Therapeutic Neuroscience (Pain) education
There is Level 1 evidence and RCTs to support current pain education. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient's cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization (Zimney, K. et al 2014).
THE IMPORTANCE OF HOPE
Pain is an invisible disability.
Osteopaths can provide the gift of therapeutic presence. We empathise carefully. We listen to people's stories, affirming the person/client, acknowledging their pain whilst challenging their understanding of why they have pain and the side effects of pain. In this way we offer them hope.
Therapeutic neuroscience/pain education
We seamlessly integrate
- What you perceive through your senses is not accurate information. It’s the brains best story.
- Pain is not necessarily an accurate indication of what is happening in your body e.g. brain freeze, paper cut.
- Pain is a protection mechanism to make you change your behaviour (not to tell you where & what & how bad the problem is)
- Reducing activity towards passivity can lead to anxiety and depression
- Decreased activities that promote mood buoyancy
- Densensitisation of fear based inactivity
- Avoidance conditioning: we move - we get pain - we stop moving
EXAMPLE ONE: WHIPLASH
Rates of healing for different tissues e.g. after whiplash, articular cartilage takes a long time to heal so may be danger signals for a long time.
EXAMPLE TWO: ACUTE MECHANICAL LOW BACK PAIN
Protection, tissue injury, TNE explanation
Why MANUAL THERAPY REMAINS important
People in pain can become 'untouchable'. They withdraw from their own body. Sensory input can improve body awareness and allow people to 'reclaim' a body part (D'Alcala, C.R. et al 2015).
Manual therapy can provide innocuous (sensory input) and verbal encouragement toward returning to pain paced movement.
When people leave with less pain this is an opportunity to reinforce helpful pain beliefs. Reinforce the ability of their body to respond - they have the power to change their pain - we avoid therapist as operator/God.
Manual therapy is not passive when combined intelligently with movement therapy and advice (active approaches) and therapeutic neuroscience education
1. Zimney, K., Louw, A., & Puentedura, E. J. (2014). Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: A case report. Physiotherapy: Theory and Practice, 30(3), 202-209.
2. D’Alcala, C.R., Webster, D.G., Esteves, J.E. (2015). Interoception, body awareness and chronic pain: Results from a case-control study. Internation Journal of Osteopathic Medicine, 18(1), 22-32