Q&A Time! Help with Pain Science Education and Referral Out | Modern Manual Therapy Blog

Q&A Time! Help with Pain Science Education and Referral Out

Thanks to Matt, a reader who submitted the following not so easy to answer question.

"When do you refer chronic pain pts to psychologists? I've been working in a new outpatient clinic that allows me hour long treatments. This is great for that population but I've come to realize that 12 visits with me is still not enough for patients with 20+ year history of persistent pain. I have been getting positive results but not to my satisfaction. Maybe this will improve as I get better (only been in practice 2 yrs) but presently I am only able to begin to scratch the surface. I feel like I do a thorough job explaining pain. I've also taken the Explain Pain course and read many pain blogs and they never indicate that this is recommended. What do you do?

Thanks in advance!"


Good for you for reading some of the must read blogs out there and implementing modern Pain Science Education. As you probably know, I took one of Butler's first Explain Pain Courses when it was offered in the US in 2002 and immediately purchased and read Explain Pain. Pain Science went from something I use in chronic, non-responding patients only, or those with high fear avoidance, to using elements of it in my entire caseload.

When you first take an amazing course like Explain Pain, or read the highly recommended Therapeutic Neuroscience Education text, it's a mind blowing experience and often is a paradigm shift in the right direction. However, the changes are by and large for the clinician to evolve in the way you interact with a patient, the words you choose, analogies and stories you use to explain their pain. It is a tough sell to many patients and only experience will give you more examples to use with different types of patients.

In regards to referring out, that is difficult and I agree not often discussed in the courses/blogs. I have been at this for more than a decade, even treated psychologists and psychiatrists who were open to the explanations, yet did not want to read/learn more or take chronic pain referrals. Only 1 of my top referring docs started to read more on pain, and the rest are steeped in pathoanatomy.

I have often felt like a patient's only positive affirming light in a dark sea of nocebo infusing clinicians. Unless you work for a Chronic Pain Center with a team that is on board with modern Pain Science, it is a tough road indeed. Since the true centrally sensitized patient needs multiple sessions with repetitive information, education on movement, nutrition, sleep, etc... it is often a job for more than one sole clinician.

Still, this is in my experience only, and the positives still outweigh the negatives. You WILL reach people and make them understand their pain and that it can change. You will empower them with self treatment, improve their quality of life and function. If you can find other practitioners that are on board to help you reinforce this, great! Keep up the good fight, there are too few of us out there doing it.

Keeping it Eclectic...


  1. Edson, do you have links to any of these texts of urls to some of these blogs or studies? I'm interested in learning more about this.

  2. See the course review of my top recommended text here. http://goo.gl/oF5vJ4

  3. Still haven't found that but I no longer use docs or market to referral sources either. Would loved to have found one years ago though.