I Have Never Been This Excited to Share a Journal Article Before: Fifteen Years of Explaining Pain: The Past, Present, and Future [Critical Review]

Some Context

Pain was always this thing that I had some interest in working as an OT in acute rehabilitation but I had so many things to focus on like function. The majority of the patients had a neurological condition such as stroke or TBI so pain often co-occurred with my patients. Much of my focus for pain management was on medication as this was quite effective and part of our team approach and goals, but we know that neuropathic pain is much more different than tissue injury pain or inflammatory pain. It does not behave the same and treating is can be much more challenging.

It wasn’t until I sustained a personal low-back injury myself that pain really hit home (quite literally) for me. I had two herniated discs in my lumbar and I ultimately put in my 2 weeks at my OT position so that I could “heal” and spend more time with my baby. But the pain never went away. To this day, I still feel it (been over a year). However, I am doing much more than I used to: lifting my 25# kid, doing yard work, taking out the trash, cleaning, driving, and more. But I do have my “bad” days and all I want to do is rest. My mental health has been affected negatively.

Lately, I have taken a more positive attitude and set out in my hunger for scientific knowledge to learn more about pain – both for myself and for my clients in occupational therapy. A journal article came up in my feed about low-back pain using graded sensorimotor injury that was published in JAMA. This lead me to read more about pain management, neuromatrix theory of pain, and the book, Explain Pain. Today I did a google search for ‘explaining pain management to patients and this article came up from the American Pain Society titled, “Fifteen Years of Explaining Pain: The Past, Present, and Future“. It’s from the same authors as Explain Pain and the same ones who published the article mentioned in JAMA. So highly influential professionals in the pain management space I suppose.

I was so excited to find this that I typed all of this before I even read this article! I know I should be careful not to appeal to authority or a single source of information in OT practice and in general, so I have to keep this in mind in my own pain journey as well as learn about pain management for my own professional development.

Off to read the article now and will continue this post below to let you know my thoughts.

Abstract

The pain field has been advocating for some time for the importance of teaching people how to live well with pain. Perhaps some, and maybe even for many, we might again consider the possibility that we can help people live well without pain. Explaining Pain (EP) refers to a range of educational interventions that aim to change one’s understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself. It draws on educational psychology, in particular conceptual change strategies, to help patients understand current thought in pain biology. The core objective of the EP approach to treatment is to shift one’s conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue. Here, we describe the historical context and beginnings of EP, suggesting that it is a pragmatic application of the biopsychosocial model of pain, but differentiating it from cognitive behavioral therapy and educational components of early multidisciplinary pain management programs. We attempt to address common misconceptions of EP that have emerged over the last 15 years, highlighting that EP is not behavioral or cognitive advice, nor does it deny the potential contribution of peripheral nociceptive signals to pain. We contend that EP is grounded in strong theoretical frameworks, that its targeted effects are biologically plausible, and that available behavioral evidence is supportive. We update available meta-analyses with results of a systematic review of recent contributions to the field and propose future directions by which we might enhance the effects of EP as part of multimodal pain rehabilitation.

EP is a range of educational interventions. EP is grounded in conceptual change and instructional design theory. It increases knowledge of pain-related biology, decreases catastrophizing, and imparts short-term reductions in pain and disability. It presents the biological information that justifies a biopsychosocial approach to rehabilitation.

Key Points

  • Psychosocial factors for pain have been recognized such as with cognitive behavioral therapy (CBT).
  • CBT has mainly focused on how to cope of pain instead of how to treat it.
  • The core objective of EP is to shift one’s conceptualization of pain from tissue damage or disease to pain being the need to protect body tissue.
  • EP is an emergent process rather than a linear process.
  • Any credible evidence of danger to body tissue can increase pain; any credible evidence of safety to body can decrease pain.
  • EP considers nociception and the nociceptive system for pain.
  • EP should explain pain to the learner the key biological concepts that underpin pain with a measure of proficiency for pain literacy.
  • This understanding includes beliefs, attitudes, behaviors, treatment, and lifestyle choices.
  • Pain is a biopsychosocial phenomenon.
  • The body tends to err on the side of protection when it comes to bodily protection.
  • Cognitively mediated shifts can be an effective way to modify the perceived response to pain.
  • Studies have investigated the efficacy of EP and more evidence is emerging.
  • EP can be combined with interventions that promote neuroplasticity, e.g., pharmacological, stimulation, hypnosis, exercise, and meditation.

Sources

Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: the past, present, and future. The Journal of Pain16(9), 807-813.

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.