Painful Conversations

Pain is a complex response by an individual’s nervous system. Inputs to this response include information from the environment (social cues), the periphery (nociception), and the individual themself (cognitions). For over 20 years, pain scientists such as Louis Gifford, David Butler, Lorimere Mosley, Paul Hodges, Jo Nijs and Adriaan Louw have researched pain to better understand the physiology, or the neuroscience, of the response. Pain neuroscience provides the scientific framework for physical therapists to understand, on a physiologic level, what is happening when an individual experiences persistent pain. However, pain neuroscience research has uncovered the intimate role that a person’s beliefs and expectations have on the pain experience. Health behaviors such as sleep, nutrition and physical activity also affect a person’s pain. The difficulty for many physical therapists arises when we try to communicate the scientific findings to our patients while preserving the therapeutic alliance we have worked so hard to establish. How do we avoid “You are saying this is in my head.”?

This presentation will present a basic review of the neuroscience of persistent pain including the three mechanisms of pain, nociception, peripheral neuropathic and neurogenic, how to differentiate between the three and how to test for each. Pain catastrophizing is a powerful predictor of rehab outcomes and subjective pain reports. I will discuss the role of fear, fear avoidance and pain catastrophizing on the nervous system, and quickly review the Pain Catastrophization Scale (PCS). Then, I will offer scenarios where a clinician might utilize pain science education in their treatment session and what that conversation might sound like.

Upon completing the course, the attendee will be able to - 

• Describe how to identify the primary pain mechanism in a patient.
• Use the PCS as a tool to identify and measure a patient’s cognitions about their pain.
• Repeat demonstration of a conversation describing pain as an output of a sensitive nervous system to a patient.