chronic-painStrong evidence supports the use of a chronic pain education program for treatment of pain and dysfunction in the chronic pain population. A systematic review conducted by Mr. Adrian Louw and colleagues found results that demonstrate that “for chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing the neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization and physical performance.”1

Our Chronic Pain Education Program runs for four weeks, with the small group sessions being led by a Registered Physiotherapist and a Registered Occupational Therapist. Content includes: physiology of the nervous system including a focus on nociception/pain pathways; nervous system sensitization (peripheral and central); “Hurt vs Harm” (i.e. explanation of the poor causal relationship between tissue damage and pain); graded activity exposure; relaxation and mindfulness techniques and physiological rationale; the role of stress in perpetuating a pain state; self-talk; activity-planning; and proper sleep hygiene.

Educational materials will be presented via power-point presentations, illustrations, handouts, and discussion amongst therapists and patients. Patients will be given small amounts of homework to complete between education sessions, including activity logs, sleep hygiene logs, and questionnaires, in order to implement learned material in a practical manner. Patients will be provided with a booklet of these and other materials during the first education session.

The goals of the program are as follows:
  1. Participants will develop a sound knowledge and understanding of the nature, mechanisms and neurophysiology of chronic pain.
  2. Participants will become aware of chronic pain management techniques and will be provided with resources that they can pursue in more depth post-program, as required, with their treating therapist and/or other resources.
Please contact the clinic at (905) 777-9838 to schedule an appointment with the program Physiotherapist or Occupational Therapist to discuss participation in the Chronic Pain Education Program. 


Evidenced-Based Intervention for Chronic Pain

Below are references supporting Therapeutic Pain Neurophysiology Education for chronic musculoskeletal injuries:

1) Louw A, Diener I, Butler DS, Puentedra EJ. The effet of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil 2011; 92:2042-56.

Systematic Review to evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain. This review includes 8 studies comprising 6 high-quality RCTs, 1 pseudo-RCT, and 1 comparative study involving 401 subjects. Most articles were of good quality, with no studies rated as poor or fair. Results demonstrate that “for chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.”

2) Moseley GL, Hodges PW, Nicholas MK. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 2004;20:324-30.

Blinded Randomized Control Trial with subjects assigned to one of two groups: 1) Education on neurophysiology of pain and central sensitization etc.; 2) Education on back pain and anatomy. The findings support that “education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.”

3) Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehabil 2010; 91:1153-9.

 A Double blind randomized control trail with patients assigned to one of two groups: 1) One individual pain physiology education session (experimental) or; 2) One pacing and self-management education session (control). Results support that “a 30-minute educational session on pain physiology imparts a better understanding of pain and brings about less rumination in the short term. Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain, given the clinical relevance of inappropriate pain cognitions.”

4) Gallagher L, McAuley J, Moseley GL. A randomized-controlled trial of using a book of metaphors to reconceptualise pain and decrease catastrophizing in people with chronic pain. Clin J Pain. 2013 Jan;29(1):20-5.

In this randomized single-blind partial cross-over controlled trial, 79 people with chronic pain received either a booklet of metaphors and stories conveying key pain biology concepts or a booklet containing advice on how to manage chronic pain according to established cognitive-behavioral principles. The primary outcome variables, pain biology knowledge and catastrophizing, were measured before randomization, at 3 weeks and at 3 months, at which time the control group was crossed over to receive the metaphors and stories booklet. Pain and disability were secondary outcome variables.

“We conclude that providing educational material through metaphor and story can assist patients to reconceptualize pain and reduce catastrophizing. Metaphor and story could be used as a precurser to other interventions that target functional capacity.”

5) Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy. 2002; 48:297-302.

Randomized Control Trial of 57 patients assigned to one of two groups: 1) combined physiotherapy with chronic pain education with focus on neurophysiology of pain; 2) control – ongoing management as recommended by their general practitioner. The findings “support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.”

Additional References to support the use of education in the management of chronic musculoskeletal pain:

6) Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, Paul L. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot stud. J Rehabil Res Dev 2011; 48(1):34-58.

7) Bruitenhuis J, de Jong PJ, Jaspers JP, Groothoof JW. Catastrophizing and causal beliefs in whiplash. Spine 2008; 33:2427-33.
8) Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000, 85:317–332.
9) Philips HC: Avoidance behaviour and its role in sustaining chronic pain. Behav Res Ther 1987, 25:273–279.
10) Vlaeuen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioural performance. Pain 1995; 62(3):363-72.
11) Ray CA, Carter JR. Central modulation of exercise-induced muscle pain in humans. J Physiol 2007; 585:287-294.
12) M.K. Nicholas, A. Asghari, M. Corbett, R.J. Smeets, B.M. Wood, S. Overton, C. Perry, L.E. Tonkin, L. Beeston. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? Eur J Pain 2012: 16: 93–104.