In your view, what is the biggest challenge physiotherapists face in managing patients with persistent musculoskeletal pain? 

Translating evidence into clinical practice. 

Even though physiotherapists are frontrunners in applying pain science clinically, we still struggle with a fundamental paradigm shift—moving away from biomedical, biomechanical and disease-based treatments towards multimodal lifestyle management for patients with persistent pain. 

This transition is both exciting—particularly with advances in e-health innovation—and hugely challenging. 

The trick is changing our own beliefs and attitudes, which are often biomedically oriented when we should be thinking biopsychosocially. 

Differentiating between pain types (eg, nociceptive versus nociplastic) in patients experiencing persistent musculoskeletal pain remains clinically difficult. 

Jo Nijs will be discussing his research on pain during two keynote talks at APASC25.

What recent advances in assessment could help physiotherapists manage these patients? 

Several international consensus recommendations now exist for pain phenotyping in specific chronic pain conditions such as post-cancer pain and low back pain. 

These recommendations include several case studies to support clinicians implementing phenotyping in practice. 

Precision pain management for patients with chronic pain should also include addressing comorbidities such as insomnia, sleep apnoea, obesity and stress intolerance. 

Tailoring physiotherapy for patients with chronic pain according to their comorbidities has much stronger evidence than tailored care according to pain phenotypes. 

With the shift toward multimodal lifestyle interventions for persistent musculoskeletal pain, how might the physiotherapist’s role evolve, if at all? 

This shift provides massive opportunities for physiotherapists, especially those with high-quality clinical trials demonstrating that physiotherapists can provide effective sleep training, stress management, weight management and behavioural physical activity and exercise interventions in patients with persistent musculoskeletal pain. 

The American Physical Therapy Association embraced dietary interventions years ago, providing another opportunity for our profession. 

With our broad biopsychosocial education, physiotherapists are perfectly positioned to play a key role in the shift towards multimodal lifestyle interventions for persistent musculoskeletal pain, but also for many other conditions often treated by physios, including neurological, oncological and cardiovascular disorders. 

Exciting times for our profession. 

>>Jo Nijs is a full professor at the Vrije Universiteit Brussel, Belgium where he runs the Pain in Motion research group. He works in private practice as a physiotherapist and manual therapist, and as a visiting professor at the University of Gothenburg, Sweden. Twenty years ago, he pioneered the study of central sensitisation in a variety of pain conditions, including osteoarthritis, cancer, back pain, neck pain, shoulder pain and fibromyalgia. 

>>Jo Nijs will present two keynote sessions: ‘A paradigm shift towards multimodal lifestyle interventions for persistent musculoskeletal pain’ on Thursday 23 October at 2.30 pm and ‘Demystifying nociplastic pain: clinical reasoning to facilitate a personalised treatment’ on Friday 24 October at 10:35 am.

Click here for more information about APASC25