An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs

A scoping review to explore the use of the Health Care Providers' Pain and Impairment Relationship Scale

OBJECTIVES

Patients' interactions with health care providers influence back pain-related outcomes. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) is an instrument that assesses providers' attitudes and beliefs about patients with persistent back pain, with lower scores implying that persistent pain does not indicate disability or limitation of activities. This scoping review aims to explore the extent of research involving the HC-PAIRS.

LITERATURE SURVEY

PubMed, Embase, and PEDro databases were searched from inception to April 2022.

METHODS

Extracted HC-PAIRS scores were standardized to 15-item scores and categorized by profession, student or professional status, and pre/post-educational intervention to evaluate scores. Psychometric properties and educational interventions of the HC-PAIRS were described.

RESULTS

After screening, 51 studies representing 10,416 participants were included. Student and professional scores were investigated in 24 and 29 studies, respectively. Twenty-one studies included educational interventions, with heterogenous follow-up. Psychometric properties of the HC-PAIRS were assessed in 10 studies and demonstrated acceptable reliability and validity. The overall baseline mean score among all participants was 55.34 (95% CI: 53.54-57.14) (students: 56.54 [56.54-60.87]; professionals: 51.67 [49.08-54.27]). Nurses (61.99 [55.66-68.31]) and non-health care professionals (65.30 [57.33-73.28]) had the highest overall baseline mean scores, whereas chiropractors (51.69 [33.73-69.66]), MDs/PAs (52.64 [47.27-58.00]), physical therapists (53.42 [50.67-56.17]), and exercise professionals (57.36 [49.39-65.33]) had lower scores.

CONCLUSIONS

The HC-PAIRS has been used across many disciplines in both students and professionals and demonstrated acceptable reliability and validity. Professionals commonly treating back pain had lower HC-PAIRS scores. Future research could benefit from standardization of interventions and timing of follow-up assessments.

What do Finnish physiotherapists and physiotherapy students know about the neurophysiology of pain? The Finnish version of the revised Neurophysiology of Pain Questionnaire

BACKGROUND

Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge.

OBJECTIVES

The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups.

METHODS

Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1).

RESULTS

Cronbach's alpha was 0.44 and ICC was 0.70 (p < .001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores.

CONCLUSIONS

The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged.

Assessment of back pain behaviors, attitudes, and beliefs of chiropractic research conference attendees after a biopsychosocial educational workshop

OBJECTIVE

The purpose of this study was to assess the behaviors, attitudes, and beliefs of attendees of a chiropractic research conference (which included chiropractic students, clinicians, researchers, and educators) toward chronic low back pain (CLBP) before and after a biopsychosocial (BPS)-based CLBP educational workshop.

METHODS

This single-arm intervention study used the Health Care Providers' Pain and Relationship Scale (HC-PAIRS) and CLBP-related clinic vignettes to assess behaviors, attitudes, and beliefs toward CLBP before and after a single 90-minute educational workshop. The HC-PAIRS is a self-reporting questionnaire that consists of 15 items rated on a 7-point rating scale, with a higher score suggesting a belief that pain is linked to movement and that recommendations should be given to avoid physical activities.

RESULTS

The pre-education intervention HC-PAIRS and vignettes were completed by 40 of 56 attendees. A total of 18 participants completed the posteducation intervention HC-PAIRS and CLBP-related clinical vignettes. Most of participants identified as full-time clinicians, employees of the United States Department of Veterans Affairs, and musculoskeletal/neuromusculoskeletal providers. The pre-education intervention HC-PAIRS mean score was 44.8 (SD 9.22), and the postscore was 39.5 (SD 6.49).

CONCLUSION

Findings suggest an immediate change in HC-PAIRS scores following a BPS-focused CLBP education intervention for a chiropractic audience. However, due to limitations related to sample size and target population, findings should be interpreted cautiously.

Toward sleep health as a focus of physical therapy practice: one lecture can positively impact sleep knowledge and beliefs in entry-level students

BACKGROUND

Challenges to integrating health promotion including sleep health into entry-level physical therapist curricula include lack of faculty expertise, time, and support. A lecture provided by a content expert may mitigate such challenges. The purpose of this study was to determine if a sleep education session impacts Doctor of Physical Therapy students' knowledge and beliefs about sleep.

METHODS

Faculty shared the opportunity to participate in the study 1-3 days prior to the remotely-provided lecture including sleep health assessment and interventions. The survey included demographics, a sleep health knowledge question, 11 questions on "What I think about sleep as a professional", and the 20-item Sleep Beliefs Scale. McNemar's and paired sample t-tests determined change in knowledge and beliefs.

