Annotated Bibliography relating to: Patients understanding of pain and how this relates to osteopathic management.

Colleary, G., O’Sullivan, K., Griffin, D., Ryan, C. G., & Martin, D. J. (2017). Effects of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomized controlled trial.



Physiotherapy, 103,



423-429.


http://dx.doi.org/10.1016/j.physio.2017.01.006

Colleary et al. investigate undergraduate students’ knowledge of and attitudes towards chronic pain and chronic pain patients following pain neurophysiology education. Physiotherapy university students with no prior pain neurophysiology education were invited by email to take part in a multicentre single-blind randomised control trial. The intervention group received pain neurophysiology education and were reassessed to determine if there were any changes to their knowledge of chronic pain, attitude towards patients with chronic pain and therapeutic recommendations for patients experiencing chronic pain. This article is useful to my research as it assesses the effects of pain neurophysiology education on student practitioners, this information may be relatable to practitioners that have completed their osteopathic education. Limitations to this study include a relatively low number of participants, the level of current education of participants (undergraduate), lack of follow-up of participants to determine levels of retention of information, attitude and behavioural change and the lack of application of pain neurophysiology education in clinical setting as vignettes were used instead of patient contact. These limitations may not be applicable to the general population of students in all manual therapy professions or practitioners that have completed their studies. Pain neurophysiology education was shown to increase students’ knowledge of pain neurophysiology education, improve attitudes towards patients experiencing chronic pain and increase knowledge and application of clinical guideline recommendations. This article forms an important part of my research as it displays changes in practitioner behaviours towards chronic pain patients following pain neurophysiology education.

Cuenca, J. J. A., Pecos-Martín, D., Martínez-Merinero, P., Lluch, E., Nijs, J., Meeus, M., Pena, R. F., & Fernandez-Carnero, J. (2019). How Much Is Needed? Comparison of the Effectiveness of Different Pain Education Dosages in Patients with Fibromyalgia.



Pain Medicine



. doi:10.1093/pm/pnz069

This article aims to identify the effect of different dosages of pain neuroscience education programs on pain processing, pain intensity and impact on activities of daily living in patients with fibromyalgia. This is a four-arm, parallel-group, assessor-blinded randomized control trial according to Consolidated Standards of Reporting Trial Guidelines in which participants with Fibromyalgia were randomly allocated into a group to receive pain neurophysiology education in a high, low, diluted-low and control dose varied in time and number of sessions. Outcomes assessed included changes in temporal summation, pressure pain thresholds, efficacy of conditioned pain modulation and reductions in pain intensity, disability, catastrophizing and pain anxiety. This study is useful to my research as it assesses the quantity of pain neurophysiology education required for a change in patient pain behaviours. Limitations to this study include a control group that was also receiving pain neurophysiology education, therefore there was no control group not receiving intervention. Follow-up of patients occurred three months post pain neurophysiology education with no further follow-up beyond this time frame and base-line education of patients was not recorded, a factor that may influence the results of pain neurophysiology education within the general population. Pain neurophysiology education in any dose improves conditioned pain modulation, pressure pain thresholds and reduces pain catastrophizing and pain anxiety in patients with Fibromyalgia with no effect on temporal summation. Higher doses of pain neurophysiology education produce greater effects in reduction of pain intensity and increased biomedical education in participants. This study will form an integral part of my research as it shows the positive effects of pain neurophysiology education in a population with chronic pain and gives an indication of the dosages required for greater effects to occur.

Formica, A., Oliver, T. P., & Esteves, J. E. (2108). ‘I just don’t have the tools’ – Italian osteopaths’ attitudes and beliefs about the management of patients with chronic pain: A qualitative study.



International Journal of Osteopathic Medicine, 27



, 6-13.


https://doi.org/10.1016/j.ijosm.2017.11.001

This article aims to determine how osteopaths perceive and conceptualise the biopsychosocial model in practice and their attitudes and beliefs pertaining to their evaluation, treatment and management of patients with chronic pain. Qualitative data was gathered through in-depth semi-structured interviews in a design based on grounded theory method to assess participants understanding of chronic pain and its management through open-ended questioning. This article is useful to my research as it assesses osteopathic understanding of chronic pain. This study is limited due to a small group of participants and the research taking place in Italy making it hard to generalise the results to the osteopathic profession as a whole. This research shows that osteopathic treatment of patients with chronic pain is primarily structural-pathology based with practitioners opting for the biomedical model in evaluation and treatment. Participants expressed difficulty in adding psychosocial elements to their patient treatments due to a lack of professional competence, clear professional guidelines, appropriate knowledge and opportunities for further clinical education. This article will not form the basis of my research however it is useful as supplementary material as it provides data on the current perception of osteopath as their treatments being biomechanically based and the need for further professional education in pain management to allow for a biopsychosocial model to be applied within osteopathic practice to provide a more person-centred framework.

