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What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education

Review written by Ben Cormack info

Key Points

  1. Pain education seeks to address common misconceptions around pain.
  2. The majority of people improved after receiving education, although efficacy cannot be determined.
  3. 3 key themes emerged from the data: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overprotective pain system.

BACKGROUND & OBJECTIVE

Education has become a prominent part of many treatment guidelines around common musculoskeletal (MSK) complaints (1). Pain education seeks to address common misconceptions around pain, such as, pain is always a sign of tissue damage that can lead to worse outcomes. Reconceptualising pain can also lead to better engagement with other treatment guidelines, such as to remain active.

Pain science education seeks not only to provide new information, but also to challenge existing potentially unhelpful beliefs around pain. Pain education interventions use target concepts that form learning objectives around pain. Currently it is unknown which of these target concepts are most important to people living with pain.

The purpose of this paper was to clarify which of these target concepts were identified as useful for those who improved after pain education.

Pain science education seeks not only to provide new information, but also to challenge existing potentially unhelpful beliefs around pain.
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Identifying key themes that are deemed helpful may help clinicians be more targeted and efficient when using education.

METHODS

This was a convergent mixed methods piece of research that involved quantitative methods employed to rank target concepts, and a qualitative component to investigate the perspective of the patient. This study involved people who were at least 16 and had persistent pain for longer than 3 months in duration. Treatment sessions involved between one and six face-to-face sessions, and between two and eight telephone or video calls. After the treatment, which aimed to provide individualized information aimed at reconceptualizing pain, the participants received a survey to examine their perception of the treatment components.

The survey contained questions regarding demographics (age, sex, and highest level of educational attainment), pain status (pain diagnosis, pain duration, and improvement), and activities since consultation (time since treatment and engagement with other treatments). The qualitative analysis was performed by another author that used an inductive approach to thematic analysis to identify themes from the data content. The authors took a critical realist ontological perspective and a post-positivist epistemological view during analysis.

RESULTS

From 119 responses received, 97 were deemed eligible for the final analysis, with 19 people excluded for not improving. Three major themes were identified from the data:

  1. Pain does not mean my body is damaged
  2. Thoughts, emotions, and experiences affect pain
  3. I can retrain my overprotective pain system

All target concepts were rated as “a little important”. The most highly rated target concept was pain as being overprotective, with 99% of participants describing this as “very important”, with changeability of the overprotective system as also being very important (92%). People who had improved from persistent pain also valued learning that a variety of factors can influence pain.

LIMITATIONS

  • It is hard to know if the change that occurred in this study was actually due to the educational strategies and messages that were utilized. So, although the messages may have been deemed useful by patients, we do not know if they were actually mediators of the outcomes.

  • The education was also provided by only one of the authors. This may have been a strength as it homogenized the information and the way it was delivered, but also a weakness as we cannot differentiate if it was the actual information or the person that applied it.

CLINICAL IMPLICATIONS

Pain education has become a prominent part of working with people with persistent pain. So far research data has yet to fully validate the efficacy of using this type of education to reduce pain intensity and disability with systematic reviews questioning the efficacy of pain education being released over the past few years leading to some criticism of this type of approach (2,3).

Time is often limited in clinical situations, and many cannot use up to six treatment sessions that use education as the main component. This means that identifying key themes that are deemed helpful by those that had some recovery may help clinicians be more targeted and efficient when using education, such as the 3 major messages mentioned earlier in this review.

Clinicians however must remain aware that such information in this research was individualized, although how this was performed was not stated, and pain science ‘dumps’ that simply contain these messages may not be effective if they go against current belief structures. The authors here state that creating ‘cognitive conflict’ does not lead to consistent change and altering cognitions can also take time. Perhaps this is not available to the average clinician, as was utilized in this study design.

+STUDY REFERENCE

Leake H, Moseley G, Stanton T, O'Hagan E & Heathcote L (2021) What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain, 162(10), 2558–2568.

SUPPORTING REFERENCE

  1. Hall A M, Aubrey-Bassler K, Thorne B, Maher C G. Do not routinely offer imaging for uncomplicated low back pain BMJ 2021
  2. Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain. 2019 Feb;
  3. Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, Dixon J, Atkinson G, Cooper K, Martin DJ. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain. 2019 Oct;20
What do patients value… By Ben Cormack