Chronic pain is a growing concern globally, affecting millions with significant socioeconomic impact. Despite its prevalence, effective care structures remain inadequate, prolonging suffering and increasing healthcare costs. Current approaches emphasize interdisciplinary management tailored to individual needs, yet the role of Neuroscientific Pain Education (NPE) remains debated, highlighting the need for further research into its efficacy and integration into treatment protocols.
Prevalence of chronic Pain and neuroscientific pain education as a modern approach: Short discussion. (2024)
Author: Tobias Giesen (M.Sc. SEM, B.Sc. PT)
The number of chronic pain patients is increasing in our society. As early as 2002, Diemer and Burchert reported that between 5 and 8 million people suffered from chronic pain. Of these, doctors identified a treatment-relevant group of 20% who required qualitative pain management care. However, it was noted that there were hardly any care structures available to treat these patients. The German Pain Society (n.d.) states that about 17% of all people in Germany suffer from chronic pain, with the duration of symptoms often exceeding seven years before improvement is seen. Approximately 20% of these patients suffer from pain for over 20 years. The article further reports that it takes more than two years for chronic pain patients to be referred to a pain specialist. The authors note that chronic pain is estimated to cost around 38 billion euros annually, with 10 billion euros being spent on sickness benefits and disability pensions. Morlion et al. (2016) reported the healthcare costs related to chronic pain in EU member states to be approximately 441 billion euros. It is estimated that one in five European citizens suffers from such conditions. Overall, this sum amounts to two to three percent of the gross domestic product, placing a significant burden not only in Germany but across Europe. The pathologies in Europe include chronic headaches (around 153 million), chronic musculoskeletal pain (around 200 million), and people with other forms of organic chronic pain (around 100 million). Statistically, according to von der Lippe et al. (2021), women (54.9%) are more frequently affected by chronic pain than men (36.2%). According to Morli- on et al. (2016), back and neck pain have the greatest impact. Around 2.3 million people were on sick leave for at least four weeks due to chronic complaints, and it is estimated that up to 500 million sick days per year in Europe are caused by this condition. As a result, the risk of permanent disability continues to increase, and the number of people unable to work may rise, putting further strain on the social system. Consequently, the costs for health insurers, both domestically and abroad, are expected to be increasingly difficult to bear in the long term.
Langley et al. (2010) reported in their study that the quality of life of people with chronic pain is significantly reduced. Sanzarello et al. (2016) wrote about a 10.7% loss of quality-adjusted life years (Years lost through Pain) of a patient's average life expectancy. The authors referred specifically to lower back pain, which according to statistics is less common than neck pain, as they themselves note. The German Pain Society (n.d.) adds to this statement the relevance of newly emerging psychosocial-emotional factors as risks for further development of clinical emotional flags. These include anxiety, depression, fear of failure, and burnout. The same literature estimates that 80% of those who become unable to work due to chronic pain are also affected by high work demands, workplace conflicts, and depression. Additionally, the use of medications has increased throughout Germany, according to the German Pain Society (n.d.). The relevance for physiotherapy is also reflected in the lack of scientific knowledge on chronic pain (Sanzarello et al., 2016). Current management strategies, according to Cohen et al. (2021), involve an interdisciplinary approach tailored to individual patients and their specific situations. Blanpied et al. (2017) focus on treatment management for neck pain, including chronic cases. Since similar treatment approaches are likely applied to all types of chronic pain patients, and guidelines recommend similar strategies, the following will explore treatment recommendations for chronic (neck) pain. General treatment methods include manual therapy in the form of mobilization/manipulation and soft tissue techniques, medical exercise therapy, dry needling or acupuncture, and in some cases, pain education. However, Neuroscientific Pain Education (NPE) plays a relatively minor role in such guidelines. It is often associated with the development of coping strategies rather than with the actual education that patients should receive, as Louw et al. (2017) points out. According to his findings, therapists are highly skilled at conveying coping strategies in various forms of therapy. However, the justification for their use is often accompanied by nocebo effects (Hohenschurz-Schmidt et al., 2022). The underlying mechanisms differ depending on the profession, such as osteopathy, chiropractic, or physiotherapy. This suggests that the core understanding of pain origins for chronic pain varies greatly. As an example, the Neck Pain Guideline by Bier et al. (2017) recommends informing patients that the pain is not harmful and serves as a warning signal. Patients are encouraged to continue moving to improve symptoms. No clear recommendation is given regarding the type and extent of education. Therefore, a hypothesis could be raised that physiotherapists, for instance, may not provide adequate pain education because of either a lack of guideline recommendations or the discussion of unproven explanatory models with patients (Evers et al., 2018). As a result, it is left to the quality of the therapist to make a conscious and differentiated decision about pain education. De C Williams et al. (2020) state that the type of communication with the patient is crucial, and therefore, the same education delivered by two therapists can have different effects. Worz et al. (2022) also highlights communication challenges with individual patients.
While Bier et al. (2017) recommends clinical neurospecific pain education, other studies question its benefits. For example, in a meta-analysis, Suso- Marti et al. (2022) found that patients receiving pain education did not fare better than those who did not. Given the many differing opinions, a study should be conducted to observe whether Neuroscientific Pain Education has an effect on the treatment of chronic pain and to assess the extent of the effect as reported by patients.
About the Author:
Tobias Giesen is a physiotherapist specialized in musculoskeletal physiotherapy. After his Bachelor's degree in Physiotherapy, he studied for a Master of Science in Sport and Exercise Medicine at a British faculty and completed it successfully. His particular interests lie in medical neuroscience, pain medicine, and manual therapy.
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- Tobias Giesen (Author), 2024, Prevalence of chronic Pain and neuroscientific pain education as a modern approach, Munich, GRIN Verlag, https://www.grin.com/document/1605327