RESULTS

209 individuals (70% female, 86% Caucasian, 25.5 ± 3.4 years old) completed the pre-lecture survey, and 137 individuals completed the post-lecture survey. There was an increase in knowledge about sleep health (p < .001) and change in Sleep Beliefs Scales score (p < .001).

CONCLUSIONS

A single remotely provided sleep education session increased DPT students' knowledge and changed their beliefs about sleep. Future studies should determine if these positive beliefs about sleep translate into clinical practice and enhance patient outcomes.

Association of pain neurophysiology knowledge and application amongst UK chiropractic students: A cross-sectional study

OBJECTIVE

To investigate if chiropractic placement students in the United Kingdom are aware of current pain evidence and how they relate this to the management of chronic pain patients. Moreover, to gain an understanding of how this can lead to improved pain education planning and engagement in the future.

METHODS

The revised Neurophysiology of Pain Questionnaire and the researchers' own questionnaire were administered online to chiropractic placement students. The aggregated total number of correct responses and the individual mean scores were calculated. Statistical analysis included tests of normality and difference using the Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Χ2 tests.

RESULTS

There was an overall response rate of 21.6% (n = 50). The mean score achieved on the revised neurophysiology of pain questionnaire was 37.8%. A significant difference between individual mean scores on the revised Neurophysiology of Pain Questionnaire was observed between male and female participants. No differences in mean score were observed between age, number of chronic pain patients seen, and previous qualifications. For the study-specific questionnaire, statistically significant differences were found in mean score for previous qualifications, number of patients seen, and sex.

CONCLUSION

Chiropractic placement students in the United Kingdom appear to have a lower level of pain knowledge than other health care professionals and education institutions may wish to consider how to best address this within their curricula.

Pain Neuroscience Education in Elementary and Middle Schools

PURPOSE

The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs.

METHODS

Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain Questionnaire and the Health Care Provider's Pain and Impairment Relationship Scale were administered before and after the PNE lecture.

RESULTS

All grades improved in pain knowledge and beliefs. Higher-grade school participants (sixth to eighth grades) experienced larger shifts in pain knowledge and attitudes and beliefs than lower-grade (third to fifth grades) participants.

CONCLUSION

PNE results in changes in pain knowledge and beliefs in school participants in grades 3 to 8.

The Effect of a Pain Educational Video Upon Child Pain-Related Memory and the Moderating Role of Parental Pain- and Non-Pain-Attending Verbalizations: An Experimental Lab-Based Study

OBJECTIVES

Early memories of pain contribute to fear and may underlie the maintenance and development of chronic pain into adulthood. Accordingly, understanding determinants that may impact children's pain memory development is key. This study examined (a) the effect of a brief engaging pain educational video in healthy children before undergoing an experimental pain task upon children's recalled pain intensity and pain-related fear and (b) the moderating role of parental pain- and non-pain-attending verbalizations before and after the pain task.

METHODS

Seventy-seven children (8-15 years old) participated in an experimental heat pain task, including actual heat pain stimuli delivered through a thermode on their forearm. Children were randomized to the experimental group (i.e., watching a pain educational video) or the control group (i.e., no video). Children's recalled pain intensity and pain-related fear were elicited 2 weeks later.

RESULTS

Findings showed that recalled pain intensity (but not recalled pain-related fear) of children who watched the pain educational video was significantly lower compared to the control group (p = .028). Further, parental pain-attending verbalizations before the pain task moderated the impact of the video upon children's recalled pain intensity (p = .038). Specifically, children in the control group, but not the experimental group, whose parents used less pain-attending verbalizations recalled higher pain intensity, whereas children whose parents used more pain-attending verbalizations recalled lower pain intensity.

CONCLUSIONS

As children's pain memories have important implications for pain assessment, treatment, and health across the lifespan, these findings might have important implications for the prevention of development or maintenance of maladaptive pain-related outcomes.

Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial

ABSTRACT

Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.

The impact of pain neuroscience education in a Hispanic-American population: A mixed-methods exploratory study

BACKGROUND

Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown.

PURPOSE

Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture.

METHODS

Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus.

RESULTS

R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility.

CONCLUSION

While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.

Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial

BACKGROUND

Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]).

OBJECTIVE

To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients.

METHOD

A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants.

RESULTS

No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001).

