3 requirements for effective pain neuroscience education

Level A evidence supports the use of therapeutic pain neuroscience for patients with chronic musculoskeletal pain. However, when using it in clinical practice, not all patients reconceptualise their pain so easily. Here are 3 (neglected) requirements for effective pain neuroscience education and some ideas on how clinicians can address them with their patients:

Requirement 1: Only patients dissatisfied with their current perceptions about pain are prone to reconceptualization of pain

This implies that therapist should question the patient’s pain perceptions thoroughly prior to commencing pain neuroscience education. Even though their pain perceptions lack medical and scientific validity, patients are often satisfied with them. In such cases, it is required to question whether the patient can think of other reasons / underlying mechanisms for their pain rather than lecturing about pain mechanisms. Before initiating pain neuroscience education, the therapist should lead the patient towards a situation where the patient doubts his or her current pain perceptions. The following questions may assist therapists in achieving this:

“Can you think of other reasons why you are still have neck pain?”  

“I guess up to now searching for the magic bullet to ‘cure’ the damaged disc in your lower spine wasn’t such a big success, wasn’t it?”

Requirement 2: Any new perception must be intelligible to the patient

If the content of the pain neuroscience education is individually-tailored (to the level of intelligence etc.), then this should not be a problem. Still, it is required to check whether the patient has understood the pain neuroscience education. Use the neurophysiology of pain test, (re)question their pain perception, or ask them to explain to you why they are in pain.

Requirement 3: A new perception must appear plausible and beneficial to the patient

Even though the content of pain neuroscience education is backed-up by a body of scientific literature, it should apply to the patient’s situation/pain. For instance, if you include the mechanism of central sensitization in your pain neuroscience education for a particular patient, then you want to be 100% certain that this patients is having a clinical picture dominated by central sensitization. If not, the patient might not recognize its own situation in the explanation, making it unlikely that the patient will reconceptualise his or her pain.

Jo Nijs

References

http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-0492 (free full text available here)

http://www.ncbi.nlm.nih.gov/pubmed/23162040

http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-0803 (free full text available here)