PPA Pain Project

Description

The Physiotherapy Pain Association (PPA) is the Professional Network of the UK`s Chartered Society of Physiotherapy and part of its recently formed NeuroMusculoskeletal Alliance. It is both pleased and proud to have led this project to develop the Pain section in Physiopedia. 

The aim of the project was to populate the site with practical, credible and thought-provoking information on the science of pain, its assessment and management. Much of our direction was guided by the IASP Curriculum Outline on Pain for Physical Therapy.

Project Lead

The Physiopedia team is currently managing this project.

Project Dates

June 2014 onwards

Articles Created

Multidimensional Experience

• Multidimensional Nature of Pain: Define acute and chronic pain terms of a multidimensional pain experience.
• Epidemiology of Pain: Describe pain epidemiology in terms of a public health problem with social, ethical, and economic considerations
  

Biological Factors of Pain

• Nociception: Describe nociceptors and the need for adequate stimuli to activate nociceptors in different tissue types (i.e. skin, muscle, joint, viscera).
• Peripheral Sensitisation: Describe peripheral sensitization and how these changes are associated with pain perception
• Neurogenic Inflammation: Describe neurogenic inflammation, the neurotransmitters involved in this process, and how these neurotransmitters could contribute to peripheral pain processing
• Processing of nociception:
  • Describe and explain the afferent innervations of the spinal cord from different tissue types, and how pain from different tissues is processed centrally.
  • Describe the changes and role of ion channels, excitatory neurotransmitters, and inhibitory neurotransmitters in the peripheral nervous system and in non-neuronal cells, and how these changes influence the processing of noceception.
• Sensory discriminative and motivational affective component of pain: Describe the pain pathways involved in the sensory discriminative and motivational affective component of pain.
• Central sensitisation: Describe and define central sensitization and how this is similar and different from peripheral sensitization.
• Pain Behaviours: Describe the mechanisms that underlie pain behaviors: referred pain, primary hyperalgesia, secondary hyperalgesia, allodynia
• Alteration of nociception transmission post injury: Describe the role of excitatory neurotransmitters, inhibitory neurotransmitters, and glia in the central nervous system in enhancement of pain transmission, and changes that occur as a result of tissue injury.
• Descending pathways - Changed to Pain Descending Pathways: Describe the descending pathways that modulate pain transmission
• Pain facilitation and inhibition: Define and describe the the differences between them in terms of brain sites and neurotransmitters that play a role in this process. And how these pathways can be activated by non-pharmacological treatments.
• Chronic pain and the brain: Describe and explain the long term impact of pain on the brain.
• Interactions between pain and motor function: Theories on the interactions between pain and motor function - describe/compare/contras

The Psychological Basis of Pain

Psychological basis of pain: Describe and explain current theories of the psychological basis of pain e.g……..fear avoidance, pain-related anxiety, pain catastrophising, stress. and learned helplessness.

Sociologocial Basis of Pain

• Sociological basis of pain

Pain Assessment

• Pain Assessment Tools:
  • Describe and explain the use of common tools used to measure each component of a pain experience: Sensory/Affective/Cognitive/Physiological/Behavioural
  • Critique the commonly used measures for different pain dimensions: 1.Self-report measures as "accepted standard" not gold standard. 2. Physical performance measures including Functional Capacity Evaluations (FCEs). 3. Physiological/autonomic response measures
• Complexities of Pain Assessment: Describe and explain the considerations that maybe required when assessing an individuals pain experience relating to : communication barriers, cognitive impairment, spirituality, ethnicity, age, pain type/state e.g. cancer pain or neuropathic pain.

Pain Management

• Multidiciplinary Care in Pain Management:
  • Multidisciplinary care: Describe and explain the role and responsibilities of the physical therapist in pain management and the integration of physical therapy into the interdisciplinary team.
  • Roles and responsibilities of other health care professionals in the area of pain management and the merits of interdisciplinary collaboration.
• Pharmacology in Pain Management : Describe the principles of the pharmacology of medications used to treat pain: non-opioid medications, opioids, adjuvants and topical analgesics and local anaesthetics. Including limitations of the pharmacological management of chronic pain.
• Patient Education in Pain Management: Describe the evidence base supporting the use of therapeutic neuroscience education and self-management as a critical part of pain management (this could include education styles: biomedical, psychological, neuroscience. Service delivery options: face to face, web-based, group education. Models used: stings of change theory etc)
• Behavioural Approaches to Pain Management: Describe cognitive and physical aspects of behavioural approaches to pain management and how applied in practice.
• Psychological Approaches to Pain Management: Describe models/theories and how applied in practice e.g. self efficacy, readiness to change, acceptance, coping 
• Exercise and Activity in Pain Management: including exercise prescription and modification for pts in pain - reps/sets/duration/intensity/pacing/goal setting/motivation 
• Re-engagement in Life Roles with Pain Conditions links between pain and function/work lags model and barriers to re-engagement
• Workplace Related Pain: links between the workplace and pain and barriers to overcome the issue
• Traditional Physiotherapy Interventions: electrotherapy/acupuncture/manipulation/massage/relaxation

Specific Clinical Conditions

• Headache and Migraine
• Cancer pain
• Fibromyalgia
• Myofascial pain 
• Neuropathic pain 
• Complex regional pain syndromes