Pain Science:

How to talk to your patients

when they are hurting
PHIL WATSON 07.06.2016

Introduction

Objectives

A Brief History of Pain

Discuss central and peripheral sensitisation

Discuss the role of pain medication and sites of action

Discuss how do we explain pain to our patients?

Discuss the concepts of pacing, thought viruses, taking control

Discuss why language we use can positively or negatively affect

clinical outcomes

A Brief History of Pain

1664 Descartes Model

1965 Melzack and Wall Gate Control Theory

A History of Pain

1996 Melzack
Neuromatrix Theory

2016 Current
Neuroscience

The Pain Experience

Areas of the brain in pain experience

Central Sensitisation
Allodynia (Pain
resulting from non
painful stimulus)
Hyperalgesia
(Excessive sensitivity
to painful stimulus)
Resulting
kinesiophobia

Peripheral Sensitisation
Increased blood
flow
Increased
inflammatory
mediators
Increased immune
response
Stimulation of
initial tissue
healing

Pain Medications
and Endogenous
Opioids
Pain Meds

Synthetic Opioids

NSAIDs

Analgesics

Endogenous Opioids

Endorphins

Enkephalins

Dynorphins

Endomorphins

How do we explain pain to

patients?
Highly

efficient alarm system designed to protect you

Reduce

fear: Explain pain does not always damage

Pain = Danger and threat, based on experience

A

communication between the mind and the body to

safely protect you from imminent threat or potential
of further damage

How language can affect outcome

+ve Non Verbal:

Relaxed, confident, open body posture

Calm environment

Warmth in smile

Firm but not intimidating/aggressive handshake

+ve Verbal:

Positive reassurance

Using words they can understand, checking understanding

Paraphrasing or Summarising

Empathy

How language can affect outcome

-ve Non Verbal

Closed Posture

Showing disinterest, lack of eye contact

Bulging red anatomical disc models

-ve Verbal

Thats the worst back Ive seen

Your X-ray shows degenerative changes

Medical jargon Arthritis, Ankylosing

Spondlylitis

Advise more what not to do than what to do

Reinforcing beliefs: your spine is vulnerable

tighten your core to protect your back

Road to Recovery
Recognise fear avoidance,
catastrophizing, negative
thoughts & beliefs
Recognise lack of pacing, flare
up management
Develop patient understanding
of what they can do to self
manage and gain control
Visualise wellbeing, better
movement and function

Thought Viruses

Pacing

We can discuss with the patient the concept

of tissue tolerance before and after injury

After injury pain comes before tissue

tolerance to protect from further damage

Optimal load management and progressive

loading through appropriate exercise
improves tissue tolerance, restores function
and can release endorphins.

Traffic Light System for pacing, Green

means go!

Giving Back Control

Education to reduce fear
Patient centred goals
Reduce conflicting Information
Prognosis
Self management tools
Minimise clinician dependence

Protectometer

New app from the Noi Group (David Butler, Lorimer Moseley and
many more).

Self management of positive and negative thoughts, feelings,

events that influence pain exeperience

Final Thoughts
Reduce

fear = better clinical outcomes

Aid

self reflection on patients beliefs and thoughts of

their pain experience

Dont forget the bio in bio-psychosocial

References

Butler D, Moseley L. Explain Pain. Noigroup Publications (2013). 133 pages. ISBN: 978-0987342669

Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M (2013) The

enduring impact of what clinicians say to people with low back pain. The Annals of Family Medicine.

Han JS, Xie CW 1984. "Dynorphin: potent analgesic effect in spinal cord of the rat".Sci. Sin., Ser. B,
Chem. Biol. Agric. Med. Earth Sci.27(2): 16977.PMID6147015.

Louw A, Puentedura E. Therapeutic Neuroscience Education: Teaching Patients About Pain;

A Guide for Clinicians. International Spine and Pain Institute; 1st edition (2013). 304 pages. ISBN:
978-0985718640

Cupples Z. 2014. http://

www.themanualtherapist.com/2014/03/guest-post-therapeutic-neuroscience.html

Multiple authors https://en.wikipedia.org/wiki/History_of_pain_theory Wikipedia. Accessed 04.07.16

Moseley, L 2013. Why things hurt? Youtube video TEDxAdelaide. Noi Group https://
www.youtube.com/watch?v=gwd-wLdIHjs

Noi Group 2016. Youtube video Thought Viruses https://www.youtube.com/watch?v=7eQpRZxXv2g