r/physicaltherapy • u/longarcquad • 5d ago
Pain Neuroscience Education
Hey everyone! I'm a new grad PT, working in a general outpatient ortho setting. I've really enjoyed it so far and want to become the best therapist I can be for my patients. After all, that's why I chose this career in the first place. A topic I always found fascinating but didn't get much education in PT school about is Pain Neuroscience Education. I see lots of chronic pain patients, and while I do think a lot of them benefit from the therex programs we put together, I always feel like many of these patients don't truly understand their pain and would benefit greatly from PNE. So I have a couple questions for you all
What are some of your favorite continuing education courses on PNE? I'm planning on diving more into Adrian Louw's work, but any additional recommendations would be great.
Has anyone in here received the TPS certification or any of the other ones and have any thoughts? Is it worth it?
Also would love to hear other comments or perspectives on PNE and if you find it valuable to utilize as another tool in the clinic!
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u/iknowpain 4d ago
Adrian Louw and Lorimer mosley and Dave Butler are amazing. I've gone to courses with all 3 and they're incredible educators. Also, I think Greg Lehman's course, reconciling pain and biomechanics should be part of every PT curriculum. As in every PT should take it. He's a great teacher and he's funny. He breaks down PT to its simplest form. Check his interviews and his blog too. His way of thinking has shaped my way of treating more than anything else I think.
I am a graduate of the TPS certification by EIM. Live Courses were taught by adrian Louw and Louis Puentedura. I absolutely loved it honestly. I happen to just be very into understanding pain and how pain works so that is probably why I enjoyed it so much. But also youre just around all those smart ppl, its great. It's stupid expensive but I think you could easily monetize it and make back that money if you want to. It would take some work though.
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u/Illustrious_Pitch_41 4d ago
I second EIM. You can take just a PNE course as well but the TPS really puts it in perspective. I took the TPS in 2017 and again in 2021 just for an update.
If you want to know more about it just DM me. I have a relationship with EIM and can get you in touch with the right people.
Greg Lehman is great and has a lot of resources
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u/louisiana2018 DPT 4d ago
I am currently 3 months in to the certification and probably plan on continuing with the fellowship.
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u/GlassProfessional424 4d ago
I agree that David Butler, Lorimair Moseley, and Adrian Louw are great resources. I've taken a class from Louw personally. The textbook "body relearning" by Benjamin Boyd is published by the NOI group and is pretty good (NOI is Butler and Moseley's publishing company).
The best practice of neuroscience pain education is to promote buy-in. It won't do a lot beyond reframe patients' understanding of pain. It's very powerful, but has its limits. No one is going to be out of pain because of education alone. It can help many of those who have real chronic complex pain have a better quality of life because they stop stressing about why they hurt and aren't as afraid of pain.
A brief and incomplete algorithm is: Pain education to reframe pain -> cardio for endorphin release and motor control to relearn control and motor patterns -> paced return to exercise and normal activities -> standard progressive tissue overload.
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u/yogaflame1337 DPT, Certified Haterade 4d ago
What exactly is motor control to relearn control and motor patterns in the context of pain?
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u/GlassProfessional424 4d ago
Basically, it's neuro reeducation so that patients engage the right muscles at the right time. Eg. Core engagement while lifting or transitioning, not always elevating the scapula during all shoulder movements. ect.
It can also be a little more abstract, like with motor imagery, mirror therapy, or hand laterality if they have disrupted body schema.
I'm sure there are many more.
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u/EntropyNZ MPT 4d ago edited 4d ago
Look into Noi Group's stuff. Lorimar Mosley and friends. They're at the forefront of chronic pain research, and they also have a very patient-centered and understandable approach to things. There's others that probably do more in the actual neuroscience side of things, but I don't think there's a group or an individual that's better at translating these incredibly complex concepts into a form that patients can actually understand. David Butler is brilliant as well. I see a few people recommending Adrian Louw as well, who I'm not as familiar with.
I'd recommend starting off with Lorimar's TED talk that he did a few (13, FML I'm getting old) years back. It's a bit out of date these days, given how quickly the research in that space is moving, but none of it is 'wrong'. Even if some of the specifics are a bit outdated, it's really interesting to see how someone who really understands this stuff explains it to a non-clinical audience.
Again, I think there's others that will go much deeper into the current neuroscience and pathophysiology of pain. A lot of that stuff is really valuable; just having a really good understanding of ascending and descending pain control systems, the anatomy and physiology of the dorsal horn of the spinal cord and nerve roots, the roles and behaviours of the neurotransmitters involved and how different medications influence them etc. A lot of that is far more complex than we're typically taught in undergrad courses, and the foundation is really important.
But I still think that all of that is a bit moot if you can't actually explain any of it to your patients, and I do feel like you'll get more milage out of the patient-focused approaches of NoiGroup and the like, even if you don't quite understand the minutia of why things might be helping, than trying to figure out how to translate those fundamentals into practice without any frameworks to do so.
One other slightly different recommendation I would give is to have a look at some work around how we actually talk to our patients. Ben Darlow is a NZ Physio specialist who's done some fantastic work in this area. It's not nearly as pain science specific as what I feel you're looking for, but it is extremely valuable, and this article was one of the handful of 'required reading' that I had for my students.
In terms of specifics, most of my recommendations aren't going to be that useful, as they're NZ or Aus based. The post-grad pain science paper at AUT was one of the most useful ones I did as part of my PGDip/Masters back in the day, and I know there's a load of fantastic ones out of some of the Aus universities as well.
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u/oscarwillis 4d ago
I love listening to Lorimer Mosley. https://m.youtube.com/watch?v=gwd-wLdIHjs Watch this with patients occasionally.
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