CONCLUSION

Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.

Hand therapists' knowledge and practice-related beliefs about pain science: A survey study

INTRODUCTION

Identifying hand therapists' knowledge and beliefs about pain can illuminate familiarity with modern pain science within hand therapy.

PURPOSE OF THE STUDY

The primary aim was to identify hand therapists' knowledge of pain neurophysiology. Secondary purposes were to explore demographic variation in knowledge, describe practice-related beliefs about pain science, and explore associations between knowledge and beliefs.

STUDY DESIGN

Cross-sectional descriptive survey study.

METHODS

An electronic survey, including the Revised Neurophysiology of Pain Questionnaire (R-NPQ) and Likert-type questions about practice-related beliefs, was distributed to American Society of Hand Therapists members.

RESULTS

Data from 305 survey responses were analyzed. R-NPQ accuracy ranged from 42% to 100%, with a mean of 75% (9/12 ± 1.5). Certified hand therapists scored, on average, 0.8 points lower than their noncertified peers. Participants with a doctoral degree scored 0.7 or 0.6 points higher, respectively, than those with a bachelor's or master's degree. Objective knowledge of pain neurophysiology was positively associated with perceived knowledge of pain science (ρ = .31, P < .001). Associations between R-NPQ and perceived importance of knowing pain science; confidence in pain-related evaluation, treatment, and education; and frequency of incorporating pain science principles into practice were small but statistically significant (ρ = .12-.25, P = <.001-.04).

CONCLUSIONS

Although hand therapists recognized the importance of knowing pain science, they had objective and subjective limitations in that knowledge. Specific errors in their R-NPQ responses suggest misconceptions related to the modern differentiation between nociception and pain. Blurring of these constructs may relate to participants' self-reported practice emphasis on acute versus chronic conditions. Future studies should explore knowledge, attitudes, and beliefs about pain beyond R-NPQ scores to understand variation in practice and training needs.

Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia

To ensure the effective management of patients’ pain, it is important that physiotherapists have a good understanding of the neuroscience behind pain. A major barrier to adequate pain management is that, for patients, there is limited access to clinicians who are knowledgeable about pain. This study examined the level of knowledge regarding pain neurophysiology among physiotherapists currently practicing in Saudi Arabia. Method: The study was a cross-sectional web-based survey that utilized the 12-item Revised Neurophysiology of Pain Questionnaire. Descriptive and inferential statistics were used to describe levels of knowledge regarding pain neurophysiology and to examine differences in knowledge based on the characteristics of the participating physiotherapists (gender, educational level, experience, practice region, and country where their highest educational level was attained). Results: One hundred and eleven physiotherapists (58.6% male) from various regions and educational backgrounds participated in the study. Out of a maximum Revised Neurophysiology of Pain Questionnaire score of 12, the mean ± standard deviation (SD) was 6.7 ± 2.2; 90% of physiotherapists scored 9 (75%) or less. None of the examined characteristics of the participants were associated with knowledge. Conclusion: Physiotherapists in Saudi Arabia showed limited knowledge of the neurophysiology of pain; however, this was not related to the personal characteristics that were examined. The continuation of education in modern pain science is recommended for physiotherapists, especially those dealing with patients suffering from chronic pain. Clinical Relevance: The physiotherapists who took part in this study displayed limited knowledge of pain neuroscience; this limited knowledge might suggest the need for a more bio-anatomical approach to pain management. There is a need for tailored medical education to address pain neuroscience knowledge in current physiotherapist practitioners.

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study

BACKGROUND

Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce.

METHODS

This study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e. experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children's demographic (i.e. sex and age) and psychological (i.e. baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (M_age  = 11.85, SD = 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e. experimental group) or to a control condition whereby they did not watch any video.

RESULTS

Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison with the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only.

CONCLUSIONS

Further investigation is needed to optimize pain educational video interventions and to determine whether more beneficial outcomes can be found in clinical (i.e. non-experimental) situations and in children with persistent or recurring pain problems.

SIGNIFICANCE

Examining the impact of pain educational interventions within a non-clinical setting is deemed particularly important given that adaptive pain coping strategies likely play an important role in preventing the development and maintenance of future maladaptive pain-related behaviour. Further, study findings provide preliminary evidence of baseline and demographic (i.e. age and sex) characteristics explaining differences in the effect of a pain educational video intervention in pain knowledge and pain-related experiences during experimental pain.

