What pain education programs can learn from teachers and their class with 6-year olds…   October 11th, 2016

What pain education programs can learn from teachers and their class with 6-year olds…

In Belgium nearly every hospital has a specialized pain center to treat patients with chronic and/or debilitating pain. These pain centers developed and evolved over the years and became multidisciplinary teams. As chronic pain is a complex and subjective problem, it is very useful to combine several different points of view on chronic pain in a patient-centered setting.

During the last years, these pain education programs have demonstrated their value. However, is there still a scope for improvement? Well, there always is and every program also depends on individual caretakers, the motivation of the patient, the setting … and lots of other factors, like even the weather.

The question I would like to discuss in this blogpost is the following. Medicine is a science and doctors treat their patients following recent scientific knowledge, physiotherapists act on a scientific basis, psychologists work scientifically structured, and so on. But what sometimes is forgotten is that ‘education’ is a science too.

So my question is: ‘Might focusing on educational skills of therapists further improve pain education programs?’ With this knowledge, there might be an opportunity to expand the success rate of pain education programs.

William Glasser (1925 – 2013) was an American psychiatrist who wrote not only about psychiatric illnesses, but also about a broader range of topics, as for example education. His theory on how children learn is very interesting for education, for 3-year olds, as well as for chronic pain patients and for elderly who like to learn how their I-pad works to skype with their grandchildren.

Glasser described the following about the way people are learning:

We learn 90% from what we explain to others.

We learn 80% from what we do.

We learn 70% from what we discuss with others.

We learn 50% from what we see and hear.

We learn 30% from what we only see.

We learn 20% from what we hear.

We learn 10% from what we read.

Do you remember your class when you were 15 years old and you had to listen to a history or geographic lesson from a not too motivational speaker – teacher? You will remember that it was boring, but the content the teacher tried to transfer will probably be lost forever in your head, if it even reached your mind while you were almost sleeping in the class…

In education, 90% of the lessons are given ex cathedra, so in 90% of the time the teacher is on speaking terms. Comparing this with the percentages above, we could presume that it will be the teacher who learns the most and the pupils learn only 20% of what the teacher is telling. Luckily, at present a lot of teachers learned lots about learning styles of children and therefore more and more shift their lessons into peer-tutoring classes, coaching groups, debates and experience-oriented learning. If we look at several educational programs in daily healthcare, they are also given for at least 90% ex cathedra and most of the speakers do not have any educational background.

I will illustrate this with a little anecdote:

I once saw a little 5-year old boy that was very dedicated to learn how to ride his new bike without training-wheels on the side. But the more his father instructed and told him how to move, the less the boy managed to really learn what was the crux to start riding his tiny bike. The father assumed his son was not ready to learn riding the bike and left the bike where it was.

A couple of days later a school friend came over to play and the boy was very interested and even a bit jealous that his friend, who was even 4 months younger, already could ride his bike. The school friend was standing next to the boy, both standing over their bikes, and said: ‘I know a very cool way to start and ride very fast’. He placed one of the pedals on top, placed his foot on it and said: ‘Now you just have to push as hard as you can on the highest knee’. He started and one second later, the boy followed the instruction of his little peer. He could ride his bike for the rest of his life, and never fell off again.

The theory of Glasser could be interesting when building patient education programs. Certainly as in the beginning a lot of patients do not see the benefit of following a pain program. They are forced into programs, which are often not just focused on their specific medical problem and some of them are even very sceptic, because they do not believe that coping strategies, tips, or changes in behavior can work as well as medication. Probably some of them resemble a lot to 15 year olds, being bored in class and refusing good advice from their parents.

To handle with the resistance or even aversion of patients on tips, scientific information and well-meant advice, the theory of Glasser could probably give a better solution.

When assembling the content for a pain educational program, time should be taken to choose the right pedagogical settings and working methods. The teacher or health expert should not be in front, but the patient himself should be, explaining his very recognizable situation to peers, debating, discussing, teaching, listening and supporting peers (pain patients).

In literature we find a lot of research about the effect of patient education, but very little information about the didactics of patient education or the methods that are used. And that is quiet strange because as we see in research on general education worldwide, the way things are teached have a big effect on the effectivity of learning at all ages.

Therefore, we can assume that very little research is done and that most patient education programs are given in group with the teacher or health professional in front of the group.

Since didactics in education by schoolchildren is widely researched and shows better learning benefits for several non – ex cathedra education methods (commonly known is that Scandinavian countries are doing very well using active learning methods), it sounds reasonable that further research should be done in patient education.

Possible areas to discover are: Group therapy versus individual approach, homogeneous versus heterogeneous patient groups, groups divided following their education level, socio-economical standard, type of pathology, age, former work type, ... Didactical working methods as debating- and discussion groups, feedback from peers (patients), working with theorema, audiovisual material, digital apps, home work, group dynamic management, short (1 of 2 lessons) or long term trajects (> 9 lessons).

Want to read more about patient education or didactics in general? Then the following literature might be interesting. But as we say: just try new things and a good therapist will soon see the effect, if you keep in mind that ex-cathedra lessons and teacher-centered lessons are not that effective!


Patient education

- Essentials of patient education (Susan B. Bastable - 2016)

- Adult education for health and wellness (L. H. Hill - 2015)

- Patient education - a practical approach (R.D. Muma, B. A. Lyons - 2011)

- The practice of patient education (Redman & Yu - 2006)

- Effective patient education (Donna R. Falvo - 2010)

Education in general

-Use search terms as cooperative learning techniques (coöreratief leren), differentiating in class (differentiëren in de klas), active learning techniques (activerende leertechnieken), activating didactics (activerende didactische werkvormen), workforms (werkvormen), ...

Good luck!

Joyce BLONDé - © www.bekkenbodemproblemen.be

2016 Pain in Motion