The Effect of Pain Neuroscience Education on Sports Therapy and Rehabilitation Students’ Knowledge, Attitudes, and Clinical Recommendations Toward Athletes With Chronic Pain

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $185.00

Context: Pain education is a fundamental part of a holistic approach to athlete injury management. Objective: To investigate the effect of pain neuroscience education (PNE) on sports therapy and rehabilitation students (1) knowledge of persistent pain, (2) attitudes toward athletes with persistent pain, and (3) clinical recommendations for athletes with persistent pain. Design: Parallel groups, single-blind randomized control trial. Setting: A university in the United Kingdom. Participants: Sixty-one undergraduate and postgraduate sports therapy and rehabilitation students. Interventions: The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. Outcome measures: (1) Knowledge—the Revised Pain Neurophysiology Questionnaire; (2) Attitudes—the Health Care Pain Attitudes and Impairment Relationship Scale; and (3) Clinical recommendations—an athlete case vignette. Results: Posteducation, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2; 95% confidence interval [95% CI], 2.1 to 4.3; P < .01) and improved attitudes (mean difference −10.1; 95% CI, −16.6 to −3.6; P < .01). In addition, students in the PNE group were more likely to make appropriate clinical recommendations (odds ratio [OR]; 95% CI) regarding return-to-work (OR = 6.1; 95% CI, 1.1 to 32.3; P = .03), exercise (OR = 10.7; 95% CI, 2.6 to 43.7; P ≤ 01), and bed rest (OR = 4.3; 95% CI, 1.5 to 12.8; P = 01). Conclusion: A brief PNE session can, in the immediate term, increase sports therapy and rehabilitation students’ knowledge of pain neuroscience, improve attitudes toward athletes with pain, and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.

Maguire and Ryan are with the School of Health, Teesside University, Middlesbrough, United Kingdom. Chesterton is with the School of Social Sciences and Law, Teesside University, Middlesbrough, United Kingdom.

Maguire (n.maguire@tees.ac.uk) is corresponding author.
  • 1.

    Bahr R, Andersen SO, Løken S, Fossan B, Hansen T, Holme I. Low back pain among endurance athletes with and without specific back loading—a cross-sectional survey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine. 2004;29(4):449–454. PubMed ID: 15094542 doi:10.1097/01.BRS.0000096176.92881.37

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Heidari J, Mierswa T, Kleinert J, et al. Parameters of low back pain chronicity among athletes: associations with physical and mental stress. Phys Ther Sport. 2016;21:31–37. PubMed ID:27428532 doi:10.1016/j.ptsp.2016.03.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport. 2012;13(3):123–133. PubMed ID:22814445 doi:10.1016/j.ptsp.2011.12.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE Guideline [NG59]. 2016.

    • Search Google Scholar
    • Export Citation
  • 5.

    Briggs EV, Carr EC, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15(8):789–795. PubMed ID: 21330174 doi:10.1016/j.ejpain.2011.01.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Noll M, Silveira EA, Avelar IS. Evaluation of factors associated with severe and frequent back pain in high school athletes. PLoS ONE 2017;12(2):0171978. PubMed ID: 28222141 doi:10.1371/journal.pone.0171978

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Moseley L. Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain. 2003;4(4):184–189. PubMed ID: 14622702

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Colleary G, O’Sullivan K, Griffin D, Ryan CG, Martin DJ. Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial. Physiotherapy. 2017;103(4):423–429. doi:10.1016/j.physio.2017.01.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Catley MJ, O’Connell NE, Moseley GL. How good is the neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties. J Pain. 2013;14(8):818–827. PubMed ID: 23651882 doi:10.1016/j.jpain.2013.02.008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Houben RM, Vlaeyen JW, Peters M, Ostelo RW, Wolters PM. Stomp-van den Berg, SG. Health care providers’ attitudes and beliefs towards common low back pain: factor structure and psychometric properties of the HC-PAIRS. Clin J Pain. 2004;20(1):37–44. PubMed ID: 14668655 doi:10.1097/00002508-200401000-00008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Peabody JW, Luck J, Glassman P, et al. Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004;141(10):771–780. PubMed ID: 15545677 doi:10.7326/0003-4819-141-10-200411160-00008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Butler DS, Moseley GL. Explain Pain. 2nd ed. Adelaide, Australia: Noigroup Publications; 2013.

  • 13.

    Ferguson F, Holdsworth L, Rafferty D. Low back pain and physiotherapy use of red flags: the evidence from Scotland. Physiotherapy. 2010;96(4):282–288. PubMed ID: 21056162 doi:10.1016/j.physio.2010.01.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Rainville J, Bagnall D, Phalen L. Health care providers’ attitudes and beliefs about functional impairments and chronic back pain. Clin J Pain. 1995;11(4):287–295. PubMed ID: 8788576 doi:10.1097/00002508-199512000-00006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain relate to attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135:187–195. PubMed ID: 18206309 doi:10.1016/j.pain.2007.11.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Ryan CG, Schofield P, Martin DJ. Therapy students’ recommendations of physical activity for managing persistent low back pain in older adults. J Aging Phys Act. 2013;21(3):309–318. PubMed ID: 23006453 doi:10.1123/japa.21.3.309

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Houben RM, Gijsen A, Peterson J, de Jong PJ, Vlaeyen JW. Do health care providers’ attitudes towards back pain predict their treatment recommendations? Differential predictive validity of implicit and explicit attitude measures. Pain. 2005;114(3):491–498. PubMed ID: 15777874 doi:10.1016/j.pain.2005.01.017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Cox T, Louw A, Puentedura EJ. An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs. J Man Manip Ther. 2016;25(1):11–21. PubMed ID: 28855788 doi:10.1080/10669817.2015.1122308

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Morris H, Ryan C, Lauchlan D, Field M. Do medical student attitudes towards patients with chronic low back pain improve during training? A cross-sectional study. BMC Med Educ. 2012;12(1):10. doi:10.1186/1472-6920-12-10

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15:S192–300. PubMed ID: 16550448 doi:10.1007/s00586-006-1072-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 269 269 31
Full Text Views 23 23 4
PDF Downloads 13 13 2