If you are advising or providing care for a person who has pain or is living with chronic pain, you need to have a firm grasp of current pain research and have an in-depth understanding of the complexity of pain and the many factors that modulate your patients’ pain experience. You also need in-depth knowledge of the many different factors which modulates pain; this can serve as a fundamental and robust starting point for a modern approach to the treatment of patients with pain.
Pain research and pain science are like cardio-respiratory science, and neurological research, and psychological science. If you are trying to help people who have pain, pain science and research should be an integral part of your clinical vocabulary. This is nothing different that if you are trying to help people with cardio-respiratory problems or neurological diseases that you should have a firm grasp of the current research about what is the optimal care of the particular disease that you are treating and the people you take responsibility for helping.
To rephrase it, in a bit more direct way. If you are providing care for people with neurological diseases, you should have a firm grape of this research field (and relevant subfields), and the same applies to providing care for people with cardio-respiratory, and with people living with pain. So “pain science” is really about applying a scientific research-based approach to understanding pain and optimizing the rehabilitation and management of people with pain.
However, if you are not trying to help and provide care for people living with pain, pain research becomes a lot less relevant. Again the same applied to research about neurological diseases, if you are not providing care for people living with neurological diseases, scientific knowledge about neurological diseases is a lot less critical.
I would argue that if you are not informed about what pain is, from a scientific view, how can you make updated and informed choices? and make sure you provide the optimal care for the people you have under your care?
As stated by Committee on Advancing Pain Research, Care, and Education (1) in 2011.
“Unfortunately, many health care providers lack a comprehensive perspective on pain and not infrequently interpret the suffering of others through their own personal lens. Misjudgment or failure to understand the nature and depths of pain can be associated with serious consequences — more pain and more suffering—for individuals and our society.” Relieving Pain in America, Institute of Medicine, 2011
Unfortunately, this lack of knowledge about pain and pain “science” and research is a global problem in health care (2):
“Problems with pain education identified by surveys of multiple health science courses in higher education institutions across the United States, Canada, and Europe include a lack of dedicated curriculum time, and that pedagogic approaches are not always thought to be effective in improving students’ pain knowledge and skills. Pedagogic approaches tend to be didactic and biomedically focussed, which may not be optimal for developing knowledge and skills relevant to a pain practitioner.”
If a member of my family get seriously sick and goes to the doctor or the emergency room, I will expect the care they provide to be evidence-based and based upon the current scientific knowledge we have about the diseases and the human body. Why should our patients expect anything less of us as health professionals?
Another important point is that you can’t treat something you do not know what is, effectively. You also can’t treat something (pain) optimally if you do not know what it is influenced and modulated by. Our clinical reasoning should be based upon the current scientific knowledge. We should be not be making treatments choices that are based upon old and outdated knowledge; this is doing a disservice to the very people that are under our care.
As Prof. Jules Rothstein, PT, PhD states “Nothing could be more humanistic than using evidence to find the best possible approach to care” (3)
Thanks to Dr. Bronnie Lennox Thompson, university lector Lennart Bentsen, and Dr. Jarod Hall for inspiration to write this blog.
1. Relieving Pain in America, Institute of Medicine, Committee on Advancing Pain Research, Care, and Education. National Academies Press, 2011
2. Thompson K, Johnson MI, Milligan J, Briggs M. Twenty-five years of pain education research-what have we learned? Findings from a comprehensive scoping review of research into pre-registration pain education for health professionals. Pain. 2018 Nov;159(11):2146-2158.
3. Rothstein JM. Thirty-Second Mary McMillan Lecture: journeys beyond the horizon. Phys Ther. 2001 Nov;81(11):1817-29.