Geneen, L. J., Martin, D. J., Adams, N., Clarke, C., Dunbar, M., Jones, D., McNamee, P., Schofield, P., & Smith, B. H. (2015). Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis.



Systematic Reviews, 4,



132. doi:10.1186/s13643-015-0120-5

This review aims to determine the current amount of evidence available to display the effect of education of the patient in facilitation of their understanding of chronic pain and consequent psychosocial outcomes. This article is systematic review with meta-analysis of randomised control trials and cluster-randomised control trials written in English that considers reported outcomes of pain severity and/or physical function. This review is useful to my research as it investigates current data on patient education. This study is limited in the number of papers included in the review and a narrow scope to include investigation of education in isolation of other interventions and outcomes of pain and disability changes. Pain neurophysiology education was shown to improve the outcomes of patients with disability due to chronic pain, reduce catastrophizing and increase patient knowledge of pain. This study be beneficial as an inclusion to my research at it highlights the positive effects of pain neurophysiology education in patients with chronic pain.

King, R., Robinson, V., Elliott-Button, H. L., Watson, J. A., Ryan, C. G., & Martin, D. J. (2018). Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study.



Pain Research and Management, 2018



, 10. doi:10.1155/2018/374565

King et a;. evaluate the extent and nature of reconceptualization in patients with chronic low back pain following pain neurophysiology education. This is a qualitative study with participants interviewed in a semi structured fashion prior to and three weeks following pain neurophysiology education. Theoretical thematic analysis focused towards deductive analysis determined the degree of reconceptualization that had taken place, education relevance to each patient, importance of prior beliefs and the perceived benefit of pain neurophysiology education. This article is useful to my research as it investigates the value of pain neurophysiology education in reconceptualization of chronic pain patients. Limitations to this study include a small group of participants with no control group. No personal information was gathered to construct pain neurophysiology education in a manner that was individualised to each patient. The degree of reconceptualization varied greatly between participants from none to partial, patchy or strong. Those that showed reconceptualization also displayed that their new understanding had personal relevance and clinical benefit. Those that displayed little to no reconceptualization or personal relevance had very strong prior beliefs that their pain was caused only by biomedical source and did not feel that pain neurophysiology education had any clinical benefit, therefore prior beliefs play a large part in the success of pain neurophysiology education. This article will play an integral part of my research as it displays the benefits of pain neurophysiology education in chronic pain patients and the need for individualized programs to assist practitioners in achieving reconceptualization in their patients.

King, R., Robinson, V., Ryan, D. G., & Martin, D. J. (2016). An exploration of the extent and nature of reconceptualization of pain following pain neurophysiology education: A qualitative study of experiences of people with chronic musculoskeletal pain.



Patient Education and Counseling, 99,



1389-1393. https://doi.org/10.1016/j.pec.2016.03.008

This study investigates the use of pain neurophysiology education in chronic pain patients and the degree and nature of reconceptualization of their own pain following pain neurophysiology education. This is a qualitative study gathering information on how a person makes sense of a particular phenomenon or experience through individual interviews based on Interpretative Phenomenology Analysis. Themes explored included the variable degrees of reconceptualization, barriers and prior beliefs to reconceptualization, the influence and clinical benefits of pain neurophysiology education. Limitations to this study include the small sample size of participants and the limited demographics of those chosen to participate, along with the input from other sources as pain neurophysiology education was not applied in a closed environment with no outside influence making this study more illustrative than applicable to the general population. Varying degrees of reconceptualization were evident after pain neurophysiology education with half the participants displaying clear evidence of reconceptualization. Those that displayed reconceptualization also showed a greater contrast in pain beliefs. This study will become an integral part of my research as it displays the benefits of individualized pain neurophysiology education for patients and the need for practitioners to ne knowledgeable and confident in the delivery of pain neurophysiology education for better patient outcomes.

Macdonald, R. J. D., Vaucher, P., & Esteves, J. E. (2018). The beliefs and attitudes of UK registered osteopaths towards chronic pain and the management of chronic pain sufferers – A cross-sectional questionnaire based survey.



