Pain Management Bundle (5 CEUs)

Current research in chronic low back pain (cLBP) suggests a shift from the biomedical to biopsychosocial approach. In physical therapy, this means extending care beyond standard training in physiology, body structure, and biomechanical function. While many clinicians recognize the psychological and social factors affecting a person’s experience of pain, lack of training limits application of this approach. Yoga, as a holistic health practice, provides the opportunity for clinicians to address multiple domains of health and to build accessible and affordable programs that extend beyond the restrictions of insurance reimbursement.

Upon completion of this course, attendees will be able to -
• Review clinical guidelines that promote yoga as an intervention for care of cLBP
• Examine a framework of therapeutic yoga as wholistic healthcare for people with cLBP
• Appraise current research for cLBP that compares yoga to physical therapy.
• Outline the benefits of yoga for cLBP across domains of health: physical, mental, social and spiritual.

Pain is a complex response by an individual’s nervous system. Inputs to this response include information from the environment (social cues), the periphery (nociception), and the individual themself (cognitions). For over 20 years, pain scientists such as Louis Gifford, David Butler, Lorimere Mosley, Paul Hodges, Jo Nijs and Adriaan Louw have researched pain to better understand the physiology, or the neuroscience, of the response. Pain neuroscience provides the scientific framework for physical therapists to understand, on a physiologic level, what is happening when an individual experiences persistent pain. However, pain neuroscience research has uncovered the intimate role that a person’s beliefs and expectations have on the pain experience. Health behaviors such as sleep, nutrition and physical activity also affect a person’s pain. The difficulty for many physical therapists arises when we try to communicate the scientific findings to our patients while preserving the therapeutic alliance we have worked so hard to establish. How do we avoid “You are saying this is in my head.”?

This presentation will present a basic review of the neuroscience of persistent pain including the three mechanisms of pain, nociception, peripheral neuropathic and neurogenic, how to differentiate between the three and how to test for each. Pain catastrophizing is a powerful predictor of rehab outcomes and subjective pain reports. I will discuss the role of fear, fear avoidance and pain catastrophizing on the nervous system, and quickly review the Pain Catastrophization Scale (PCS). Then, I will offer scenarios where a clinician might utilize pain science education in their treatment session and what that conversation might sound like.

Upon completing the course, the attendee will be able to - 

• Describe how to identify the primary pain mechanism in a patient.
• Use the PCS as a tool to identify and measure a patient’s cognitions about their pain.
• Repeat demonstration of a conversation describing pain as an output of a sensitive nervous system to a patient.

This webinar was presented as part of the celebration of OPTA's 73rd birthday.

This webinar will discuss interventional pain management (IPM) and how it can be incorporated to achieve your patient goals. Physical therapists and physical therapist assistants will learn about interventions ranging from osteoarthritis treatments and musculoskeletal interventions to cancer pain. Dr. Mukhdomi will also discuss niche areas from hypermobility spectrum disorders to pelvic floor dysfunction.

Upon completion of this course, the attendee will be able to - 

• Identify patients that may benefit from interventional therapy.
• Identify limitations of patients in current physical therapy treatment and how IPM physicians can assist PT treatments.
• Understand the varying degree of interventions and how they can help physical therapy patients.
• Describe and identify interventions that may prevent surgery or treat post-surgical pain limitations.

This course will discuss limitations of commonly used pain measures such as the numeric rating scale and visual analog scale and discuss evidence-based alternatives which capture the complexities and impact of pain. We will focus on person-centered outcome measures and choosing the correct outcome measures for specific patients or research objectives. We will discuss patient reported outcome measures and mechanistic pain outcomes and associated challenges in assessment and interpretation. We will discuss lessons learned from a previous attempted clinical trial which was not able to be completed due to these challenges. We will focus on clinical and research implications, focusing on how to improve future clinical practice and research to align with evidence-based standards in pain assessment.

Upon completion of this session, the attendee will be able to:

• Understand the limitations in traditional measures of pain.
• Understand alternative patient reported and mechanistic outcomes including measurement tools and clinical utility.
• Understand challenges and limitations in pain assessment through different measures.
• Understand evidence based application of pain measures in the clinic, research setting, and classroom.

This course presents results of Dr. Keter's and Dr. Learman's OPTA grant funded research project, supported by the OPTA's Research Committee.