Explaining pain - where do we stand today?
Explaining pain (EP) teaches the relationship between the danger messages (nociception) and pain: the upregulation in the danger transmission (nociceptive) system when pain persists, the coexistence of potential protective systems and the adaptability, and therefore trainability, of pain. The following article aimed to address the common misconceptions and propose future directions of EP.
The core objective of EP is to shift one’s conceptualization of pain from that of a marker of tissue damage or disease, to that of a marker of the perceived need to protect body
tissue. A common misconception is that EP teaches patients how to manage their pain. On the contrary, EP teaches people about the biological processes underpinning pain, without including instructions or strategies for pain management.
Neuroimaging studies clearly revealed the biological plausibility of cognitive modulation of pain. Furthermore, there is emerging behavioral evidence that reconceptualization of the underlying biology of pain is associated with real-time modulatory effects. A study with 121 people with chronic back pain compared the effects of EP-based with the effects of a back school–based education and showed that the EP group demonstrated an immediate increase in pain-free straight leg raise, whereas those in the back school group did not.
Systematic reviews concluded that the evidence for EP in decreasing pain, increasing physical performance, decreasing perceived disability, and decreasing catastrophization was compelling. Although, the evidence base is clearly growing quickly it still faces challenges, such as that EP is often investigated in isolation rather than as part of a multimodal approach.
Critically, the state of the evidence does not suggest EP alone as a viable intervention to induce long-lasting improvements in pain and disability. However, EP is clinically intended to be combined with multimodal approaches.
To sum up, EP seems to offer clear benefits when tested in isolation or as part of a wider rehabilitation program. However future research is needed in which EP is combined with other promising interventions.
> From: Moseley et al., J Pain 16 (2016) 807-813. All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.