One world, one education?   April 7th, 2019

​Increasing research all over the world is indicating the importance of giving pain neuroscience education to chronic pain patients (Malfliet et al. 2018). Results have indicated an increase in the level of knowledge of the patient and a decrease of in the level of perceived threat, consequently increasing the quality of life. 

Many similar pathologies and pathological mechanisms can be found throughout the entire world, i.e. multiplication of cells leading to cancer, joint destruction resulting in rheumatoid arthritis, etc. Chronic pain can result from such pathologies and although finding a specific cause for this chronic pain can be complex, similar underlying neurophysiological mechanisms will often be found, known as central sensitisation. This state of sensitisation induces changes in the central nervous system which will facilitate pain production and counteract the mechanisms responsible for pain inhibition. As these principles are often seen across different chronic pain populations, we would expect that one type of education would be able to fit all people.

However, not only the biological mechanisms should be taken into account and explained to these patients, but the biopsychosocial aspects are extremely important as well (Peacock & Patel 2008). Although we have learned to pay attention to these aspects, we do not always dwell on the importance of social aspects, such as the differences in ethnicity and culture. Previous research has repeatedly shown differences in pain coping strategies, illness perceptions, self-efficacy, fear avoidance beliefs, locus of control, and pain attitudes between people from different ethnicities (Orhan et al. 2018; Orhan et al. 2019). For example, pain coping strategies such as praying, hoping, distraction and catastrophizing are more often seen in African-American populations than in Caucasians, while Caucasians have stronger beliefs in their ability to control pain than the African-Americans. 

As the main goal of pain neuroscience education is to change the coping strategies and pain beliefs of patients with chronic pain, it is of utmost importance to pay attention to social context of the patient in order to provide a patient-tailored education and approach. One can only change a patients’ coping or perspective if they have first taken their time to assess all elements that can shape a persons’ cognitions and behaviours. 

So, even if you manage to find a common language in which you can provide pain neuroscience education to a person from a different ethnicity or culture, don’t automatically assume that they understand the concepts you’re trying to explain just because they understand the words you’re using. Communication and a proper assessment of all aspects, including ethnicity and culture, are a first key to success.

How do you adapt your pain neuroscience education to the culture of the patient? Poll in the link:

Dorine Lenoir

PhD researcher in the area of chronic pain at the university of Ghent and the Vrije Universiteit Brussel. 

2019  Pain in Motion

References and further reading:  

Malfliet A., Kregel J., Meeus M., Danneels L., Cagnie B., Roussel N., Nijs J. Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM R. 2018 Dec;10(12):1330-1343.e1.

Mrs Sue Peacock and Mrs Shilpa Patel. Cultural Influences on Pain. Rev Pain. 2008 Mar; 1(2): 6–9

Orhan C., Van Looveren E., Cagnie B., Mukhtar NB., Lenoir D., Meeus M. Are Pain Beliefs, Cognitions, and Behaviors Influenced by Race, Ethnicity, and Culture in Patients with Chronic Musculoskeletal Pain: A Systematic Review. Pain Physician. 2018 Nov;21(6):541-558.

Orhan C, Cagnie B, Favoreel A, Van Looveren E, Akel U, Mukhtar NB, De Meulemeester K, Pas R, Lenoir D, Meeus M. Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study. Musculoskelet Sci Pract. 2019 Feb;39:1-9.