International Journal of Osteopathic Medicine, 30



, 3-11. https://doi.org/10.1016/j.ijosm.2018.07.003

This article aims to determine osteopathic attitudes and beliefs towards chronic pain, management of chronic pain sufferers, sociodemographic determinants of practitioners’ attitudes towards chronic low back pain and the comparison of osteopaths’ attitudes towards chronic pain compared to other professions. The authors invited osteopaths in the UK to participate in a survey using quantitative HC-PAIRS and PABS-PT questionnaires via email. Questionnaires assessed attitudes and beliefs of practitioners towards perceived harmfulness of activities in patients with chronic low back pain and attitudes towards chronic pain management. This article is useful to my research as it provides important data on attitudes and beliefs of osteopaths to chronic pain from a biomedical and psychosocial aspect. Limitations in this study include sample size, method of invitation through email only and minor follow up of non-responding invitees. This article shows that the beliefs of osteopaths towards chronic pain and management were varied however the general consensus was that physical activity is not harmful for patients experiencing chronic low back pain although many recommend restriction of daily activities including time off work, making the distinction between biomedical and psychosocial attitudes towards chronic pain hard to distinguish. Results showed that there is potential for UK based osteopaths to improve their knowledge of the complexity of pain to include neurophysiology alongside a biomedical and psychosocial approach. This study is useful to my research as it indicates the general attitude of osteopaths towards chronic pain and provides information on ways to successfully obtain data. It highlights the need to assess clinician’s skills in applying knowledge of pain neurophysiology education to patients in order to adjust their personal pain beliefs, an important aspect of our research project.

Robinson, V., King, R., Ryan, C. G., & Martin, D. J. (2016). A qualitative exploration of people’s experiences of pain neurophysiological education for chronic pain: The importance of relevance for the individual.



Manual Therapy 22



, 56-61. https://doi.org/10.1016/j.math.2015.10.001

The aim of this study is to examine the experience of patients with chronic pain who received pain neurophysiology education and assess their understanding of pain following pain neurophysiology education to determine the level of reconceptualization. The authors conducted a qualitative study using semi-structured interviews based on Interpretive Phenomenology Analysis. The interviews focused on the perceived relevance and benefits of pain neurophysiology education for the participant and evidence of reconceptualization following pain neurophysiology education. This article is useful to my research as it assesses pain neurophysiology education from a patient perspective. Limitations to this study include small sample size with very little variation in patient demographics with only one type of pain neurophysiology education applied to all participants, rather than an individualized program or delivery format. Most of the participants found pain neurophysiology education relevant to their circumstances however expressed that the format in which it was delivered (group session) was not individualized enough for them to gain the greatest benefits. Many participants expressed that they felt better equipped to understand, cope with and manage their pain. Half of the participants displayed some evidence of reconceptualization following pain neurophysiology education. This article highlights the benefits of pain neurophysiology education in patients with chronic pain and highlights the importance of information and delivery methods to be individualized to each patient and will become an important part in my research as it is assesses patient perspectives of pain neurophysiology education.

Watson, J. A., Ryan, C. G., Cooper, L., Ellington, D., Whittle, R., Lavender, M., Dixon, J., Atkinson, G., Cooper, K., & Martin, D. J. (2019). Pain Neurophysiology Education for Adults with Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis.



The Journal of Pain.



https://doi.org/10.1016/j.jpain.2019.02.011

In this article Watson et al. review the perception of pain neurophysiology education and its effectiveness as an intervention for the management of chronic musculoskeletal pain in adults. This is a mixed-method systematic review and meta-analysis of qualitive and quantitative studies using the 2017 Joanna Briggs Institutes Reviewers Manual. Papers selected to be included in the review aimed to explore the experiences of patients participating in pain neurophysiology education, the perception of its effectiveness and how this influenced their understanding of pain. This article is useful to my research as it assesses pain neurophysiology education from a patient perspective. Limitations to this study include the exclusion of articles not written in English and consideration of economic outcomes such as cost. The results of this review show that pain neurophysiology education is more effective for patients if delivered in a relevant manner following a comprehensive assessment of the patient where they have had an opportunity to clarify their story with a health care professional. Pain neurophysiology education delivered by a health care provider with adequate training promotes pain reconceptualization and enhances patient’s ability to cope with their pain levels. This article highlights the need for appropriate training of health care providers to deliver pain neurophysiology education effectively to assist patients in understanding chronic pain and continuing with activities of daily living and will allow us to direct a line of questioning to find gaps within pain neurophysiology education for practitioners.