The onset of the pandemic forced businesses to shapeshift and adapt. For us, that meant our team had to pivot fully to Virtual Physical Therapy. While I have personally FaceTimed with patients to help them better understand an acute injury or to simply walk them through a program, I never had to virtually take them through a full plan of care from beginning to end. PT through a screen not only felt new but incredibly foreign for multiple reasons. Over time it became clear that the skillful hands-on treatments that we pride ourselves in, truly paled in comparison to the efficacy of proper pain education and the trust built between patient and PT through a virtual relationship. While I always knew this, it wasn’t until it was the ONLY thing we could do, that I realized the communication and education that helped patients build context around their pain was really the center of the work that we do.
We believe proper pain education is key to helping a patient feel that they have some control over their unique situation. In fact, it’s been proven that individuals who are educated on their pain, report lower pain intensities and higher expectations of recovery.1 Pain alone isn’t adequate enough to gauge the severity of an patient’s injury, so reducing fear and anxiety associated with their pain through education right off the bat paired with a thorough evaluation increases confidence and can set the course of action in the right direction.
At MOTIVNY, we see ourselves not only as physical therapists but as pain educators. As we mentioned earlier in our pain series, we know pain as an emergent process where many factors come together to create the chaos that results in pain versus a singular origin. This paradigm shift has led us to look even closer at the psychology behind pain and the implications of how we educate our patients on their injuries.
Pain is complex and multifactorial. Every patient that ends up on our tables have their unique pain experiences, which must be respected. Variables that contribute to their personal pain experience can range from mental health, stress, nutritional habits, and poor sleep quality, to list a few. It’s up to both the patient and the physical therapist to work together to re-conceptualize the pain they’re coming in with, put things into perspective, and use it to guide the plan of care.
Our responsibilities as pain educators doesn’t just lie solely on the information that we deliver but also how we deliver it. Butler and Moseley's Explain Pain, has been a valued resource for all pain educators, as it challenges common explanations and metaphors that are seemingly benign but may negatively impact a patients’ self-efficacy and consequently their outcomes (i.e. classic “your spine is not aligned, I’ll put it back” conversation). Furthermore, props such as disk bulge/herniation models used as patient education tools can leave patients feeling fragile which can be damaging to patient recovery. Educational strategies that aid in changing patients’ misconceptions about their conditions need constant refining and implementation as we understand more about the biology and psychology underpinning pain.
Lastly, there is the undeniable trust between patient and practitioner that is foundational to reducing the impact of pain in someone’s life. Without trust, pain education is in many ways incomplete and ineffective. Without a relationship rooted in empowerment, the benefits of our interventions are short-lived. To tackle this at MOTIVNY, we’ve structured our visits to be one-on-one with a single provider, as opposed to with an aides or techs, giving patients the environment to feel heard and build a personalized results-driven plan. We’ve even baked into our intake questions that touch on the myriad of other possible psychological and societal factors that contribute to the pain that patients experience. Ultimately, by relaying the message that pain can be complex but that we’re adaptable rather than fragile is what will empower our patients leading to better and faster outcomes.
As we continue to adapt to our surroundings, pandemic or not, I can confidently say that education, information delivery, and trust building will always be the components of a successful patient outcome.
Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients' expectation of recovery and pain intensity. Scand J Pain. 2018 Apr 25;18(2):211-219.