Pain is an elusive subject, continuously shifting and changing as we as health practitioners become more informed and sharpen our tools in treatment thereof. We might find ourselves confronted with our own shortcomings as treatment modalities fail to provide the desired outcome and our efforts to relieve pain only result in disgruntled clients. Therefore, the functional evaluators at Obair seek to make recommendations based on evidence-based research and the latest findings in the field of pain research.
Lorimer Moseley and David Butler at the Noigroup in Australia have long been interested in the way in that pain is addressed, particularly focusing their research on improving clients’ understanding of pain in an effort to reduce fear-avoidance behaviour and catastrophisation.
Moseley and Butler have recently released an article that will be published in the Journal of Pain, which takes a closer look at the strides made in the past 15 years with regards to Explaining Pain (EP), a range of educational interventions aimed at improving understanding of the physiological processes with regards to the development and persistence of pain. In the paper, Moseley and Butler seek to clear some of the misconceptions with regards to this treatment modality and shed light on the practicality and utility thereof.
From the outset, the researchers highlight the importance of explaining the biological processes underpinning pain, stating that traditional treatment modalities will be of little value whilst the client have problematic thinking or inaccurate beliefs regarding his or her pain.
EP is theoretically grounded in Engel’s biopsychosocial model with attention paid to psychosocial factors that contribute to the pain experience – pain is a biopsychosocial phenomenon, modulated by beliefs. The researchers note the increased usage of cognitive behavioural therapy (CBT) in addressing these thoughts and beliefs. However, they stress the difference between EP and CBT, indicating that the latter focuses on teaching individuals how to cope with their pain; taking the stance that pain is unavoidable and therefore CBT is aimed at managing rather than treating pain. This conflicts with the EP model, which proposes that pain can be modified, with pain being a result of perceived danger to body tissue.
Pain is seen as a way for the brain to protect the individual, interpreting ‘danger’ messages received from nociceptive information as well as other sources of information, such as the environment and thoughts and beliefs. Therefore, pain is dependent on meaning and influenced by context. Treating pain should therefore impart the knowledge that the development of pain is highly dependent on a combination of inputs that suggest the body is in danger, resulting in protective behaviour.
By providing information on the biological processes underpinning pain, the individual becomes aware that pain output is regulated by the way that the brain interprets ‘danger’ and therefore, noticing factors that decrease or increase pain is key to treatment. Indeed, the researchers use the acronym DIM for “Danger in Me” and SIM for “Safety in Me”, enabling individuals to identify which factors influence their pain experience. These factors are highly individualised and will depend on each person’s lived experience. As stated by the researchers, “any credible evidence of danger to body tissue can increase pain and any credible evidence of safety to body tissue can decrease pain”.
Following the reconceptualisation of pain, the health practitioner can move towards including other treatment strategies, including pacing, graded activity participation and moving smart. In enabling clients to understand their pain and interpret the many contributing factors, health practitioners provide hope and move clients towards increased function and independence.
Written by Lezanne Fieuw
 Moseley GL, Butler DS, 15 Years of Explaining Pain – The Past, Present and Future, Journal of Pain (2015)