Whenever I am asked about my approach to chiropractic care, I always emphasize patient education and empowerment as important aspects of treatment. While pain is often thought of as a measurement of tissue damage, research suggests it actually acts closer to an alarm system to inform us of any potential or perceived danger. Fear of the unknown is common and feeling like your body is broken or weak due to an injury can be disheartening. Simply informing a patient about their injury, why they are feeling pain, and what activities should and should not be done (and why) has consistently been shown to help decrease reported pain levels.
While the importance of this knowledge is likely self-evident, it becomes especially relevant during the current pandemic. Patient education can be used as an important tool for treatment, complementing activity modification and corrective exercises to effectively treat pain remotely during telemedicine visits. While the body of research into this subject is robust, here are four studies supporting this approach to patient care.
Adriaan Louw, Jo Nijs & Emilio J. Puentedura (2017) A clinical perspective on a pain neuroscience education approach to manual therapy, Journal of Manual & Manipulative Therapy, 25:3, 160-168, DOI: 10.1080/10669817.2017.1323699
This article outlines Pain Neuroscience Education (PNE). The authors argue in favor of patient education regarding the neuroscience of pain and provide numerous peer-reviewed studies detailng the benefits of taking this approach with patients suffering from chronic pain.
Quote from the abstract: “PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization (a phenomena playing a major contributing role in chronic pain)…we argue that PNE can be used in manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant (as we generally see in chronic pain patients).
Brendan J. McCullough, MD, PhD; Germaine R. Johnson, MD; Brook I. Martin, PhD, MPH; Jeffrey G. Jarvik, MD, MPH (2012). Lumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management? Radiology: Volume 262: Number 3
Here is a study both emphasizing the importance of patient education, and warning against the dangers of over utilizing medical imaging. This study found that by simply educating patients regarding the origins of radiographic finds, they became less likely to receive pain medications from an MD. It is natural to become fearful after seeing results of an MRI or X-ray and being told your spine is degenerating or that you have some sort of abnormality. Even hearing that your images are negative when you are in significant pain can be disheartening (then what IS causing my pain?!). It is therefore vital to only order images when clinically recommended, and educate the patient regarding the findings with up to date information regarding the severity and significance of what is found, and teach them about the nature of their pain—why they have it and what it is trying to communicate—so that they can have the required knowledge to remain confidence and driven to overcome their pain.
Quote from results: “MR imaging findings demonstrated that patients in the statement group were significantly less likely to receive a narcotics prescription for their presenting symptom at their follow-up clinic visit than patients in the nonstatement group (odds ratio = 0.29; 95% confidence interval: 0.11, 0.77; P = .01).”
Yan Zhang1,*, Li Wan2,* and Xueqiang Wang (2014). The effect of health education in patients with chronic low back pain. Journal of International Medical Research Vol. 42(3) 815–820
This study found that learning about your pain and what exactly the body is trying to communicate can help build confidence to overcome an injury or pain experience. I commonly tell patients: “you want to listen to your pain, but don’t be afraid of it”; the first step in this approach requires preparing patients with the required education to give them confidence to trust their bodies.
Quote from abstract: “At the end of the 12-week intervention period, pain, disability, SF-36 physical component and SF-36 mental component were significantly better in the health education group (n 1⁄4 25) than in the control group (n 1⁄4 24). There were no significant between-group differences in static or dynamic endurance.”
Sevil Bilgin, PT, PhD, Hatice Cetin, PT, MSc, Jale Karakaya, PhD, Nezire Kose, PT, PhD (2019). Multivariate Analysis of Risk Factors Predisposing to Kinesiophobia in Persons with Chronic Low Back and Neck Pain. J of manipulative and physiological therapies, 42, 8, pp. 565-571
This study showed that fear of movement due to pain (kinesiophobia) is correlated with both a lack of education and an increase in pain. Just more evidence demonstrating the importance of treating the entire patient—not just the painful area. Working to improve patient knowledge regarding their pain and building confidence in their bodies is critical.
Quote from results: “In the univariate analyses, the persons who had high-level kinesiophobia had a significantly lower level of education and had significantly higher scores for the Million Visual Analogue Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile ( P < .001).”