Does pain neuroscience education appear to work because it teaches patients to downplay their pain?

I've had the suspicion for a while that pain neuroscience education might belong in the category of interventions that appear to work because 1) they modify the patient's perception of their health, 2) the patient's perception of their health is used as measure of whether the intervention works. In theory this would allow an intervention to appear effective despite having no real effect on health.

The best example of such an intervention is the lightning process that explicitly tells patients they can achieve a cure if they believe and tell others that they have been cured.

PNE seems to contain similar elements. For example, PNE explicitly attempts to modify the patient's perception of pain.

https://www.physio-pedia.com/Pain_Neuroscience_Education_(PNE)

 

Especially during the afternoon, as the pain interference (my term for it) increases, instead of telling myself: oh woe is me, screw fibro, I remind myself to do what will lower my pain: capsaicin cream, or a hot bath, stretching, and taking a muscle relaxant, lying on a heating pad. Or all of them in a certain temporal order.

I don't think educating patients about central sensitization in the spinal cord and brain is going to be as helpful as finding ways to decrease pain levels. Pain is noxious.

Most pain programs (Beth Darnall, PhD at Stanford) propose that patients ignore (how is that possible?) their pain and just get on with their day and accomplish any task they have a mind to doing.

I find that simplistic and ridiculous.

 

[Tacky advertising jingle]: Thaaaat's the BPS method, folks!

The only explanation I can come up with is that they think chronic pain is on the level of general traffic noise, which you soon learn to tune out when you live right next to a busy road.

They forget that it's not really feasible to tune out fire engines, especially as they travel in twos and threes and use bullhorns as well as sirens. What are you supposed to do if your condition effectively means you live next to the national training centre for fire service drivers?

 

Can I stab someone in the abdomen with one skewer, and then stab them in the left kidney with another one? Both skewers need to be quite thick and driven in about 10 inches and wiggled about every minute or two? Then ask the person I've stabbed if they can just ignore the pain for the next 50 years? I would also need a few more skewers for occasional use in the back.

Anyone who believes that severe pain can be ignored is someone who simply has no experience of severe pain.

 

100%. Power asymmetry is so easy to abuse.

 

I had a lot of help with coping with pain from a very good physio.

However, a lot of the stuff we did involved me focusing on the pain before we worked out what to do about it.

She would get me to lie on her treatment table, I'd be asked to describe the pain and probably started with the generalized been driven over by a big, industrial rolling machine, beaten with wooden bat type answer. Not good enough, not be a long shot.

No. She explained to me I was shutting out the pain and ignoring it. How could I possibly alleviate any of it while I did that?

I had to assess where precisely the pain was and what exactly it felt like. We considered could the pain be referred - if my right ankle hurt, was it my ankle or could it be my knee, or hip etc. Was it possible the shoulder pain was related or separate?

I discovered the way my posture changes when I sit for too long or I am unsupported really increases pain. My chest slumps down on my upper abdomen, the neck goes back and the chin forward. As the muscles that hold the skeleton in place start to struggle then other muscles start to work to help out. Then they hurt because they aren't designed to do that and they are working a lot harder than they should be just to keep you sitting still.

Now what can I do about that? Making sure I am supported when sitting, not sitting for too long and so on.

I have pain but I was given tools to help prevent that pain causing further pain.

It was the opposite concept of central sensitization in a way because we identified and focussed on it. It was very helpful.

 

I have had decades of practice of tuning out low to moderate level constant pain. I am doing it even now. That in no way prepares me for sharp or sudden pain, or repeated bursts of pain, or increasing pain, or very severe pain. It especially does not help when doing things that immediately increase my pain level.

In the 80s with muscle pain I was taught to ice the muscle and do physio (mostly stretching and weights). The pain got worse and worse over time, and eventually muscles stopped responding (would not contract, or were in constant contraction) and I lost all sensation in one of my fingers. By the way, things like this are why I moved from an authoritarian position to an anti-authoritarian position. We are told what reality is, but reality has other ideas.

One thing that I have observed repeatedly is how fast medical authorities ignore symptoms once you stop complaining. I am convinced they typically think the symptom is gone, while what is really happening is I am not talking about it any more. What is the point? They not only cannot help they don't want to help. Waste of time discussing it.

CFS patient not complaining after BPS treatment? MUST be cured!!! Sigh.

 

I recently had a conversation with a niece who is also qualified as a personal trainer. Apparently, the guy who came up with the acronym RICE - Rest, Ice, Compression & Elevation - now says that the Ice bit should not longer be used. Now they reckon that ice simply reduces the inflammation but that inflammation is actually part of the healing process, so when you ice you are working against yourself.

The hubris of those who make absolute pronouncements, pronouncements that have an effect on people's health, never thinking to qualify that any information should carry the caveat to the best of our knowledge & at that point in time.

It doesn't absolve them of the need to keep their eyes open to evidence to the contrary & remain curious.

It also doesn't absolve them.of the need to keep their ears open and their mouths shut while patients are telling them how the treatment has affected them.

The feedback loop is missing.

 

Yes – and the trouble with releasing something like R.I.C.E. into the wild is that even if you're the most curious and least status-conscious scientist in the world, you can't call it back! It will stay in people's minds, often for decades. Folk who get niggles from training that aren't bad enough to need physio treatment will just keep doing it at home, and salaried physios who're more inclined to stick to their initial training than to keep up with the latest research won't know any better either.