Changes in Burnout, Pain Attitudes and Beliefs, and Confidence in Treating Patients in Pain Following Pain Education for Healthcare Providers.

Background: Educating occupational therapy (OT) students in pain science is essential to align with biopsychosocial treatment models and multidisciplinary approaches. This knowledge equips them to tackle the pain and opioid epidemic in clinical practice. This study aimed to evaluate if a pain neuroscience education (PNE) lecture for OT students produced immediate positive shifts and whether these changes correlated with those observed in physical therapy and physician assistant students. Methods: This case series involved 120 OT students from four United States (US) schools who participated in a two-hour PNE lecture, delivered in-person or online. Pre- and post-lecture assessments included the revised neurophysiology of pain questionnaire (rNPQ), Likert Scale questions on pain beliefs, and the pain attitudes and beliefs scale (biomedical) PABS-BM and pain attitudes and beliefs scale (biopsychosocial) PABS-BPS to evaluate changes in pain knowledge and attitudes. Results: Data collected from 120 OT students enrolled in four entry-level OTD programs yielded significant changes in rNPQ (p <0.001), PABS-BM (p < 0.001), PABS-BPS (p < 0.001) and all beliefs shifted positively after the PNE lecture. Positive postPNE lecture changes were similar for in-person and online presentations. Conclusion and Relevance: Our results indicate that PNE taught to OT students, either online or in person, results in increased knowledge of pain neuroscience, healthier beliefs regarding persistent pain, and shifts students from a biomedical model towards a biopsychosocial model.

Background: The chronic pain epidemic requires all healthcare providers to develop an updated, uniform understanding of modern pain science. Objective: To determine if a 2-hour pain neuroscience education lecture to physical therapy assistant (PTA) students yields any positive shifts in pain knowledge and attitudes and beliefs regarding chronic pain. Design: Pre and post-education survey Methods: A convenience sample of PTA students at two schools volunteered for the study. Students received a 2-hour pain neuroscience lecture, either in-person or live, online. Prior to and immediately following the presentation, knowledge of pain (revised neurophysiology of pain questionnaire) and attitudes and beliefs regarding pain (health care provider’s pain and impairment relationship scale and pain attitudes and beliefs scale) were administered. Results: Thirty-five students completed the pre- and post-education surveys. No significant changes were found in pain knowledge, (p = 0.241). Interestingly, nearly all (94.3%) of the students were exposed to pain neuroscience education prior to the lecture in their PTA program, with high pre-education pain knowledge scores then previous studies investigating student pain knowledge Significant changes were found for the health care provider’s pain and impairment relationship scale (p = 0.01), and pain attitudes and beliefs scale for biomedical beliefs (p = 0.014), but not the biopsychosocial scale (p = 0.142). Conclusion: PTA students in this study had a lot of previous exposure to pain education, leading to high pain knowledge levels. A lecture on pain neuroscience can shift physical therapy assistant students away from a pure biomedical view of chronic pain and increase their empathy and compassion towards patients with chronic pain, but it is not able to foster a stronger biopsychosocial view of chronic pain.

Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale (PABS)

To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. Our analysis included data from 156 participants (mean age: 20.9±2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p=0.00; η 2 =0.654), for PABS-PT factor 1(p<0.001; η2=0.50) and for PABS-PT factor 2 over time (p=0.02; η 2 =0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.

Pain Knowledge, Attitudes and Beliefs of Allied Health Learners Across Three Curricular Models

The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs. Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain Questionnaire and the Health Care Provider's Pain and Impairment Relationship Scale were administered before and after the PNE lecture. All grades improved in pain knowledge and beliefs. Higher-grade school participants (sixth to eighth grades) experienced larger shifts in pain knowledge and attitudes and beliefs than lower-grade (third to fifth grades) participants. PNE results in changes in pain knowledge and beliefs in school participants in grades 3 to 8.

BackgroundChronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions.The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS).MethodsA pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module.ResultsLearners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = − 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = − 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS.ConclusionsThere was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge.

Introduction Physician assistants treat patients with chronic musculoskeletal pain on a regular basis. This pilot study implemented a pain education module in the first semester of didactic training and evaluated changes in knowledge, attitudes, and recommendations for lower back pain. Methods The biopsychosocial pain education module, focused on the social, cultural, psychological, and biological complexities of pain and incorporated online training and in-person case based discussions. Students completed surveys on pain knowledge, attitudes, and recommendations for a case scenario before and after the module and at a one-year follow-up. Results Physician assistant students' pain attitudes and beliefs demonstrated statistically significant shifts toward a biopsychosocial perspective immediately after the educational module (P &lt; 0.001) and at one-year follow-up compared with pretest levels (P = .034). Pain knowledge demonstrated statistically significant improvements immediately after the module (P = .006). At one-year follow-up, pain knowledge was not statistically significantly different from pretest levels (P = .530). Clinical recommendations for the case-based scenario trended toward increased agreement with clinical practice guideline recommendations after the module and persisted at the one-year follow-up. Discussion Implementing a pain education module with emphasis on the multidimensional nature of pain using a case-based approach can improve pain knowledge, attitudes, and recommendations for care.

