Recently, we hosted a webinar on low back pain neuroscience presented by Todd Lewarchick, Outpatient Rehabilitation Manager of the renowned Cleveland Clinic in Cleveland, OH. Todd provided a lot of information to considered when it comes to treating patients with chronic pain. Much of it focused on the importance of educating patients on the neuroscience of their pain.
Todd began by mentioning that medical community as a whole hasn’t been that great at treating pain, simply based on the outcomes: low back pain rates are increasing along with medical costs and many treatment methods don’t have high long-term success rates.
Todd argues that the ultimate goal of treatments should be to slow down the disability rate of low back pain. While back pain itself may not completely disappear with treatments, there is the possibility that, with patient education, more people will be able to manage their pain while continuing to work and do the things they enjoy. This is based on the concept of fear associated with back pain. Todd dives into this in detail in the webinar.
One of the principles of pain neuroscience education is that words truly do matter. What a medical professional tells a patient can hurt a patient’s recovery or contribute to their healing. Good communication can have true impact on the pain experience.
By definition, pain neuroscience is a process to explain the neurobiology of a patient’s pain experience that is easily understandable and applicable. The goal is to make a complex topic something they can relate to and understand. If they do understand, they will have better cognitions in relation to their pain. Then they can reconceptualize their pain experience and become an active participant in their recovery. Subsequently, they will move better, do more and do better with rehab. PNE includes a shift from anatomical or pathological to neurobiology and neurophysiology while sharing that there is hope.
In the webinar, Todd discusses the 4 things that patients want to know:
- What’s wrong? (Or why do they hurt?)
- What can they do to make themselves feel better?
- What can the provider do to make them feel better?
- How long will it take?
Todd provides a great list of things that a provider should do in order to communicate well and ultimately help the patient, which often means helping the patient become a more active coper and less reliant on providers. There is great research that identifies the true effect of communication on reduction of pain.
Fear plays a large factor in patient’s recovery. The ability to reduce the fear and the threat of pain helps to reduce the pain itself. Ultimately, a provider needs to tell the patient that a lot of their pain is “in their head” without minimizing what they are experiencing. More research shows that teaching people about pain can significantly reduce brain activity related to pain, which helps to end the pain meeting in the brain.
In relation to aquatic therapy specifically, Todd sees a lot of value in using it for multiple phases of helping a patient with low back pain. One of his favorite uses is the underwater cameras, simply because patient’s are able to move more freely in the water with less fear. When they see themselves doing things with their back that they are afraid to do on land, they can break some of that fear avoidance they have been experience in relation to the pain cycle.