It's Time to Incorporate Pain Science into PT Education and Practice

Over the past several months, a couple of articles have been published which urge [hysical therapists (PTs) and educators to incorporate the biopsychosocial model of healthcare into the education and practice of physical therapy.  I agree completely.  Below I have summarized both articles:
Jones LE and Hush JM. Pain education for physiotherapists: is it time for curriculum reform? Journal of Physiotherapy 2011: 57; 207-208.
These authors have written a very convincing but concise editorial on why pain education needs to be included in Physiotherapy curriculums.  They begin their article by talking about the complexity and commonality of pain and how research over the past 10 years has indicated that pain can occur in absence of tissue damage.  They discuss the gate control theory and how additional explanations of how TENs may be effective (rather than the gate control theory).
The authors suggest that PT programs should adopt a pain education curriculum as developed by the International Association for the Study of Pain (IASP).  They site how incorporated strategies of pain education have led to a better understanding of the importance of the personal and emotional contexts related to pain.  They also state how despite the current influx of literature coming out about pain, many programs have yet to effectively incorporate it into their curriculum. 
Overall, this article discusses why it is important for PTs to develop a comprehensive understanding of the facors that influence pain and how to apply or prescribe appropriate treatment.  They urge PT programs to design curriculum and develop competancies based on current pain neuroscience.   Read the original article here…
Foster NE and Delitto A. Embedding psychological perspectives within clinical management of low back pain: integration of psychologically informed management principles into physical therapist practice – challenges and opportunities. Phys Ther. 2011; 91:790-803.
These authors did a fantastic job of identifying the challenges and opportunities for using a biopsychosocial model of practice for the treatment of low back pain.  Below I have summarized each:

  1. Entry-level PT programs tend to focus on biomedical models of health and wellness.  Early teaching focuses on musculoskeletal problems as having clear anatomical and pathological links to pain and disability.  The definitions of what we do heavily rely on disease and injury models of pain and the majority of attention is spend on biomedical assessment and treatment and little time is spent on psychological variables. 
  2. There is a lack of cohesion across entry-level clinical education environments and PT students are often placed in environments where clinical instructors fail to develop psychosocial perspectives in relation to pain.   In many clinical environments, the adherence to evidence-based standard of practice is less than optimal. 
  3. The physical therapy culture and practice continues to proogate anatomical and biomechanical models of practice despite literature stating to do so otherwise.
  4. Patients who have recieved PT in the past have a certain expectation of what PT is and how low back should be treated.  They expect diagnostic images to tell them “their problem”. despite evidence showing a low-correlation between the results of imaging and pain.
  5. PTs are unsure which psychosocial factors are important and how to assess or manage them.  There is a confidence hoop that many must go through when it comes to incorporating this concept into practice.  So many just ignore it.


  1. We can change the focus and priorities of entry-level training to incoroporate the biopsychosocial model which can bring about more positive student attitudes toward function despite pain.  By teaching this model, students will be better able to utilize adult learning theories, encourage conjunctive problem solving, deeper learning and skill developement.   Overall, it will facilitate a more comprehensive management of pain.
  2. It can facilitate cohension across entry-level clinical education, flowing from the classroom into a clinical environment.  Students and other healthcare professionals can learn from each other and facilitate and apply material taught from a theoretical framework into treatment of a patient.  This can be done by “training” the “trainer” to improve confidence in the psychosocial management of back pain.
  3. More studies can be conducted to show how incorporating this type of practice can improve outcomes.  Despite current evidence showing promising outcomes, much more data needs to be collected.
  4. There will be enhanced roles for PTs to educate the public.  The success of PTs having a better understanding of the biopsychosocial models of pain open up doors in which we can educate the public and be on the forefront on changing their perception of back pain.
  5. It can hange the reimbursement system and service priorities to include patient-reported outcome measures which will ultimately  influence improvements in practice.  Paying for outcomes vs. paying for time spent on treatment, can improve how we practice and make us better clinicians.

Read more here…

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