I notice more and more as I read and talk to people and look at the various handouts that practitioners send us at NOI, that we are going through a bastardisation of the Explain Pain work. Dumbed down versions of Explain Pain are all the rage – as if a simple 5 minute video clip, on its own, is enough to alter deeply held pain concepts, or prescriptive treatments that assume pain is a universal experience for all, with a minute on this and two minutes on that. It’s almost a return to the horror days when therapists offered 10 minutes of hotpack and 5 minutes of ultrabullshit. Perhaps worst of all are interventions that include some useful explanations of pain, followed by a “traditional treatment” based on out-dated assumptions that pain starts in the periphery – thus perpetuating the fantasy of pain generators and pain endings in the tissues.
I must be grumpy!
Oooh, I just re-read that first paragraph and I must be quite grouchy at the moment! Practitioners send us their pamphlets, books and handouts with the best of intentions – good on people for at least trying an educational intervention. Please don’t stop.
Perhaps the problem is that many clinicians, therapists and practitioners just don’t understand the Explain Pain approach. Misconceptions abound about what Explain Pain is, and we have to take some of the blame for this. Lorimer Moseley and I have tried to summarise these misconceptions and provide accurate conceptions in a recent paper (Moseley and Butler 2015). The table below is an adaptation.
Getting serious about education
Article 26 of the 1948 Universal Declaration of Human Rights states that “everyone has the right to education” thus initiating the Education For All (EFA) movement. Few of us are trained in education but a fundamental difference between life as a clinician and life as an educator is that as an educator with an EFA goal I must adapt, whereas in health, broadly, it is the patient who is required to adapt. Walk through an education faculty and note the different departments and names on doors – gifted, remedial, indigenous, sensory and physical needs etc etc. The educator adapts in a way that addresses individual differences in striving towards the goal of EFA.
And so should we with health education. Quality Explain Pain is tricky as it must be delivered on a framework that indulges changing neuroscience, evidence based multimedia, conceptual change and learning theory, and clinical reasoning. There is no place for short cuts or one size fits all.
“I’m already using Explain Pain.”
When clinicians tell me about how they are using educational strategies, I will often say “tell me about your current curriculum”. This is usually met with surprise, yet the notion of curriculum, while poorly considered in the health domain, should be fundamental to individual and group education. It makes the educator consider issues like content, key learning objectives, appropriate metaphors and similies, tailoring to group or individual, using multimedia, timing, dealing with outliers, understanding the influences of chronic pain on learning, place, associated teaching skills, measurement and reinforcement.
While not new, I feel that Explain Pain is at a somewhat perilous stage of its clinical integration. The attempts at simplification that ‘dumb down’ rather than add any value, the misconceptions that abound and continuing outright rejection in some therapy quarters, all threaten to derail this evidenced based intervention. All of this at a time when we are also seeing some positive signs too – Explain Pain making inroads into professions other than its traditional ‘home’ of physiotherapy, clever clinicians the world over truly embracing a biopsychosocial approach and integrating quality pain education with modern thinking about manual and movement based therapies, and a new breed of young researchers that are working as hard on their EP curriculum as the other aspects of robust trial designs.
Overall, this is a call to be careful with Explain Pain – to understand what it is, as well as realise what it isn’t, to acknowledge the skills required to effectively deliver Explain Pain, and develop them where necessary, and finally, to recognise the need to think differently and more broadly, bringing in the rich world of education science and psychology, in the effort to achieve the very worthy goal of pain education for all.