State of the art: What have the pain sciences brought to physiotherapy?

Abstract

BackgroundPain is the most common reason for people to present for healthcare. The vast majority of patients treated by physiotherapists report pain, yet it is only in the past few decades that the scientific study of pain has yielded substantial progress in its treatment. The shift in focus -from studying tissue damage to studying pain itself -was arguably prompted by the recognition that the pain people report frequently does not match up with the condition of bodily tissue. Therefore, the assumption that pain reflects tissue state had to be reconsidered (Wall & McMahon 1986). Thus emerged the pain sciences -multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. This focus on the mechanisms underlying pain has required knowledge from diverse fields -including neurology, immunology, endocrinology, epigenetics, psychology and physiology -among others. It has catalysed a seismic shift in physiotherapy and changed the underpinnings of clinical reasoning, expanding and deepening clinical practice and student training, empowering patients, and has thereby influenced research practice. This ultimately has raised the profile of the physiotherapy profession by contributing to its shifting from its origins as a profession that was reliant on expert opinion to a profession that now relies on scientific evidence. Key concepts that have shifted our understanding of painScientific research on pain has largely converged in support of three 'game-changing' concepts that have fundamentally shifted physiotherapists' understanding and treatment of pain (Box 1). The first game-changing concept is that pain is not a signal that originates from bodily tissues (Wall & McMahon 1986). Rather, pain is now thought to be a highly motivating perceptual experience that seems to be generated on the basis of a perceived need to protect bodily tissue from harm (Moseley 2007). The second game-changing concept is that pain is not a dependable indicator Background: Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences -multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain. Objectives:In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession.Method: A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession.Results: Scientific research on pain has largely converged in support of three 'game-changing' concepts that have shifted the physiotherapy profession's understanding and treatment of pain:(1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous syst...

Physiotherapy support for self-management of persisting musculoskeletal pain disorders

“…• the natural course of MSKP conditions (Foster & Delitto 2011;Lin et al 2020;Parker & Madden 2020) • the evidence-base for radiological imaging and the negative effect of unnecessary scanning (Lin et al 2020;Caneiro et al 2020) • the benefits of activity and exercise (Elbers et al 2018;Kjaer et al 2018;Lin et al 2020;Miller et al 2020;Skou & Roos 2017;Wade 2020).…”

“…Research on pain has largely converged in support of three concepts that have shifted the healthcare profession’s understanding and treatment of pain. Firstly, that pain is not a signal originating from bodily tissues; secondly, that pain is not an accurate measure of tissue injury; and thirdly, that the nervous system demonstrates plasticity, which then becomes a viable target of treatment (Parker & Madden 2020 ). Consistent recommendations for the management of persistent MSKP include, amongst others: patient-centred care; red flag and psychosocial factor screening; minimum radiological imaging; thorough first clinical examination; patient education; assessment and address of functional physical activity; and facilitating continuation or resumption of work (Lin et al 2020 ).…”

“…Therapists’ own beliefs about MSKP and the best management thereof plays an important role in the way a SM support programme is structured (Caneiro et al 2020 ). Healthcare providers therefore need to have knowledge of the current evidence-base of care for persistent pain (Lin et al 2020 ; Parker & Madden 2020 ). Also, they should strive to follow researched requirements to implement a successful SM support programme and facilitate adherence to the programme (Hutting et al 2020 ; Peek et al 2016 :127–135).…”

“…Screening for recommended psychosocial risk factors (aka yellow flags), which may be barriers to recovery has been researched abundantly in recent years. It has become apparent that these psychosocial risk factors, like fear of movement, anxiety, maladaptive beliefs, etc., may in many cases be the dominating factors associated with recovery in MSKP disorders, and need to be identified and addressed (Diener et al 2016 ; Foster & Delitto 2011 ; Lin et al 2020 ; Parker & Madden 2020 ). The role of vulnerability factors such as pain-related fear, catastrophising, and avoidance have been well-documented in the development and maintenance of chronic pain disability (Meulders 2019 ).…”

“…the natural course of MSKP conditions (Foster & Delitto 2011 ; Lin et al 2020 ; Parker & Madden 2020 )…”