Wijma A.J.1,2,3, van Wilgen C.P.1,2,3, Meeus M.3,4,5, Nijs J.1,3
1Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Brussels, Belgium, 2Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, Netherlands, 3Pain in Motion, www.paininmotion.be, Brussels, Belgium, 4Antwerp University, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Antwerp, Belgium, 5Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent, Belgium
Background: Pain Neuroscience Education (PNE) is increasingly used in physiotherapy as part of the treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how this assessment should be administered.
Purpose: The purpose of this study was to provide a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice.
Methods: A narrative review based on scientific research and clinical expertise.
Results: The clinical biopsychosocial physiotherapy assessment is described based on the PSCEBSM-model, which includes: Pain Somatic factors Cognitive factors Emotional factors Behavioral factors Social factors Motivation. This model attempts to first establish the dominant pain mechanism. Based on a prior described algorithm, proposed by 18 pain experts from seven countries, with a set of classification criteria a differentiation can be made between predominant neuropathic, nociceptive and CS pain in patients with chronic pain. (Nijs et al, 2014). When this is established the next step is to assess the provoking and perpetuating biopsychosocial factors in the patient with chronic pain. Somatic factors can be other medical conditions, medication, nonuse or disuse of body parts, changed movement patterns, exercise capacity, strength and muscle tension/tonus during movements. Cognitive factors/perceptions contain the thoughts of patients about the physical and mental aspects of pain, the expectations for care, expectations regarding the prognosis of their pain, emotional representation of the pain, as well as cognitive patterns, such as catastrophizing, perceived injustice and perceived harm. Emotional factors include anxiety, anger, fear of movement, depressive feelings, stress and post-traumatic stress. Behavioral factors comprise of (un)conscious behavior patients carry out, such as: avoidance behavior, persistence behavior, having a saw-tooth-pattern of activities and avoided activities based on the Fear Avoidance model, operant conditioning, the Common Sense Model of Self-regulation and the Imprecision Hypothesis. Social factors can be divided into: housing or living situation, social environment, work, relationship with the partner, and prior/other treatments. Last, the motivation of the patient is determined according to psychological flexibility and/or the stage of change model. After the intake it is advised to use a pain analysis sheet, in which the PSCEBSM-model is processed.
Conclusion(s): To our knowledge this is the first study describing the comprehensive biopsychosocial intake of patients with central sensitization in physiotherapy practice. The approach used is derived on scientific evidence as well as expert opinion. The PSCEBSM-model and approach, however, needs to be investigated further in clinical trials with chronic pain patients.
Implications: Chronic pain is complicated, and a thorough biopsychosocial intake, examination and interdisciplinary treatment plan are required for success. Using the PSCEBSM-model allows the clinician to specifically classify the patient and tailor the plan of care, including PNE, to the individual patient.
Funding acknowledgements: This study was unfunded.
Topic: Pain & pain management
Ethics approval: This study was conducted complying with the Dutch law and international principles on research. Further ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
