PATIENT DISABILITY: A CASE FOR THE DETRIMENTAL EFFECTS OF PATIENT EDUCATION

Main Article Content

Nathan Hinkeldey
Jace Peters

Keywords

Chronic Pain; Therapeutic Neuroscience Education, Low Back Pain

Abstract

Pain treatment often includes education about the pathoanatomical model which emphasizes pain resulting from tissue pathology. The model can be accurate in cases of acute pain, but it impedes progress, elevates anxiety, and increases fear of movement in the chronic pain population; therefore, methods of education that de-emphasize tissue damage need to be implemented. This case illustrates both disability driven by fear of movement resulting from a pathoanatomical explanation of pain and return to function following 9 treatments over 6 months. Treatment included manual therapy and incorporation of Therapuetic Neuroscience Education (TNE). Quantified improvements of 16 points in the Oswestry Disability Index (ODI), 19 points on the Fear Avoidance Belief Questionnaire Physical Assessment(FABQ-PA), and 25 points on the Neck Disability Index (NDI) occurred following treatment. Implementing TNE in conjunction with manual therapy in this case resulted in a significant decrease in disability related to the low back and neck pain and fear related to movement.

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References

1. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil 2011;92(12):2041-2056. doi:10.1016/j.apmr.2011.07.198
2. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009;10(9):895-926. doi:10.1016/j.jpain.2009.06.012
3. Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 1997;224(1):5-8.
4. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008;131(Pt 8):2161-2171. doi:10.1093/brain/awn154
5. Tsao H, Danneels LA, Hodges PW. ISSLS prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine 2011;36(21):1721-1727. doi:10.1097/BRS.0b013e31821c4267
6. Bray H, Moseley GL. Disrupted working body schema of the trunk in people with back pain. Br J Sports Med 2011;45(3):168-173. doi:10.1136/bjsm.2009.061978
7. Lotze M, Moseley GL. Role of distorted body image in pain. Curr Rheumatol Rep 2007;9(6):488-496.
8. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain 2011;152(3 Suppl):S90-8. doi:10.1016/j.pain.2010.10.020
9. Forget N, Piotte F, Arsenault J, Harris P, Bourbonnais D. Bilateral thumb’s active range of motion and strength in de Quervain’s disease: comparison with a normal sample. J Hand Ther 2008;21(3):276-84; quiz 285. doi:10.1197/j.jht.2008.03.004
10. Heales LJ, Lim ECW, Hodges PW, Vicenzino B. Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability--implications for central nervous system involvement: a systematic review with meta-analysis. Br J Sports Med 2014;48(19):1400-1406. doi:10.1136/bjsports-2013-092535
11. Koltzenburg M, Wall PD, McMahon SB. Does the right side know what the left is doing? Trends Neurosci 1999;22(3):122-127.
12. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152(3 Suppl):S2-15. doi:10.1016/j.pain.2010.09.030
13. Baliki MN, Petre B, Torbey S, et al. Corticostriatal functional connectivity predicts transition to chronic back pain. Nat Neurosci 2012;15(8):1117-1119. doi:10.1038/nn.3153
14. Mansour AR, Baliki MN, Huang L, et al. Brain white matter structural properties predict transition to chronic pain. Pain 2013;154(10):2160-2168. doi:10.1016/j.pain.2013.06.044
15. Davis KD, Moayedi M. Central mechanisms of pain revealed through functional and structural MRI. J Neuroimmune Pharmacol 2013;8(3):518-534. doi:10.1007/s11481-012-9386-8
16. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49-64. doi:10.1016/j.pain.2010.11.010
17. Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair 2012;26(6):646-652. doi:10.1177/1545968311433209
18. Mansour AR, Farmer MA, Baliki MN, Apkarian AV. Chronic pain: the role of learning and brain plasticity. Restor Neurol Neurosci 2014;32(1):129-139. doi:10.3233/RNN-139003
19. Wand BM, O’Connell NE. Chronic non-specific low back pain - sub-groups or a single mechanism? BMC Musculoskelet Disord 2008;9:11. doi:10.1186/1471-2474-9-11
20. Puentedura EJ, Cleland JA, Landers MR, Mintken PE, Louw A, Fernandez-de-Las-Penas C. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther 2012;42(7):577-592. doi:10.2519/jospt.2012.4243
21. Curatolo M, Arendt-Nielsen L, Petersen-Felix S. Central Hypersensitivity in Chronic Pain: Mechanisms and Clinical Implications. Phys Med Rehabil Clin N Am 2006;17(2):287-302. doi:10.1016/j.pmr.2005.12.010
22. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52(2):157-168. doi:10.1016/0304-3959(93)90127-B
23. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 2004;20(5):324-330.
24. Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: a review of randomized clinical trials. J Clin Epidemiol 1994;47(8):851-862.
25. Nijs J, Meeus M, Cagnie B, et al. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Phys Ther 2014;94(5):730-738. doi:10.2522/ptj.20130258
26. Cohen JE, Goel V, Frank JW, Bombardier C, Peloso P, Guillemin F. Group education interventions for people with low back pain. An overview of the literature. Spine 1994;19(11):1214-1222.
27. Gross AR, Aker PD, Goldsmith CH, Peloso P. Patient education for mechanical neck disorders. Cochrane database Syst Rev 2000;(2):CD000962. doi:10.1002/14651858.CD000962
28. Maier-Riehle B, Harter M. The effects of back schools--a meta-analysis. Int J Rehabil Res Int Zeitschrift fur Rehabil Rev Int Rech Readapt 2001;24(3):199-206.
29. Poiraudeau S, Rannou F, Baron G, et al. Fear-avoidance beliefs about back pain in patients with subacute low back pain. Pain 2006;124(3):305-311. doi:10.1016/j.pain.2006.04.019
30. Hirsch MS, Liebert RM. The physical and psychological experience of pain: the effects of labeling and cold pressor temperature on three pain measures in college women. Pain 1998;77(1):41-48.
31. Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 2004;8(1):39-45. doi:10.1016/S1090-3801(03)00063-6
32. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000;25(22):2940-52; discussion 2952
33. Hagg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 2003;12(1):12-20. doi:10.1007/s00586-002-0464-0
34. MacDermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 2009;39(5):400-417. doi:10.2519/jospt.2009.2930
35. Murphy D. Clinical reasoning in spine pain. Volume I: primary management of low back disorders using the CRISP protocols (volume 1). CRISP Education and Research LLC.; 2013
36. Kolski M, O’Connor A. A world of hurt: a guide to classifying pain. Thomas Land Publishers, Inc.; 2015