Utilizing Pain

Neuroscience Education
in the Acute Care Setting
UCMC In-service Presentation
July 8, 2021
Sarah Doren, SPT
Key Points About Pain1
★ Pain is complex

★ Pain is individualized

★ Pain = brain’s response to perceived danger

★ Pain ≠ “something is wrong”

★ What we say matters2

★ What we don’t say matters

What is Pain Neuroscience Education (PNE)?
★ New model pioneered by Louis Gifford in 19991
★ Response to:
○ Failing biomedical model1
■ Increases pain catastrophizing and pain-related fear
○ Pain epidemic
■ 56% of people globally have bodily pain weekly1
○ Opioid epidemic
■ 3x more fatalities than heroin + cocaine combined1
★ Empowerment strategy
 “The transition from acute to
chronic MSKP is not yet fully
Why use PNE in understood, but associations
between pain beliefs,
the acute care depression, and self-efficacy

setting? have been observed to increase

the risk of developing chronic
MSKP”3
Why use PNE in the acute care setting?

Prevent Chronic Pain Utilize 1:1 Time Decrease pain meds

STOP the transition Therapeutic Relationship Movement = Medicine

Start education BEFORE Hospital environment Shift the mindset from

acute pain becomes a allows for 1:1 time with meds before therapy to
chronic issue pt that busy outpatient therapy as a pain
clinics might not. intervention.
How do we
implement this in the
acute care setting?
Assess red flags
Referral to pain
Functional Goal Setting: management
What is your pain Reinforce: review key specialists
stopping you from doing? points, try new metaphors

Initial Eval Tx #1 Tx #2 Tx #3 Discharge

Introduce PNE Follow up: What questions do

you have about your pain?
Pain & The Body1

Nervous System Harm = Alarm Post-Threat

The body has a When the system In a perfect system,

45-mile long alarm senses a threat, it the alarm slowly
system that is sets off the alarms quiets when the
constantly looking and the brain sends threat has been
for danger. a danger message. handled.
But what happens when the system
never gets a chance to calm down?4
 4
Hypersensitive System
 “The art of explaining
pain to a patient is to tell
them it’s in their head,
without telling them… it’s
in their head”1
- David Butler
Tell a
story...4
It worked... Ratings of metaphors one
year after PNE:4

0 = do not remember

1 = not very helpful

2 = neutral

3 = helpful

4 = very helpful
 Pain Education + EXERCISE!5

Is education ➔ 5 studies with education

ONLY
alone enough? ◆ NONE showed
decreased pain ratings
➔ 6 studies with education +
Of course not!!
exercise
◆ 5 studies had significant
decrease in pain ratings
 5
PNE + Exercise
★ Create positive exercise experiences
★ “We need to teach your brain that it is
safe to move in these ways again”
★ “Blood flow speeds up the healing
process”
★ “Your knee/hip/ankle is stable now
and the doctor wants you to use it”
For more information…
Pain Neuroscience Education: Teaching People About Pain by Adriaan Louw, PT, PhD
APTA CSM 2021 - Know Pain: Acute Care Style6
References
1. Louw A, Puentedura E, Schmidt S, Zimney K. Pain Neuroscience Education: Teaching People About Pain. 2nd ed.
Minneapolis, MN: OPTP; 2018.
2. Ruben MA, Meterko M, Bokhour BG. Do patient perceptions of provider communication relate to experiences of
physical pain?. Patient Educ Couns. 2018;101(2):209-213. doi:10.1016/j.pec.2017.08.002
3. Bülow K, Lindberg K, Vaegter HB, Juhl CB. Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain:
A Systematic Review and Meta-Analysis. Pain Med. 2021;22(4):891-904. doi:10.1093/pm/pnaa484
4. Louw A, Puentedura EJ, Diener I, Zimney KJ, Cox T. Pain neuroscience education: Which pain neuroscience education
metaphor worked best?. S Afr J Physiother. 2019;75(1):1329. Published 2019 Aug 13. doi:10.4102/sajp.v75i1.1329
5. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A
systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-355.
doi:10.1080/09593985.2016.1194646
6. Mepham M, Green K. Combined Sections Meeting. In: Know Pain: Acute Care Style. American Physical Therapy
Association; 2021.