Pain Education is Valuable in Rehabilitation of Patients with Persistent Musculoskeletal Pain
Central sensitization often explains why patients experience ‘unexplained’ ongoing musculoskeletal pain. Introducing this pain education early in rehabilitation helps patients understand that their central nervous system is sending altered messages to their muscles and tissues. Instead of the brain inhibiting pain, it facilitates pain messages, causing hypersensitivity. Patients who understand the physiology of persistent pain are more likely to adhere to therapy.
The Purpose of Pain Education
Pain education aims to change patient’s maladaptive illness perception. Unexplained musculoskeletal pain is threatening. Patients often present with a lower pain tolerance, thoughts are more catastrophic, and coping strategies are often diminished. Pain education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization, and 2) maladaptive pain cognitions, illness perception or coping strategies are present. Maladaptive pain conditions include ruminating about pain and hypervigilance to somatic signs.
Therapists providing tailored education to each patient increases motivation for rehabilitation. This should be initiated during the first session when discussing treatment rationale, and continually reinforced at each session. This would include explaining how pain becomes persistent (central sensitization) and how factors such as emotions, stress, illness perceptions, pain cognition, and pain behavior feed painful sensations. The therapist can ask the patient if they are willing to set new goals as they better understand this new concept in pain science. Typical examples may include stopping rumination and worry about the etiology of the pain, reducing stress, increasing physical activity, decreasing hypervigilance, becoming more physically active, and learning how to better relax. Changing strategies for dealing with their pain can help them understand how to better deal with their ‘hypersensitive nervous system’.
The Process of Pain Education
Rehabilitation of patients with persistent musculoskeletal pain must consider the process of central sensitization. Patients need to be convinced that hypersensitivity of the central nervous system is causing their symptoms, rather than local tissue damage. A biopsychosocial-oriented rehabilitation program includes stress management, graded activity, and exercise, while explaining how each will help reduce the body’s hypersensitive nervous system. These strategies are useful during face-to-face sessions in the clinic or by telehealth.
The following literature offers Practice Guidelines and more specific information on this topic:
Nijs, J., Van Wilgen, C. P., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines. Manual therapy, 16(5), 413-418.