Elsevier

The Journal of Pain

Volume 16, Issue 9, September 2015, Pages 807-813
The Journal of Pain

Critical Review
Fifteen Years of Explaining Pain: The Past, Present, and Future

https://doi.org/10.1016/j.jpain.2015.05.005Get rights and content
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Highlights

  • Explaining Pain (EP) is not a technique but a range of educational interventions.

  • EP aims to change understanding of the biological processes that underpin pain.

  • EP emphasizes the distinction between nociception and pain.

  • EP emphasizes that pain is a protective mechanism, not an indicator of tissue damage.

  • EP increases pain-related biological knowledge and decreases catastrophizing.

  • EP presents a biology of pain that underpins a biopsychosocial approach.

Abstract

The pain field has been advocating for some time for the importance of teaching people how to live well with pain. Perhaps some, and maybe even for many, we might again consider the possibility that we can help people live well without pain. Explaining Pain (EP) refers to a range of educational interventions that aim to change one's understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself. It draws on educational psychology, in particular conceptual change strategies, to help patients understand current thought in pain biology. The core objective of the EP approach to treatment is to shift one's conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue. Here, we describe the historical context and beginnings of EP, suggesting that it is a pragmatic application of the biopsychosocial model of pain, but differentiating it from cognitive behavioral therapy and educational components of early multidisciplinary pain management programs. We attempt to address common misconceptions of EP that have emerged over the last 15 years, highlighting that EP is not behavioral or cognitive advice, nor does it deny the potential contribution of peripheral nociceptive signals to pain. We contend that EP is grounded in strong theoretical frameworks, that its targeted effects are biologically plausible, and that available behavioral evidence is supportive. We update available meta-analyses with results of a systematic review of recent contributions to the field and propose future directions by which we might enhance the effects of EP as part of multimodal pain rehabilitation.

Perspective

EP is a range of educational interventions. EP is grounded in conceptual change and instructional design theory. It increases knowledge of pain-related biology, decreases catastrophizing, and imparts short-term reductions in pain and disability. It presents the biological information that justifies a biopsychosocial approach to rehabilitation.

Key words

Pain education
cognitive intervention
chronic pain
therapeutic neuroscience education
pain biology education

Cited by (0)

G.L.M. is supported by the National Health & Medical Research Council of Australia. D.S.B. is Director of Noigroup, which offers professional development courses entitled Explain Pain. G.L.M. and D.S.B. receive author royalties for books entitled Explain Pain.

Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.