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A neglected citation about patient dissatisfaction with Pain Explaining

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I missed a particularly obvious citation last week when posting about the gaslighting of chronic pain patients with pain neuroscience education (PNE, better known as “Explain Pain”). I knew about the study, but neglected it. I was too focused on a juicy anecdote, and I just temporarily forgot to science! Oops.

*gives head a shake*

Okay, I’m back. Better late than never, the citation is:

Weisman A, Yona T, Gottlieb U, Masharawi Y. Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Musculoskelet Sci Pract. 2022 Jun;59:102551. PubMed 35287028 ❐

Flash review: PNE is about exploring the nature of pain with patients, especially the idea that its bark is often worse than its bite. The knowledge-based confidence boost will allegedly tame some pain.

 Weisman et al. studied the attitudes about PNE in social media users. It’s a small study with significant limitations — clearly acknowledged by the authors — but it is actual data that echoes my own impressions of what patients say about PNE both publicly, and what my readers say privately to me (like the example I blogged yesterday). So the data backs up a conclusion I had already tentatively arrived at:

“People with persistent pain tend to express negative attitudes to PNE statements.”

Unsurprisingly, patients are also more likely to be cranky about PNE than the professionals delivering PNE. As I have been arguing for 20 years now, the clinicians who choose to use a methodology are the very last to find out that patients don’t like it, for many reasons.

“The possible problematic nature of PNE statements should be acknowledged,” the authors write. Agreed, that possibility should indeed be acknowledged, and that’s what this is all about. Patient dissatisfaction with a modality isn’t necessarily a deal-breaker, but it is certainly one of those “things that make you go hmmmmm.” 🤔 We always need to be aware of the potential pitfalls of any kind kind of treatment, so that we can guard against them. I am certainly not throwing out any PNE babies out with their bathwater (not yet, anyway), but I am interested in the problem … because patients are complaining, and I want to undertand why.

My concern is not just that some clinicians do PNE badly — which obviously can happen with any treatment — but that many of them do it quite badly, because it’s just too hard to do well. And because, perhaps, it combines disastrously with common clinician biases and foibles.

But all of this is just a “concern,” not a condemnation.