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      An exploration of primary care healthcare professionals’ understanding of pain and pain management following a brief pain science education

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          Abstract

          Background

          Persistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this.

          Purpose of the study

          1) Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE).

          Methods

          An exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention.

          Results

          Clinicians’ relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients’ passive and often oppositional biomedical treatment expectations; and clinicians’ lack of readily understandable language to communicate with patients.

          Conclusion

          The findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles.

          Trial registration

          This study was prospectively registered at ClinicalTrials.Gov ( NCT04587596) in October 2020.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12909-022-03265-2.

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          Most cited references20

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          How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes

          G Guest, Emily E Namey, K McKenna (2016)
          Article 0 comments Cited 298 times – based on 0 reviews     Review now
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            Fifteen Years of Explaining Pain: The Past, Present, and Future.

            G Lorimer Moseley, David S Butler (2015)
            The pain field has been advocating for some time for the importance of teaching people how to live well with pain. Perhaps some, and maybe even for many, we might again consider the possibility that we can help people live well without pain. Explaining Pain (EP) refers to a range of educational interventions that aim to change one's understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself. It draws on educational psychology, in particular conceptual change strategies, to help patients understand current thought in pain biology. The core objective of the EP approach to treatment is to shift one's conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue. Here, we describe the historical context and beginnings of EP, suggesting that it is a pragmatic application of the biopsychosocial model of pain, but differentiating it from cognitive behavioral therapy and educational components of early multidisciplinary pain management programs. We attempt to address common misconceptions of EP that have emerged over the last 15 years, highlighting that EP is not behavioral or cognitive advice, nor does it deny the potential contribution of peripheral nociceptive signals to pain. We contend that EP is grounded in strong theoretical frameworks, that its targeted effects are biologically plausible, and that available behavioral evidence is supportive. We update available meta-analyses with results of a systematic review of recent contributions to the field and propose future directions by which we might enhance the effects of EP as part of multimodal pain rehabilitation. Perspective: EP is a range of educational interventions. EP is grounded in conceptual change and instructional design theory. It increases knowledge of pain-related biology, decreases catastrophizing, and imparts short-term reductions in pain and disability. It presents the biological information that justifies a biopsychosocial approach to rehabilitation.
            Article 0 comments Cited 243 times – based on 0 reviews     Review now
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              How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists

              Annette Bishop, Nadine Foster, Elaine Thomas … (2008)
              Guidelines for the management of low back pain (LBP) have existed for many years, but adherence to these by health care practitioners (HCPs) remains suboptimal. The aim of this study was to measure the attitudes, beliefs and reported clinical behaviour of UK physiotherapists (PTs) and general practitioners (GPs) about LBP and to explore the associations between these. A cross-sectional postal survey of GPs (n = 2000) and PTs (n = 2000) was conducted that included the Pain Attitudes and Beliefs Scale (PABT.PT), and a vignette of a patient with non-specific LBP (NSLBP) with questions asking about recommendations for work, activity and bedrest. Data from 1022 respondents (442 GPs and 580 PTs) who had recently treated patients with LBP were analysed. Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations, 28% reported they would advise this patient to remain off work. Work advice was significantly related to the PABS.PT scores with higher biomedical (F 1,986 = 77.5, p < 0.0001) and lower behavioural (F 1,981 = 31.9, p < 0.001) scores associated with advice to remain off work. We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse. Many HCPs held the belief that LBP necessitates some avoidance of activities and work. The attitudes and beliefs of these HCPs were associated with their self-reported clinical behaviour regarding advice about work. Future studies need to investigate whether approaches aimed at modifying these HCP factors can lead to improved patient outcomes.
              Article 0 comments Cited 75 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jagjit Mankelow: j.mankelow@tees.ac.uk
                Cormac G. Ryan: c.ryan@tees.ac.uk
                Paul W. Green: paul.green6@nhs.net
                Paul C. Taylor: p.c.taylor@tees.ac.uk
                Denis Martin: d.martin@tees.ac.uk
                Journal
                Journal ID (nlm-ta): BMC Med Educ
                Journal ID (iso-abbrev): BMC Med Educ
                Title: BMC Medical Education
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6920
                Publication date (Electronic): 28 March 2022
                Publication date PMC-release: 28 March 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 211
                Affiliations
                [1 ]GRID grid.26597.3f, ISNI 0000 0001 2325 1783, School of Health and Life Sciences, Centuria Building, , Teesside University, ; Middlesbrough, Tees Valley TS1 3BX England
                [2 ]Linthorpe Surgery, 378 Linthorpe Road, Middlesbrough, TS5 6HA England
                [3 ]GRID grid.26597.3f, ISNI 0000 0001 2325 1783, School of Social Sciences, Humanities and Law Education and Social Work, , Teesside University Middlesbrough, ; Middlesbrough, Tees Valley TS1 3BX England
                [4 ]NIHR Applied Research Collaboration for the North East and North Cumbria, Newcastle Upon Tyne, England
                Article
                Publisher ID: 3265
                DOI: 10.1186/s12909-022-03265-2
                PMC ID: 8962069
                SO-VID: 17443c16-b3d5-4bcb-bd02-0fbca214659d
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 4 August 2021
                Date accepted : 11 March 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Education
                Keywords: pain education,gps,nurse practitioners,mixed-methods
                Data availability:
                ScienceOpen disciplines: Education
                Keywords: pain education, gps, nurse practitioners, mixed-methods

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