) is to teach patients more about the pain they’re experiencing from a biological AND physiological perspective, embracing a biopsychosocial approach.
The focus should be on behavioural change, starting with the phrase "despite the pain..."; this can be achieved using for example graded exposure.
It is important to inform the patient about the pain he or she is experiencing - nociception and pain are not necessarily synonymous - and what is normal and to be expected.
Further research should focus on the controversy whether PNE should be performed in combination with ‘hands on’ or ‘hands off’ therapy. Until now, PNE has only been studied in combination with ‘hands on’ therapy.
> From: Louw et al., J Orthop Sports Phys Ther (2016) 4(Epub ahead of print). All rights reserved to Journal of Orthopaedic & Sports Physical Therapy. Click here for the Pubmed summary.