Pain Management Bundle (3 CEUs)

Current research in chronic low back pain (cLBP) suggests a shift from the biomedical to biopsychosocial approach. In physical therapy, this means extending care beyond standard training in physiology, body structure, and biomechanical function. While many clinicians recognize the psychological and social factors affecting a person’s experience of pain, lack of training limits application of this approach. Yoga, as a holistic health practice, provides the opportunity for clinicians to address multiple domains of health and to build accessible and affordable programs that extend beyond the restrictions of insurance reimbursement.

Upon completion of this course, attendees will be able to -
• Review clinical guidelines that promote yoga as an intervention for care of cLBP
• Examine a framework of therapeutic yoga as wholistic healthcare for people with cLBP
• Appraise current research for cLBP that compares yoga to physical therapy.
• Outline the benefits of yoga for cLBP across domains of health: physical, mental, social and spiritual.

Pain is a complex response by an individual’s nervous system. Inputs to this response include information from the environment (social cues), the periphery (nociception), and the individual themself (cognitions). For over 20 years, pain scientists such as Louis Gifford, David Butler, Lorimere Mosley, Paul Hodges, Jo Nijs and Adriaan Louw have researched pain to better understand the physiology, or the neuroscience, of the response. Pain neuroscience provides the scientific framework for physical therapists to understand, on a physiologic level, what is happening when an individual experiences persistent pain. However, pain neuroscience research has uncovered the intimate role that a person’s beliefs and expectations have on the pain experience. Health behaviors such as sleep, nutrition and physical activity also affect a person’s pain. The difficulty for many physical therapists arises when we try to communicate the scientific findings to our patients while preserving the therapeutic alliance we have worked so hard to establish. How do we avoid “You are saying this is in my head.”?

This presentation will present a basic review of the neuroscience of persistent pain including the three mechanisms of pain, nociception, peripheral neuropathic and neurogenic, how to differentiate between the three and how to test for each. Pain catastrophizing is a powerful predictor of rehab outcomes and subjective pain reports. I will discuss the role of fear, fear avoidance and pain catastrophizing on the nervous system, and quickly review the Pain Catastrophization Scale (PCS). Then, I will offer scenarios where a clinician might utilize pain science education in their treatment session and what that conversation might sound like.

Upon completing the course, the attendee will be able to - 

• Describe how to identify the primary pain mechanism in a patient.
• Use the PCS as a tool to identify and measure a patient’s cognitions about their pain.
• Repeat demonstration of a conversation describing pain as an output of a sensitive nervous system to a patient.

Pain has become a hot topic in the physical therapy profession as the APTA has pushed the #ChoosePT campaign to promote physical therapists (PTs) and physical therapist assistants (PTAs) as front-line providers to deal with pain at multiple different stages. The problem with this initiative is that many PTs/PTAs do not feel confident, or at times comfortable discussing pain with their patients. While it is important to understand the science behind the pain experience, including identifying different types of pain; what is equally important is translating that knowledge into the clinic.

This course is designed to better clinicians' understanding of what pain is, including the understanding that it is an output produced by the pain (an emotion) rather than a sensation. This course is further designed to help providers understand the importance of discussing pain with their patients related to outcomes, as well as understand how to discuss pain with their patients using clinical examples that the patients can understand.

Upon completion of the course, the attendee will:

1. Understand what pain is, how it is produced, and different types of pain which can be experienced.
2. Understand the effects our words have on patient outcomes related to pain including the Role of Placebo and Nocebo effects when discussing pain with our patients.
3. Understand research regarding patient perception and role of education on pain management.
4. Learn clinical examples to be utilized with patients to strengthen efficacy of pain education.