Taking the pain out of pain education
An online survey of Australian physiotherapists working in private practice is now underway and needs your help.
It is estimated that one in five Australians has chronic pain (Australian Institute of Health and Welfare 2020, Henderson et al 2013), resulting in a substantial reduction in wellbeing and increased healthcare visits annually (Blyth et al 2004).
As first contact practitioners who do not require referral, private practice physiotherapists are often the first to see someone about their pain, making them highly influential in setting the stage for what patients understand about pain and expect from their care.
On top of this, GP referral rates to physiotherapists are increasing rapidly in Australia, having nearly doubled over the past 20 years (Dennis et al 2017).
We are also seeing a greater number of pain science-trained practitioners.
Yet research suggests that physiotherapists can feel underprepared and under-resourced to provide pain science education, which is compounded by the juggling of competing demands under strict time constraints in current systems of clinical practice (Forbes et al 2017).
Pain science education has been successfully developed and validated through an array of trials.
But the next step—implementation into clinical practice—remains challenging.
A national survey of Australian physiotherapists found that although pain science education was rated as important or very important by nearly 70 per cent of respondents, less than half reported using it very often or always (Forbes et al 2017).
Thankfully, research has shown that condensed versions of pain science education (eg, a single short session or 5–10-minute snippets) are still effective at positively shifting pain beliefs, one of the mechanisms by which pain science education exerts its effect (King et al 2018, Louw et al 2014, Sillevis et al 2021).
Implementation issues may partly be due to challenges physiotherapists face in private practice settings when trying to apply condensed versions of pain science education.
Many shorter or condensed pain science education resources were created with the general public in mind.
Associate Professor Tasha Stanton is researching ways to better implement pain science education.
Most have not been designed for implementation by physiotherapists in private practice nor set up to target barriers specific to this setting.
While recent work aiming to identify the most potent aspects of pain science education from a patient perspective (Leake et al 2022) is ongoing, this has not yet been developed into condensed resources specific to private practice encounters.
Readily available, simplified resources or educational strategies may be beneficial for clinicians.
So, what can be done to help physiotherapists implement pain science education more efficiently, but with just as much impact, within the constraints of clinical practice systems?
Under the supervision of Associate Professor Tasha Stanton from the University of South Australia, I am undertaking work to answer this question.
The first step is to better understand how physiotherapists use pain science education, including resources, in clinical settings.
This knowledge will then help develop and test simplified pain science education resources for use in clinical encounters, along with strategies to better use pre-existing resources.
It is hoped that the strategies and resources will begin to address the translational gaps, including improving the provision of consistent information and helping physiotherapists become more confident educators.
The University of South Australia is recruiting participants for the first study in this line of work via an online survey exploring physiotherapists’ uptake and experiences of pain science education.
If you are a physiotherapist who has worked in a private practice in Australia in the past five years and you have received formal education in pain science (through either university training or a professional development course), you are eligible.
Click here to take part in the online survey, which takes about 20 to 30 minutes to complete.
>> Monique Wilson APAM is a musculoskeletal physiotherapist working in private practice and a PhD candidate at the University of South Australia. The focus of her research is on the clinical implementation of pain science education.
- References
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1. Australian Institute of Health and Welfare. Chronic Pain in Australia. Canberra, Australia: AIHW, 2020.
2. Henderson JV, Harrison CM, Britt HC, Bayram CF, Miller GC. Prevalence, Causes, Severity, Impact, and Management of Chronic Pain in Australian General Practice Patients. Pain Medicine 2013; 14: 1346–61.
3. Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111: 51–8.
4. Dennis S, Watts I, Pan Y, Britt H. Who do Australian general practitioners refer to physiotherapy? Australian Family Physician 2017; 46: 421–6.
5. Forbes R, Mandrusiak A, Russell T, Smith M. Evaluating physiotherapists’ practice and perceptions of patient education: A national survey in Australia. International Journal of Therapy and Rehabilitation 2017; 24: 122–30.
6. King R, Robinson V, Elliott-Button HL, Watson JA, Ryan CG, Martin DJ. Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study. Pain Res Manag 2018; 2018: 3745651.
7. Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine 2014; 39: 1449–57.
8. Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9: e11543.
9. Van Oosterwijck J, Nijs J, Meeus M, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev 2011; 48: 43–58.
10. Leake H, Mardon A, Stanton T, et al. Key Learning Statements for persistent pain education: an iterative analysis of consumer, clinician and researcher perspectives and development of public messaging. The Journal of Pain 2022. DOI:10.1016/j.jpain.2022.07.008. -
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