Knowledge and attitudes toward musculoskeletal pain neuroscience of manual therapy postgraduate students in the Netherlands

BACKGROUND

Health care practitioners' knowledge and attitudes influence patients' beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain.

OBJECTIVES

The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students.

DESIGN

A cross-sectional study.

METHOD

Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1<2 < 3). A two factor ANOVA was used to determine the interaction effect of focused pain education and year in the curriculum with KNAP.

RESULTS

There was an overall significant difference of KNAP scores with a medium effect size (F(3, 218.18) = 13.56, p < .001, ω² = 0.059). Differences between years ranged from small to medium. Interaction effect of knowledge and attitudes and focused pain education was significant with a small effect size (F(6) = 2.597, p = .017, ω² = 0.012). Sensitivity analyses were consistent with the main results.

CONCLUSIONS

Positive differences in knowledge and attitudes toward pain neuroscience in MT students occur between the progressing years of the curriculum. Differences may be related to the provision of focused pain education.

Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students?

BACKGROUND

To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain.

METHODS

This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation.

RESULTS

Our analysis included data from 156 participants (mean age: 20.9 ± 2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p = 0.00; η ²  = 0.654), for PABS-PT factor 1(p < 0.001; η2 = 0.50) and for PABS-PT factor 2 over time (p = 0.02; η ²  = 0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.

Pain knowledge, attitudes and beliefs of doctor of physical therapy students: changes across the curriculum and the role of an elective pain science course

Introduction: Entry-level physical therapist education on pain has been described as lacking. Calls have been made to include pain science courses to address this knowledge gap.Methods: Physical therapist students' pain knowledge and attitudes were measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), respectively. Univariate ANOVAs, with post hoc pairwise comparison and effect sizes, were used to measure these aspects over time.Results: Pain knowledge and clinician beliefs were significantly different (p < 0.001) at various curricular timepoints. rNPQ scores increased from 1^st to 2^nd year (effect size: 1.10), remained similar between years 2 and 3, and improved following the pain course (effect size: 1.25). Biomedical beliefs were similar during years 1, 2 and 3, and declined following the pain course (effect size: 1.56). Conversely, psychosocial belief scores increased from 1^st to 2^nd year (effect size: 0.82), remained similar between years 2 and 3, and increased following the pain course (effect size: 1.08).Discussion/Conclusions: Physical therapist education, without a dedicated pain science course, may be insufficiently preparing students to treat patients in pain. Educators should consider adopting a dedicated pain science course or substantially bolstering embedded curricular pain content to promote best practice in pain treatment.

The effect of pain neurophysiology education on healthcare students' knowledge, attitudes and behaviours towards pain: A mixed-methods randomised controlled trial

OBJECTIVE

1) To investigate the effects of a brief pain neuroscience education (PNE) lecture on multi-disciplinary healthcare students' knowledge, attitudes and behaviours towards people with pain post intervention and at 6-months follow-up, 2) To explore students' perceptions of PNE.

DESIGN

Mixed-methods randomized controlled trial.

SETTING

UK university.

PARTICIPANTS

Thirty-seven students (30♀, mean age 30 years) from six healthcare disciplines.

INTERVENTION

70-min PNE lecture (intervention group) or a 70-min control education.

MAIN OUTCOME MEASURES

1) Knowledge: The Revised Pain Neurophysiology Quiz (RPNQ); 2) Attitudes: Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS); 3) Behaviours: A case vignette to assess clinical recommendations; and 4) Thematic analysis of semi-structured interviews (n = 12).

RESULTS

The intervention group increased knowledge compared to the control, post-intervention [mean difference 3.7 (95% CI, 2.4, 5.0), P < 0.001] but not at 6-months (0.1 (-1.1, 1.3), P = 0.860). Greater improvements in attitudes for the intervention group were seen post-intervention [-10.4 (-16.3, -4.6), P < 0.001] and at 6-months [-5.8 (-11.5, -0.2), P < 0.044]. There was no difference in behaviours between groups. Thematic analysis identified increased patient empathy, partial and patchy reconceptualisation of pain and increased confidence in recommending an active management programme following PNE.

CONCLUSION

This study adds to existing knowledge by demonstrating that a 70-min PNE lecture can have a short-term effect on knowledge and positively shift attitudes towards people with pain in the short and medium-term. It also resulted in some students' reconceptualisation of pain, increased empathy, and confidence to recommend activity. The effect of PNE on clinical behaviours was unclear.

