Education, Behavior Change, Spaghetti and Bricks

The research continues to mount that drugs for persistent pain may not be a great option, while the evidence continues to support exercise and biopsychosocial care. So why is it so easy to prescribe meds and so difficult to follow an exercise program? Obviously this is a bit of a facetious question, but it does get to the heart of the problem.

For many of our patients the belief in popping the magic pill to fix their pain is strong compared to the reality of the work needed to exercise to potentially help their pain. Let’s face it, we live in a society here in the US that believes in the power of the pill (that is why 80% of the consumption of prescription pain pills comes from the US). Even though the use of these drugs are killing us, it doesn’t seem to be slowing down consumption. Match that with understanding that the lack of physical activity is also killing us, which doesn’t’ seem to be improving our exercise habits.

If just educating patients was enough, you would think that the warnings on cigarettes would be enough to change people’s behavior.

If Physical Therapy wants to transform society, this may be one of the bigger areas we can make a difference by changing the behavior our patients from taking pills to taking walks. Unfortunately, behavior change is no simple task. Bill Fordyce, who I talked about previously, was known to say: “Education is to behavior change as spaghetti is to bricks.” If just educating patients was enough, you would think that the warnings on cigarettes would be enough to change people’s behavior.

So if education doesn’t change behavior, and pain is about behavior, how does education help with pain? Those that view pain neuroscience education (PNE) as ONLY educating patients about pain would be correct in saying PNE is NOT going to help with pain reduction. This is actually what our recent Systematic Review (in press) found. Of the 5 RCTs that used only PNE, none of them had reductions in pain for the subjects. Of the 6 RCT’s that included physical treatment with PNE, five of them found reductions in pain for the subjects. In research we control variables to answer questions, so we provide PNE without physical treatments. Hopefully clinically no one is providing PNE without physical treatments also. So what does the PNE do then?

Simply put, PNE helps people exercise despite the pain. By providing a new context for the patients to see that their pain is due to a sensitive nervous system and not tissue damage is one of the primary keys to successful delivery of PNE. When patients can come to understand that pain and injury are not the same thing, the potential of them following exercise programs becomes greater. If you want more on this you need to read this paper by Meeus, Nijs and colleagues. (If you thought that paper was good and want to hear Jo Nijs in person then you need to come to the ISPI Clinical Conference this summer).

Okay your turn: – What say you?

Via Dr. Kory Zimney

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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