How to introduce 'Pain science education' without the patient thinking 'it's all in my head'
As pelvic health physiotherapists, we regularly treat patients with chronic pelvic pain. From our early physio education we are hopefully familiar with the foundational concepts of ‘pain science education’ commonly known as "Explain Pain" (as per the famous book by David Butler and Lorimer Mosley).
Despite Phyios working in the space often having an excellent understanding of pain science education and how this is critical in recovery for some of our chronic pain clients, a recurring challenge remains: effectively communicating these principles to patients, particularly those who have come to develop a rigid set of beliefs around the source of their pain and problems without the patient walking away being made to feel ‘they think it’s all in my head’.
Understanding the Patient's Journey
It is not uncommon for patients with chronic pelvic pain to arrive at a physio’s door AFTER having undergone extensive medical treatments, including surgeries, medications, and other interventions to try and find and treat the source of their pain. They often hold a strong belief that their pain is solely rooted in physical or structural issues. When these interventions do not alleviate their pain, usually because they have developed sensitisation of the nervous system after having pain for so long, it can be incredibly frustrating and disheartening for both the patient and the healthcare provider.
The Delicate Task of Addressing Pain Beliefs
Introducing the concept of central sensitization and the brain's involvement in pain perception requires a nuanced approach which can be difficult to apply for both junior and experienced physiotherapists. And if we do it poorly, it is often the cause of the patient abandoning care and you losing the opportunity you had to help them.
When considering when and how to introduce pain science education to your clients, it can first be helpful to ask them some questions to gauge their understanding of their pain such as:
What do you think is happening?
Why do you think this is happening?
What do you think you need?
How do you think I can help you?
This can help you understand where their existing beliefs lie.
Before trying to introduce new education to the patient, which may challenge their beliefs, it is important to develop trust and rapport first. Acknowledge your client’s experience by validating their patient's pain and experiences. Acknowledge the physical aspects of their condition and the impact it has had on their life. It is important for you as the therapist to continue to affirm that their pain is real and valid, regardless of its origin.
From your questions, you might find that some patients already possess existing knowledge around the basics of pain and what helps their pain. Encourage their input and use this as a foundation to gradually introduce more complex ideas about pain processing.
Frame the education process with empathy. Explain that understanding the brain's role in pain is not about denying their physical suffering but about providing additional tools to manage and reduce their pain.
Encourage patients to see pain management as a collaborative process. Emphasize that addressing the nervous system's sensitivity is a complementary strategy to their previous treatments, not a replacement.
Emphasise the brain's ability to change and adapt (neuroplasticity). This can instill hope and empower patients to engage in therapeutic activities aimed at retraining the nervous system.
Empowering Patients Through Education
Ultimately, the goal of pain education is to empower patients with knowledge and strategies that can help them manage their pain more effectively. By approaching these conversations with empathy, respect, and a clear understanding of the patient's journey, we can help them see the potential for improvement and regain control over their lives.
If you are a patient looking for more resources and support in managing chronic pelvic pain, visitMelbourne Pregnancy and Pelvic Physio. Our experienced team is dedicated to providing comprehensive care and empowering patients through evidence-based treatments and education.