You’ve just finished a weekend course in pain science education. It’s Monday and you are back at work as a private practice physiotherapist, and you think – how on earth can I integrate this into my already hectic workload? You look down at the Explain Pain book sitting on your desk, but you don’t think you’ll have time to use it because you have back-to-back appointments all day. You think, wow – this is harder than I thought!
As first contact practitioners that do not require a referral, private practice physios are often the first person that someone will see for their pain. This means that we can be highly influential in setting the stage for what people with pain understand and expect from their care. On top of this, GP referral rates to physios are increasing rapidly in Australia, having nearly doubled in the last 20 years.1 We are also seeing a greater number of pain science-trained practitioners in clinical practice, thanks to increased pain science curricula in university courses as well as attendance at courses such as those run by Noigroup. Yet, research suggests that physiotherapists can feel underprepared and under-resourced to provide pain science education, which is compounded by the daily juggling of competing demands under strict time constraints in current systems of clinical practice.2
So why might this be the case? Why is it that evidenced-based treatments aren’t being successfully implemented?
To answer this question, it is helpful to take a closer look into the literature and explore how interventions should be developed and tested. Pain science education has been successfully developed, and then validated through an array of trials. BUT, the next step, implementation into clinical practice, remains challenging.
Barriers to pain science education uptake are likely multifactorial. Do any of the following thoughts sound familiar?
“I don’t feel comfortable bringing it up with this person as I don’t think it will go overly well.”
“I can’t find the right words to discuss this pain science concept with this person.”
“Pain science education is so time-consuming; I won’t be able to fit it into my 20-minute appointment.”
The good news is that research has shown that condensed versions of pain science education (i.e., a short single session, or 5-10 minute snippets) are still effective at positively shifting pain beliefs which is proposed to be one of the mechanisms by which pain science education exerts its effect.3–6 WONDERFUL!
So, problems implementing pain science education might partially relate to challenges that we face in our private practice settings when trying to apply condensed versions of pain science education. Many pain science education resources that are shorter/condensed were created with the general public in mind. Most have not necessarily been purposefully designed for implementation by physiotherapists in private practice settings nor designed to target barriers specific to this setting. Further, recent work has aimed to identify the most potent aspects of pain science education from a patient perspective;7 while work is ongoing, these have not yet been developed into condensed resources specific to private practice clinical encounters. Readily available simplified resources or educational strategies may be beneficial for clinicians.
So, we really want to know… how can we help Australian physiotherapists implement pain science education more efficiently – but with just as much impact – within the constraints of current clinical practice systems?
The first step to answering this question is to better understand how physiotherapists are currently using pain science education in the clinical setting, including what educational resources they like and frequently use. I will then use this knowledge to develop and test simplified pain science education resources (or strategies to better use pre-existing resources) for use in clinical encounters. If we can improve the provision of consistent pain education information and equip our physiotherapist colleagues, particularly graduates entering the profession, with resources to help them become more confident educators – this will be a huge leap forward in addressing the translational gaps in this area.
The implementation process is not a straight line. Most frameworks that we use to guide how a resource is implemented clinically are actually non-linear and iterative. This means we purposefully want to go back and forth between all those using a pain science education resource, both those delivering it and those receiving it. Consequently, I will be partnering with clinicians and consumers as co-researchers and co-designers of these resources. Exciting times lie ahead that’s for sure!
So, we would love your help in completing an online survey. This survey will explore the current uptake of pain science education by physiotherapists trained in pain science, what they’re finding difficult, and what can be done to streamline this process at the clinical coalface.
If you are a registered physiotherapist who has worked in a private practice clinical setting in Australia within the last 5 years who has received formal education in pain science (either via university training or a professional development course), you are eligible!
If you are eligible and interested, I would be most grateful if you could complete our online survey by visiting the link HERE
The survey will take approximately 20-30 minutes to complete, and respondents will be placed in a draw to win 1 of 3 vouchers valued up to $250.
Sorry that this may not apply to all of you. If you aren’t a private practice physio, but are interested in being involved in future work in this area, please drop me a line at monique.wilson@mymail.unisa.edu.au.
Thank you!
Monique Wilson
PhD Candidate
Body in Mind Research Group
IIMPACT In Health, Allied Health & Human Performance
University of South Australia
References
1 Dennis S, Watts I, Pan Y, Britt H. Who do Australian general practitioners refer to physiotherapy? Australian Family Physician 2017; 46: 421–6.
2 Forbes R, Mandrusiak A, Russell T, Smith M. Evaluating physiotherapists’ practice and perceptions of patient education: A national survey in Australia. International Journal of Therapy and Rehabilitation 2017; 24: 122–30.
3 King R, Robinson V, Elliott-Button HL, Watson JA, Ryan CG, Martin DJ. Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study. Pain Res Manag 2018; 2018: 3745651.
4 Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine 2014; 39: 1449–57.
5 Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9: e11543.
6 Van Oosterwijck J, Nijs J, Meeus M, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev 2011; 48: 43–58.
7 Leake H, Mardon A, Stanton T, et al. Key Learning Statements for persistent pain education: an iterative analysis of consumer, clinician and researcher perspectives and development of public messaging. The Journal of Pain 2022. DOI:10.1016/j.jpain.2022.07.008.
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