This was October’s Journal Club article at the hospital. We were building on what we learned and discussed in September as seen here.
The majority of the first bit of the article rehashes what central sensitization is and the 3 main options for treating it: 1) pain science education couple with 2) graded exercise which is provided by physical and/or occupational therapists and 3) cognitive behavioral therapy provided by our psychologist friends. If you need to revisit those topics I encourage you click here.
This article expounds on how exactly to go about providing the pain science education. Interestingly, it states that having a patient read information about pain science isn’t enough. The best method, which is the practice guideline mentioned here, is to do a face-to-face verbal education session using pictures and diagrams. The article suggested using the book Explain Pain. (I’ve heard good things about it other places, but haven’t read it myself. I think I know what’s going on my Christmas list! Although it looks like the print version is the way to go, not the Kindle version.) There are also several self-report outcome measures that may be useful in determining just “how bad” the central sensitization and how much it is effecting your patient– Pain Catastrophizing Scale (Appendices A, B); Pain Vigilance and Awareness Questionnaire ; Brief Illness Perception Questionnaire. The topics they most highly suggested were the difference between acute and chronic pain, neuroplasticity as related to pain, and how other things (like stress) exacerbate symptoms. Then to send the patient home with reading material that supports only (does not add new information to) what you discussed in the clinic using the same pictures and diagrams you used in the verbal session. If you’re doing this type of education a lot, it may be beneficial to blow the pictures up and have laminated posters on the clinic walls of the most important pictures/diagrams. The article recommends sending sections 1,2,4 of Explain Pain home. After finishing the reading, the patient takes a little quiz to see how much they learned. At this point they are ready for face-to-face education session number two.
In the second education session, you as the therapist can utilize the take home quiz to see which areas the patient isn’t understanding and revisit those areas. Once you and the patient have agreed the patient understands the education he/she has received, then you may continue into making a plan of care together. You will want to explain the kinds of treatment you will be providing in the clinic, that the patient will likely will have “homework” (HEP) and most importantly WHY you’re selecting these treatments. It will also be important to set your goals TOGETHER. Maybe even have the patient physically sign the plan of care too, so they can see that they are an integral part of this plan. Appropriate goals might be: “stopping rumination and worrying about the aetiology and nature of their pain disorder, reducing stress, increasing physical activity levels, decreasing hypervigilance, becoming more physically active, relaxation, etc.” The self-report outcome measures may be helpful in measuring these goals as well. (See links above.)
The education doesn’t stop there. Whenever the patient begins to show fear or doubt in the plan during treatment. Stop and revisit the education piece that is being called into question in that moment. Pain science can also be used to explain ups and downs in symptoms and “flare ups.” Don’t forget to get your psychologist friends involved too. Get to networking if you don’t know one that provides cognitive behavioral therapy.
I do want to look at one more article in this central sensitization education series, so stay tuned for that!