pain perceptions

Perceptions of Pain and Making Sense of It – Study Summary

Perceptions of Pain – The Power of Proper Education


“Non-specific” neck pain is defined as pain without a known cause. Usually, it disappears on its own after a few days or weeks. However, some people have pain that lasts longer, or that returns frequently. It is deemed chronic if a patient experiences neck pain for more than three months. It affects 10 to 20% of adults, and its severity can range from a persistent ache to a stabbing, burning, or shooting pain. 

 

This article summarizes a study that set out to investigate how communication from physicians impacts how patients with chronic, disabling, non-specific neck pain perceive their condition and match it with their personal experiences and how an improvement in communication can influence their emotional well-being and the way they cope with their health condition.1

Factors that Worsen Chronic Disabling Non-Specific Neck Pain

Patients described several factors that they believed contributed to making their pain worse. Some of these factors include:

 

Physical Activities: Physical activities like sitting for long periods in an incorrect posture or engaging in activities that strained their neck muscles were reported to exacerbate their pain.

 

Psychological Factors: Participants mentioned that stress, anxiety, and negative emotions could worsen their pain. Emotional distress seemed to have a significant impact on their perception of the intensity of the pain.

 

Environmental and Working Conditions: Factors like uncomfortable seating arrangements or prolonged exposure to specific working conditions (e.g., sitting in front of a computer for long hours) were also cited as contributors to increased pain.

 

Previous Experiences: Negative experiences with certain treatments or interventions, as well as feelings of frustration and uncertainty about prognosis, were reported to worsen their pain and emotional well-being.

 

Participants’ illness perceptions often arose from information provided by healthcare professionals. Biomedical explanations, such as patho-anatomical or biomechanical processes, were frequently emphasized, shaping participants’ understanding of their condition.

 

The study suggests that properly addressing illness perceptions may facilitate patient recovery. Healthcare professionals must embrace a biopsychosocial paradigm, explore patients’ initial perceptions, and develop management strategies considering physical and psychosocial factors.

How Participants Were Selected

The study included 20 patients with moderately or severely disabling chronic non-specific neck pain, recruited from the region of Rotterdam by primary care physiotherapists using flyers in waiting rooms, through information provided during treatment consultations, or via social media posts on platforms such as Facebook and Twitter.

Average Age: 46.8 years 

Average neck pain duration: 21.0 months.

Patients were eligible to participate in the study having met the following conditions:

  • Aged 18 years or older.
  • Patients with an NDI greater than 15.
  • Patients with sufficient command of the Dutch language.
  • Patients with chronic Grade II neck pain (pain without signs of serious pathology interfering with daily activities).

 

Out of the 26 people invited to the study, 25 were willing to participate, but 4 were excluded due to a <15 NDI, and 1 withdrew from the study citing that it was too burdensome.

Results and Findings

The study’s outcome showed how the approach of healthcare professionals, which often emphasized biomedical explanations, strongly influenced participants’ illness perceptions and coping strategies. Some quotes that showed the recurring themes described by the participants regarding how they perceived their chronic non-specific neck pain include:

  • “It’s not a broken leg that you can see and repair. Unfortunately, I have experienced that this cannot be fixed.” – Participant 16
  • “I think I am in pain because of my posture, I am told that I was sitting in an incorrect position on a bad chair.” – Participant 12

 

Some agreed with their clinicians’ perspectives, while others needed a new perspective to help them cope with the condition.

Some of the perspectives shared by patients included:

 

Negative Perception:

A negative perception of the illness was mostly associated with a sense of confusion and resignation regarding the pain.

 

  • “I’ve been to the chiropractor before… he told me that I have some kind of scoliosis.” – Participant 19
  • “Some tell me ‘it’s a herniated disc’, based on the information from a CT-scan, and others say ‘it is just a muscle’, so to be honest, I really don’t know what to believe anymore.” – Participant 9

Perceptions of Pain

Positive Perception:

In cases where patients got a positive perspective from their clinician, there was more of an upbeat attitude towards the pain.

 

  • “The therapist said ‘let’s start with relaxed movements’, … she also told me that a painkiller would be released, which was enough for me to start with exercising.” – Participant 11
  • “I’m glad I visit someone who opened my eyes… I’m moving my head more frequently, it is painful, but he [the therapist] says: ‘nothing will happen to your neck’.” – Participant 3

 

The Importance of Perspective:

Some patients explained how being catered to emotionally and having a better understanding of their condition helped them cope with managing the pain.

  • “What does the explanation mean to me? It helps me a little bit in understanding my own body… and then, usually the next time, I feel much, much better.” – Participant 20
  • “I just need someone to say: ‘how are you today? How was your week?’ And not that the message is: ‘if you do this or do that, then next week it will be much better.” – Participant 16

Conclusion

Most participants reported that they found it necessary to be able to make sense of their pain and that understanding what was behind it was a key factor in dictating how they coped with pain. To provide proper patient-centred care, physicians must consider this “sense-making process” by listening carefully, validating their feelings, and sharing ideas regarding perceptions and coping strategies.

 

At Dynamic Disc Designs, we understand how important it is for the healthcare professional to make sense to the patient. This is why we have worked to develop the best in anatomical modelling so the chiropractor, physiotherapist, medical doctor, osteopath, spine surgeon or whoever is responsible for delivering effective education about the patient’s pain so the pathoanatomy can be explained effectively – in a sense-making process for the patient’s specific condition. Whether the patient is experiencing a level of minor spinal instability or even an open fissure disc bulge, we have the anatomical models to make patient education clear.