Context:Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in chronic pain. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and attitudes and beliefs related to chronic pain.Aims:The objective of this paper was to assess the chronic pain-related attitudes and beliefs among nursing professionals in order to evaluate the biomedical and behavioral dimensions of their perceptions on pain.Settings and Design:Cross-sectional survey of 363 nurses in a multispecialty hospital.Materials and Methods:The study utilized a self-report questionnaire – pain attitudes and beliefs scale (PABS) – which had 31 items (statements about pain) for each of which the person had to indicate the level at which he or she agreed or disagreed with each statement. Factor 1 score indicated a biomedical dimension while factor 2 score indicated a behavioral dimension to pain.Statistical Analysis Used:Comparisons across individual and professional variables for both dimensions were done using one-way ANOVA and correlations were done using the Karl–Pearson co-efficient using SPSS version 11.5 for Windows.Results:The overall factor 1 score was 52.95 ± 10.23 and factor 2 score was 20.93 ± 4.72 (P = 0.00). The female nurses had a higher behavioral dimension score (21.1 ± 4.81) than their male counterparts (19.55 ± 3.67) which was significant at P < 0.05 level.Conclusions:Nurses had a greater orientation toward the biomedical dimension of chronic pain than the behavioral dimension. This difference was more pronounced in female nurses and those nurses who reported very “good” general health had higher behavioral dimension scores than those who had good general health. The study findings have important curricular implications for nurses and practical implications in palliative care.

Introduction: Increasing school students’ knowledge and beliefs regarding pain yield positive behavior changes including decreased medication use and school absenteeism, as well as increased participation in physical activity. Objectives: To determine if a brief, one-time pain neuroscience education (PNE) lecture developed in the United States (US) to school students in Belize can yield similar positive shifts in pain knowledge and beliefs. Methods: One hundred and fourteen Belize elementary school students attended a 30-minute PNE lecture. Prior to and immediately following the lecture measurements regarding pain knowledge and pain beliefs were completed. Pain knowledge was measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and pain beliefs were measured using the adapted Health Care Provider’s Pain and Impairment Relationship Scale (HC-PAIRS). Results: Immediately following the lecture, overall pain knowledge improved significantly (p &lt; 0.001) from 28.6% to 35.4%. Eight of the statements in the rNPQ shifted significantly following PNE. All pain beliefs shifted positive, with two reaching significance - “You can control how much pain you feel” (p = 0.02) and “Your brain decides if you feel pain, not your tissues” (p = 0.003). Conclusions: A one-time PNE lecture to elementary school students in Belize positively shifts pain knowledge and beliefs. The shift in pain knowledge, albeit significant, was less compared to previously US studies and with similar pre-PNE baseline scores indicate a need to further investigate and explore a PNE program specific to students in Belize to better match their ethnic and cultural needs.

Objectives: To compare if a video-delivered pain neuroscience education (PNE) session yield comparable results to a live-PNE session delivered to middle school students in terms of pain knowledge and attitudes and beliefs regarding pain. Methods: Two hundred and fifty-one 5th through 8th grade middle school students were randomly assigned to receive a live (n = 147) or video-delivered (n = 104) presentation (30 minutes). Prior to and immediately following the lectures, students completed a knowledge of pain questionnaire (Neurophysiology of Pain Questionnaire – NPQ) and beliefs regarding pain questionnaire (Health Care Provider’s Pain and Impairment Relationship Scale - HC-PAIRS). Results: Both video (p < 0.001) and live presentations (p < 0.001) yielded significant increases in pain knowledge and both showed large effect sizes (video 0.81 and live 0.82) as well. Pain beliefs questions of “You can control how much pain you feel” and “Your brain decides if you feel pain, not your tissues” both had significant changes (both groups p < 0.001), with moderate effect size for both groups (video .45 and .56; live .51 and 68). Conclusion: A 30-minute video-delivered PNE resulted in similar changes to a live, in-person PNE session. The results from this study may help PNE approaches for middle schools to become standardized, costeffective and scalable. Larger trials with long-term follow-up are needed to determine if video-delivery PNE is effective in altering behavior change.

Reply to "Pain neuroscience education for fibromyalgia syndrome".

Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23–28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists’ treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument’s responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach’s alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test–retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.

BACKGROUND: The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists’ (PTs) beliefs and attitudes regarding LBP with those of PCPs.OBJECTIVE: We compared PCPs’ and PTs’ attitudes and beliefs regarding LBP management.METHODS: We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia.RESULTS:In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs.CONCLUSIONS: HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs’ treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.

This study investigates the impact of a comprehensive pain science framework that includes integrated content, a standalone course, and training of core faculty in a physical therapist (PT) education program. The aim is to determine if this approach leads to significant changes in students' knowledge, beliefs, and confidence. Recent studies have examined various implementation strategies for pain education in entry-level PT education programs, yielding mixed results in knowledge retention and changes in attitudes and beliefs. Physical therapist students enrolled in a hybrid, accelerated program (n = 99). Before the program's start, core faculty members completed a pain science continuing education (CE) course. Pain science content was integrated throughout the curriculum, coupled with a standalone 2-credit-hour course. Data were collected using the revised Neurophysiology of Pain Questionnaire, the Pain Attitudes and Beliefs Scale for Physiotherapists, and the 5-question Pain Care Confidence Scale. A repeated-measure ANOVA was used to examine knowledge and beliefs, and a repeated t-test was used to examine confidence. Students' pain knowledge fluctuated over time but showed an overall significant increase, with the largest increases occurring in the first 6 months of the integrated course curriculum (54-75%) and during the standalone pain science course (70-90%). The biomedical belief scores significantly decreased over time, while psychosocial belief scores fluctuated over time, with a significant overall increase by the end of the pain science course. Confidence scores significantly increased during the standalone pain science course, t(84) = -14.309, P < .001, d = -1.552. This study examined the implementation of a pain science framework in 1 cohort and found significant changes in students' knowledge, beliefs, and confidence. This framework uniquely combined CE for core faculty, integrated pain education information throughout the curriculum, and culminated with a standalone pain science course. This study provides insight into effective comprehensive pain science education curriculum changes, which may help other PT programs model and analyze their pain science curriculum.