Sunday 3 March 2019

Pain Science Education: What It Is And What It Isn't

            Over the course of this weekend two main themes filled my social media feed. The first were videos of the amazing feats of strength from the various events at the Arnold Sports Festival (side note: props to two-time Arnold Strongman Classic champ Hafthor Bjornsson as well as to powerlifting world record breakers Blaine Sumner and Stefi Cohen for their successes). The other was this study that provided a systematic review & meta-analysis on pain science education (PNE). The article showed that…
·         PNE did not significantly reduce pain or disability
·         But PNE did reduce catastrophizing and kinesiophobia

It created a lot of controversy and debate amongst therapists from different backgrounds & ideologies as well as a need for clarification as to what PNE is and isn’t – the topic of this article.

What PNE isn’t

PNE is not

1) A cure or magic bullet

As we’ve discussed above pain science education doesn’t create significant improvements in pain. This review showed a reduction in pain of 3.2/100 – less than half a point on a 0-10 pain scale.

2) A standalone intervention

Some studies have shown better effectiveness of PNE mixed with exercise versus one or the other alone. Granted this is still being studied and is still up for debate.

3) An intervention that will produce the same results in everyone

Some qualitative studies have shown that PNE can create great reductions in fear and improvements with activity in some people but can be useless or even counterproductive with others.

Side note: studies like these, plus my own experiences, are why I disagree with (well meaning but misguided) practioners who think that everyone needs PNE. As with everything else the intervention needs to be tailored to the individual.

4) The only part of biopsychosocial rehabilitation

As Jarod Hall and Sandy Hilton say “pain science should be the air you breathe” – not something you just do to people. There are many components of biopsychosocial rehab (and proper rehab in general) including
·         Simply being a good person who’s attentive, caring and is a good listener
·         Acknowledging that there are numerous contributors to the pain experience, working to address these different areas and referring out for help when needed
·         Educating people on how to get back to a lifestyle that is meaningful for them through pacing
·         Also educating people on healthy lifestyle habits
·         Experiential learning & graded exposure to activities: to me this is a great way for people to experience that hurt doesn’t equal harm and that they can likely do more than what they’re capable of
·         Getting people more physically active
·         Using positive language & self-management skills to empower the patient and build their self-efficacy

What PNE is

PNE is

1) A means to explaining the science of pain and the contributing factors behind a person’s pain

2) A means to (hopefully) decrease some of the anxiety, fear and negative beliefs surrounding pain and a means to get people more physically active & working towards the lives they want to live.

I hope this article sheds some light for you (and others) on what PNE truly is & isn’t and where it fits in the grand scheme of things. As always – thanks for reading.

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