The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial

OBJECTIVES

The aim of this study was to investigate the short- and mid-term effects of pain neuroscience education (PNE) combined with manual therapy (MT) and a home exercise program (HEP) on pain intensity, back performance, disability, and kinesiophobia in patients with chronic low back pain (CLBP). Methods: This study was designed as a prospective, randomized, controlled, single-blind study in which 69 participants were randomly assigned to three groups. Participants in Group 1 received PNE, MT, and the HEP, while Group 2 received MT and the HEP. Participants in the control group did the HEP only. All interventions lasted 4 weeks. The participants' pain intensity, disability, low back performance, and kinesiophobia were assessed. All assessments were executed before intervention, at 4 weeks, and at 12 weeks post-intervention by the same blinded physiotherapist. A mixed model for repeated measures was used for each outcome measure. Results: Analysis of pain level (p < .05), back performance (p < .05), disability (p < .05) and kinesiophobia (p < .05) revealed significant time, group, and time-by-group interaction effects. The participants in Group 1 exhibited greater improvement in terms of pain intensity and kinesiophobia compared to the participants in Group 2 and the control group. Level of disability was significantly decreased in both Group 1 and Group 2 compared to the control group. Conclusion: This study suggests that a multimodal treatment program combining PNE, MT, and HEP is an effective method for improving back performance and reducing pain, disability, and kinesiophobia in the short (4 weeks) and midterm (12 weeks).

Pain knowledge, attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession

BACKGROUND

Pain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines.

OBJECTIVES

Evaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables.

METHOD

Australian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp).

RESULTS

Complete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = -0.45, p < 0.01).

CONCLUSIONS

Australian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.

Evaluation of pain knowledge and attitudes and beliefs from a pre-licensure physical therapy curriculum and a stand-alone pain elective

BACKGROUND

Adequate pain education of health professionals is fundamental in the management of pain. Although an interprofessional consensus of core competencies for health professional pre-licensure education in pain have been established, the degree of their incorporation into physical therapy curriculum varies greatly. The purpose of this study was to 1. Assess students' pain knowledge and their attitudes and beliefs in a pre-licensure physical therapy curriculum using a cross sectional comparison, and 2. Using a sub-sample of this population, we evaluated if an elective course on pain based on International Association for the Study of Pain (IASP) guidelines had an effect on students' knowledge and beliefs.

METHODS

The Neurophysiology of Pain Questionnaire (NPQ) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) was completed by first semester (n = 72) and final (n = 56) semester doctor of physical therapy (DPT) students. Final semester students completed surveys before and after participation in an elective course of their choosing (pain elective (PE) or other electives (OE)).

RESULTS

Participation rate was > 90% (n = 128/140). We found mean differences in NPQ scores between final semester (3rd year) students (76.9%) compared to first semester students (64%), p < 0.001. Third year students showed a mean difference on PABS-PT subscales, showing decreased biomedical (p < 0.001) and increased biopsychosocial (p = 0.005) scores compared to first semester students. Only final semester students that participated in the PE improved their NPQ scores (from 79 to 86%, p < 0.001) and demonstrated a significant change in the expected direction on PABS-PT subscales with increased biopsychosocial (p = 0.003) and decreased biological scores (p < 0.001).

CONCLUSIONS

We suggest that although core pre-licensure DPT education improves students' pain knowledge and changes their attitudes towards pain, taking a IASP based pain elective continues to improve their pain neurobiology knowledge and also further changes their attitudes and beliefs towards pain. Therefore, a stand-alone course on pain in addition to pain concepts threaded throughout the curriculum may help ensure that entry-level DPT students are better prepared to effectively work with patients with pain.

The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial

BACKGROUND

Chronic spinal pain affects many in the United States and is associated with rising healthcare costs - but not improved outcomes. Education and self-care promotion are hallmarks of the recommended approach for this condition. Pain Neuroscience Education (PNE) is a method of educating patients about the neurophysiology of pain that aims to reconceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system. PNE has shown efficacy in controlled situations when delivered by experts, but its effectiveness has not been investigated among trained clinicians in a pragmatic setting.

METHODS

A cluster randomized trial will randomly assign 16 clinic regions to either receive PNE training or continue with usual care. Patients with chronic neck or back pain will be enrolled to provide outcome data. Measures will be collected at baseline, 2 weeks, and 12 weeks. The primary outcome will be the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer-adapted test (PF-CAT). Pre-specified statistical analyses will compare outcomes between clinic regions assigned to PNE treatment or usual care while using random effects to account for region-level clustering.

