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First things first

By Noigroup HQ Education for all 18 Jan 2018

So, you’re happy asking your clients how they like to learn, and gathering some really useful data along they way – data that is informing and improving your educational interventions.

But, there is a question that should come first – one even more fundamental than asking ‘how do you like to learn?’. You’ve probably guessed it already – ‘do you want to learn?’.

When you’re excited by the knowledge that you have, and confident in the benefit of sharing it with others, it can be easy to overlook the fact that not everyone will feel the same. Society and culture will have influenced what a client will expect from your profession before they arrive, and there’s a good chance they’re not expecting education.

When you ask a client ‘would you like to learn more about your pain and some science?’, many will say yes – and you know what to ask next as part of The Explain Pain Assessment* ‘how do you….’. Others will be less sure – having an explanation of why learning about pain is so important is necessary here. Others yet will flat out say no – the ‘get stuffed’ response, often accompanied by (the very understandable) ‘can’t you just fix me?’ You need to be prepared for this too – what else will you offer, will you try education again, at another time and place? Can you weave some science into story, narrative and metaphor as you’re delivering what your client expects? Should you?

Asking ‘do you want to learn’ also respects the person for who they are and helps bring you into their world, and their narrative.

From the stories we hear, many Explain Pain attempts fail before they even get started because the therapist forget to ask their client if they want to be a learner.

What’s your experience with those first appointments when you are introducing some education? Feel free to share your experiences below

– noigroup
Knowledge driving health

* The Eight Great Questions in The Explain Pain Assessment come from Explain Pain Supercharged, available at (worldwide), and the NOI USNOI UKNOI NLNOI DE and NOI ES book stores.












  1. Mat Richardson

    I have found clients are less likely to enguage in further learning, when in the past pain science has been taught to them poorly. The educators usually failed to address target concepts applicable to the client and only did some aspects of EP. It can then take a few session to inspire them to want to know more.

    1. Yep, it can be doubly hard to start education when it has been attempted (sometimes poorly/hurriedly, other times with the best of intention but perhaps lacking skills) in the past “you better not try and tell me it’s all in my head like the last guy”…

  2. I do believe that one can evolve their practice into a centre where the patient expects to be educated just as much as they expect hands on therapy…….

  3. Wendy Willcox

    I am a patient and have nothing but admiration for what you do
    I live in South Africa so it was very difficult to get this ‘education’
    It’s been a path of self education, and a very circuitous one.
    But I kept trying and the break through came with understanding the concept of Dims and Sims
    In the initials stages I met no one who would have asked ‘do you want to learn?’
    But after exhausting my options in medical opinions, someone said that if I had had pain for so long, it must be in my head, and that sparked my journey of self learning which led to Explain Pain and remarkable improvement
    Thank you so much!
    From this side of the consulting desk I would say the ‘do you want to learn’ question depends very much on where you are on that path
    I have tried passing on my hard fought knowledge to family and friends in trouble, but get the impression they think there’s more than pain going on in my head!

    1. Most patients like to hear from health processionals, in the professional setting, including family despite having you ‘on tap’ It’s just the way there wired! Knowledge is power, investigating gaps and willingness to learn is half the battle.

    2. Hi Wendy, thanks for sharing your story. Great insight to on the readiness of the potential learner – that’s why it’s so important to carefully listen to the answer and work with the person at their rate and when they are ready.

  4. alison lingwood

    What patients like to learn for themselves the most is how to move through their current experience .Helping them to explore curiously the experience of their pain in their own language is the key .

    1. I would even hazard that “Helping them to explore curiously the experience of their pain in their own language” has many of the essential elements of treating pain – exploration, curiosity, language….!

  5. I find as a manual therapist the problem is the 2nd session onwards.I have been using PNE for some years and find the first treatment to be very helpful often involving data gathering/listening and responding and generally little touch involved.Patients generally respond well to this as it is novel and creates hope and hopefully insight.However the next session I think” I can’t just give them more education, after all I’m a physical therapist not a psychotherapist”.I end giving a rather duĺl physical treatment with some education but really probably giving them what they have had many times already from other practitioners.
    I get cross at myself and frustrated.
    What I would really like to see from the world of manual therapy is for practitioners to put out on youtube recorded whole treatments for us to see what others are doing and to learn from each other. Practitioners I think love to blog but underneath many have fears around showing what their treatments look like.
    It is something I am thinking of trying if my governing body give the all clear.Only by putting ourselves in an admittedly uncomfortable place can we learn from each other, instead of just saying lovely words like “attunement” or “alliance”.

  6. davidbutler0noi

    Thanks Tim et al.,

    Great posts on an important question. I usually say something like “there is a lot of new information and knowledge out there about pain. It’s really worthwhile picking up some of this new information as it can help you get going. Most of my clients have found it very helpful”. I avoid statement like “teach you some pan sciences”. Many clients are scared of the notion of learning science, not everyone likes science and some may still recall being revolted by the frog dissections in high school. ‘Teaching” is not so good either –“sharing a few stories” may be better.

    “Knowledge is power, education is the greatest pain liberator” are related to target concept number one. Unless the learner gets this, you won’t get full bang for your buck with subsequent knowledge delivery.

    Matt – there is a lot of “explain pain lite” out there – education delivered in a generic, formulaic and non-tailored way which may ultimately becomes non-caring . You do need a “let’s go deeper and really relate the information to your particular issues”. Alison sums it up beautifully…”helping them to explore curiously the experience of their pain in their own language is the key”

    Graham – just do it! We have a mass of social media commentators there days who have probably never been exposed to multiple peer review. Second sessions should be exciting – having a curriculum framework makes it easier and for me a contract has always made it easier ie a mutual discussion on what we will try to achieve in x number of visits. Geraldine and Wendy – hang right in there ! Professional settings work best – Explaining pain to a family member around the BBQ has its problems! And Wendy – you may be more along the path than many health professionals,

    David, like you, I do believe that “one can evolve their practice into a centre where the patient expects to be educated just as much as they expect hands on therapy…”

    Cheers all


  7. Rhea Crighton

    I am a nurse specialist in a persistent pain clinic in UK. As part of the patients pathway all new patients attend a pain education session before they have their 1:1 assessment. We have found that this makes sharing knowledge about persistent pain and self-management, in clinic, a lot easier; as they are already primed that this is what will happen.

    Also if they are not ready to learn more about their pain and how to manage it using a biopsychosocial approach and they are still focused on the medical model and are looking for a “fix” then they often choose not to attend their 1:1 appointments at that point and often come back to us at a later date when they are ready to engage with developing pain knowledge and self-management strategies.

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