"How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain: Practice guidelines."

Nijs J, et al. (2011)  Manual Therapy  16(5):413-418.

Pelvic PT Distance Journal Club 3/5/14

Beth Shelly PT, DPT, WCS, BCB PMD

Prior to starting rehab

·         Correct maladaptive pain beliefs

·         Reconceptualize pain

·         Affect deep learning

·         Resulting in the perception that pain is less dangerous

RCT - short term pain education alone is more effective for pain relief and improving pain self-efficacy than pain education and group exercise for patients with chronic LBP (Ryan 2010)

Just handing the patient a booklet is not effective in changing beliefs, need to have individually tailored sessions, one on one in person or phone in patients with fibromyalgia. (Van Oosterwijck 2013)

First session

·         Acute versus chronic pain - how pain becomes chronic

·         Factors making chronic pain worse - stress, emotions, pain behavior

·         Centralized pain physiology

Between sessions patient reads book and takes pain test

Second session

·         Go over concepts the patient did not get the first time.

·         Test patient's understanding by asking patient to explain how it applies to them and encourage them to set new goals such as

o   Stopping rumination and worry about etiology and nature of pain

o   Reducing stress, relaxation

o   Increasing physical activity

o   Decrease hyper vigilance

Treatment to followed

·         Stress management

·         Graded activity and exercise

·         Ask the patient explain treatment rationale

·         Side effects and symptoms fluctuations can be explained using the CS model

·         Shift patients focus away from somatic signs toward adaptive coping strategies.

Several on the call note that they use this video to start the discussion and then discuss specifically with the patient aspects of the video.  https://www.youtube.com/watch?v=4b8oB757DKc

Great new resource Therapeutic neuroscience education teaching patients about pain by Louw and Puentedura. International spine and pain institute. 2013, available from OPTP.