Blog
Pain Education: does it matter ?
The debate that seems to be raging in the pain education science is what type of education benefits patients most. The two major types of education being often discussed in the literature are biomechanics/pathology and pain neuroscience. Is one better than the other ?
Distress Tolerance and Chronic Pain
The unwillingness to experience distress (distress intolerance), can lead to avoidance behaviors that result in maladaptive coping strategies. Self-efficacy for tolerating negative emotions and willingness/unwillingness to experience distress are important factors to consider in determining engagement or avoidance behaviors. These aspects of the modulation of the pain experience represent clinical targets in the management of pain.
The complexity of pain
The understanding of pain has been dominated by a brain-centric paradigm focused on nociceptive processing. This reductionist interpretation of pain needs to be balanced by the multiple processes outside of the central nervous system involved in the experience of pain. Assigning the whole experience of pain to one organ, the brain, fails to account for the complexity of the phenomenon. Pain is better understood when assigned to the whole itself and to the interactions of the components of the system.
Pain-sensorimotor interactions
Management strategies directed towards simply treating the muscles in pain are insufficient since the muscles are the end point of a large and complex sensorimotor system that is influenced by many biopsychosocial factors, and so a more holistic approach needs to be considered.
Effective and reassuring consultations
Clinicians need to develop their skills in patient-centered communication and develop therapeutic collaboration with patients to achieve meaningful results. The literature clearly shows that better therapeutic outcomes are achieved that way.
Expectancy violations and pain coping
People experiencing pain try to make sense of their experience to gain control of the pain experience and its impact on their life. In order to make sense of their experience, patients form a cognitive representation of their symptoms that undergoes predictive processing in the brain.
Overdiagnosis
Overdiagnosis is one of the most harmful and costly problems in modern healthcare. Musculoskeletal care has been plagued by over-detection, overdiagnosis, and overtreatment of structural anomalies to try to manage patients’ complaints.
Osteoarthritis and Physical Activity
Physical activity and/or physical exercise can bring health benefits in patients living with osteoarthritis by preventing cartilage degeneration, inhibiting inflammation, and by improving pain, stiffness joint dysfunction and muscle weakness.
Dispositions relative contribution to non-specific chronic low back pain
Specific factors such as catastrophizing and fear, depression and anxiety, pressure-pain thresholds, thermal pain thresholds and functional brain connectivity were significantly different in non-specific chronic low back pain compared to pain-free controls.
Emotion Regulation and Pain Catastrophizing
Maladaptive emotion regulation, such as rumination, can shift the pain response from BAS-dominant to BIS-dominant, therefore promoting pain catastrophizing. Pain catastrophizing can then lead to pain-related fear and activity avoidance, eventually resulting in disability (disuse and depression).