It’s that time of the New Year and predictions on what the “Next Big Thing” for 2017 might be. I want to go on record to say, pain neuroscience is NOT the “Next Big Thing” in physical therapy. This may surprise a few of you, but hopefully I can explain. Now that I get to check the “20+” box on surveys that ask how long I’ve been practicing physical therapy, I’ve seen just a few “Next Big Things” come and go in physical therapy. (It might be a fun Twitter experiment to list out PT interventions that were once the next big thing that came and went - #PT-NBTTCAW) I want to go over a few reasons, why I don’t think pain neuroscience is the next big thing in physical therapy and why it won’t come and go.
First, pain neuroscience is not new. Pain neuroscience is just the biology, psychology, and sociology of what happens during a pain experience for individuals. It has been around since biology began, people had brains, and walked the earth interacting with each other. I hear some people in internet chat rooms and Twittersphere say they don’t need to bother with understanding pain neuroscience. It might be because they only treat acute pain and not chronic pain. They argue that pain neuroscience only matters with chronic pain and not acute pain. Or maybe worse yet they still are under the assumption of Descartes. They still believe that the ‘pain’ they treat is only biomechanical and not the ‘pain’ being looked at in pain neuroscience research. The reality is pain neuroscience is happening in every patient that you treat with pain. It does not matter if acute or chronic, biomechanical or not, tall or short, male or female. Pain and the pain neuroscience behind that pain is always present during a pain experience. Whether you want to understand it or not is up to you. For me personally and professionally, I think it is best to try and understand all the processes going on in my patients. It is through the understanding of the biological, psychological and social processes going on with my patient that allows me to most effectively educate and treat them on what is going on in their body. It is through a shared understanding that we can work together to set up the best interventions to combat what they are dealing with.
Next, pain neuroscience is not going to go away. Pain neuroscience is just that ‘science’, a systematic process that builds and organizes knowledge in the form of testable explanations and predictions about the universe as it relates to pain specifically. Science helps reveal the mysteries of our universe and helps us explain natural phenomena that we see daily. Our understanding of pain neuroscience will continue to evolve and grow as our understanding and knowledge grows with the science.
The “application” of pain neuroscience on the other hand will produce a few “next big things” in physical therapy and health care. Various applications of pain neuroscience will lead to innovations to clinical practice. One of those applications that is an innovation to clinical practice is pain neuroscience education. If we map it out on the Diffusion of Innovation curve, I think we could say it is somewhere around the middle to latter stages of early adopters. I don’t think we have hit the “tipping point” just yet. We have the early innovators with Louie Gifford and others about 20 years ago, and we have moved into the next phase with early adopters. Many of you reading this post and starting to incorporate it into your clinical practice, fall into this early adopter phase. I think how well pain neuroscience education is applied will help determine how well it moves along the innovation curve over time. If the application of pain neuroscience education stays rooted in the science of pain, it will be around forever and lead to significant innovation of practice. In order to do this, pain neuroscience education will have to evolve and change as the science and our understanding of pain evolves and changes. Pain neuroscience is not the Next Big Thing of 2017, but the application of it in the form of pain neuroscience education may very likely continue to grow as one of the next big things in physical therapy and health care. The question I might ask is where will you be at on the Diffusion of Innovation curve to pick up this innovation? Will you be the person that helps get it to the tipping point or a laggard?
Via Dr. Kory Zimney, DPT
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