In a recent article 1 by G Lorimer Moseley, he explains how pain education is the cornerstone of best practice care for acute and persisting back pain, but does not get the attention it deserves. Though education is universally recommended as a first-line treatment, it does not attract the same amount of attention as when patients are told to remain active and seek psychological therapy. Moseley points out how these are the correct steps to follow for recovery, but without proper pain education, this advice from doctors can feel insulting, illegitimatizing, and infuriating. Once patients are properly educated, however, they can engage in active, psychologically informed strategies, that are potentially far more powerful for treating persistent pain than drugs or anything else doctors can offer.
Unfortunately, according to a study 2 by Moseley, most doctors do not know what pain education is or how to practice it. Often they do not even have the content knowledge, and if they do, they do not have time to properly educate their patients. For this reason, Moseley argues that a community approach is necessary so that collective strength can be harnessed to shift the conversation and clinical practice around back pain to focus more on pain education.
Pain education research has identified key concepts that, when patients really understand, it helps them to recover.
Examples Moseley gives of these concepts are:
- The back is strong (ie, it is NOT an inherently unstable structure!) and highly protected by a comprehensive network of danger detectors.
- Back pain can be brutally painful even when there is no identifiable tissue injury.
- Tissue healing is an irresistible life force.
- Pain provides our tissues a protective buffer.
- The protective buffer offered by pain increases with a huge range of variables including inflammation, cognitive and social cues.
- Our pain system learns over time to become more protective.
- The best ways to retrain an overprotective pain system are learning about pain, adopting active management strategies, gradually loading the painful tissue through movement and activity and using psychological therapies.
Much still needs to be done to shift the industry’s focus towards pain education, but fortunately, research in this field indicates that pain sufferers who are prepared to retrain their overprotective pain system to be less protective will likely see a gradual recovery.
KEYWORDS: pain education, acute back pain, persisting back pain
- Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for? ↩
- Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology ↩