Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study

Abstract

Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients' reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.

The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program

“…It appeared that a biomedical focus was tenacious and that any shift in beliefs was vulnerable to being contradicted and undermined by other health professionals. This finding is supported by previous qualitative research following pain science education, where varying degrees of reconceptualization were observed, from zero to almost complete [ 56 ]. While face-to-face interviews may have increased the depth of the responses, and these results highlight the need for future quality improvement innovations in pain management to develop more effective and convincing ways of delivering this important message.…”

Patients’ experiences of the BetterBack model of care for low back pain in primary care – a qualitative interview study

“…However, participation in group sessions could also be experienced as negative, because of fear that their pain might be reinforced if they listened to other people's pain stories. King et al (King et al, 2018) found that patients with chronic LBP showed varying levels of reconceptualization (≈ changes in beliefs about back pain) 3 weeks after receiving one session of group education. The degree of reconceptualization was influenced by the patients' previous beliefs and the estimated relevance of the information, and was related to the perceived benefit, and patients without perceived benefit did not change their perceptions.…”

“…The degree of reconceptualization was influenced by the patients' previous beliefs and the estimated relevance of the information, and was related to the perceived benefit, and patients without perceived benefit did not change their perceptions. King et al (King et al, 2018) suggest that having more sessions and combining the education with other interventions may improve the benefits. Translated into CSM terminology, group education may heighten the possibility for patients to reflect upon and influence illness and treatment beliefs, and content of personalized condition-specific action plans.…”

“…Due to high appreciation by the participants in the current study and potentially lower health care costs, group exercise should be offered to all patients with moderate-high risk of prolonged LBP activity limitations. However, patient preferences should also be taken into consideration (King et al, 2018;O'keeffe et al, 2017;Slade et al, 2009) because some participants wanted to do exercises at home and some could not attend the group sessions, e.g., due to working hours. As exercise may work via multiple mechanisms, future studies should also include analysis to better understand which patients respond best to individual or group exercise.…”

Knowledge of Pain Neurophysiology Among Physiotherapists Practising in Saudi Arabia

“…Like cognitive behavioural therapy, this technique aims to change patients' inappropriate beliefs and consequent behaviours (King, 2018). However, to properly guide patients in pain management, health professionals must themselves have a basic knowledge of pain neuroscience Nijs et al, 2013;Adillón et al, 2015;Alodaibi et al, 2018).…”