DISCUSSION

Pain Neuroscience Education has been shown efficacious for a variety of patient-centered outcomes for those with chronic pain, but it has not yet been investigated outside of controlled settings. This trial has the potential to promote PNE as a low-cost intervention for chronic spinal pain and affect physical therapy education.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03168165 , registered May 30, 2017.

Changes in pain knowledge, attitudes and beliefs of osteopathy students after completing a clinically focused pain education module

Background

Chronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions.

The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS).

Methods

A pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module.

Results

Learners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = − 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = − 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS.

Conclusions

There was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge.

Electronic supplementary material

The online version of this article (10.1186/s12998-018-0212-0) contains supplementary material, which is available to authorized users.

Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study

BACKGROUND

Pain is a leading cause of disability and accounts for many hospital and physical therapy visits. Current pain science understanding has evolved and changed substantially in the past 20 years; however, university health science curricula may not have progressed at the same rate. This study aimed to examine knowledge about pain neurophysiology among physical therapy students in Saudi Arabia, and to compare their knowledge across different education levels and by gender.

METHODS

A cross-sectional study conducted to examine the pain neurophysiology knowledge among college physical therapy students in Saudi Arabia. The Revised Neurophysiology of Pain Questionnaire (12 items) was used. Descriptive statistics including frequencies and percentages were used to describe the sample. Analysis of variance and t-test were also used to examine the significant differences between scores.

RESULTS

Physical therapy students (n = 202) from 18 different universities in Saudi Arabia participated in this study. The mean score of the participants on the questionnaire was 6.20 ± 2.07 (i.e., 52% ± 17%) and there was no significance difference between males and females. There was a statistically significant incremental increase in total score through the educational process (P < 0.05); however, this increase was very small comparing early- and final educational-level students (8% in RNPQ).

CONCLUSION

While final year physical therapy students showed higher levels of pain science knowledge than those at the beginning of their course, the magnitude of the difference was small and likely of little meaningful relevance. This may reflect the need for more emphasis on pain science in the physical therapy curriculum in Saudi Arabia.

Physiotherapy pain curricula in Finland: a faculty survey

Background and aims

Despite the recognition of pain as a global health problem and advancements achieved in what is known about effective pain management, pain education for undergraduate health care professionals remains insufficient. This study investigated the content of pain curricula and the time allocated to pain education on physiotherapy programs at bachelor’s level at Universities of Applied Sciences (UASs) in Finland.

Methods

A web-based survey questionnaire was sent to the directors of the physiotherapy programs at all the Finnish UASs (n=15) where physiotherapy is taught at bachelor’s level. The questionnaire consisted of 14 questions covering basic concepts and the science of pain, pain assessment, pain management, and the adequacy of pain curricula. Each UAS completed one questionnaire i.e. returned one official opinion.

Results

The response rate was 80% (n=12). The mean for the total number of contact hours of pain education was 74 (standard deviation 34.2). All UASs had integrated pain education. In addition to this 42% (n=5) of the UASs had a separate pain course. The UASs offering such a course over and above the integrated pain education had twice the amount of pain content education compared to those UASs that only had integrated pain education (mean 103 h vs. 53 h, p=0.0043). Most of the education was devoted to conditions where pain is commonly a feature, manual therapy, and electrical agents for pain control. The biopsychosocial model of pain, cognitive behavioral methods of pain management, physician management, and multidisciplinary management were the least covered topics. Five UASs (42%) payed attention to the International Association for the Study of Pain curriculum outline and only 33% (n=4) considered their pain education to be sufficient.

Conclusions

Our results indicate that more contact hours are devoted to pain education on the Finnish UASs’ physiotherapy programs at bachelor’s level, than has previously been reported in faculty surveys. A separate pain course is one way to ensure a sufficient amount of pain education. Overall, despite a sufficient time devoted to pain education, some essential pain contents were inadequately covered.

Implications

The study contributes information on how pain education can be organized on physiotherapy programs at undergraduate level. Besides a sufficient amount of pain education, which can be ensured by a separate pain course, attention should be paid to pain education content being up-to-date. This could help in estimating the different proportions of pain content needed in educational settings. Efforts should also be made at keeping integrated pain education well-coordinated and purposeful. There is a need for further research estimating the effectiveness of pain education according to the different ways in which it is organized. There is also a need to investigate whether more hours allocated to pain education results in better understanding and professional skills.

A clinical perspective on a pain neuroscience education approach to manual therapy

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.