Physician-Delivered Pain Neuroscience Education for Opioid Tapering: A Case Report

Abstract

We describe the case of a 75-year-old female with chronic low back pain (CLBP), on opioids for more than 15 years. She presented with an acute episode of nausea, vomiting, abdominal pain, and shortness of breath. After a complete work-up, it was concluded that her presenting symptoms were likely due to her high levels of CLBP and high dose opioids. At the time of intervention, her opioid dosage was between 50–90 MME (Morphine milligram equivalent) (Norco 8 × 7.5 mg/day + Fentanyl 12 mcg patch). She was subsequently seen by the physician for seven outpatient internal medicine appointments over nine months and received Pain Neuroscience Education (PNE) in conjunction with monitored tapering of opioids and other medication associated with her CLBP. This case report demonstrates how a physician might deliver PNE as a viable nonpharmacological treatment option for the tapering of long-term opioids for chronic pain.

Clarification of the “pain neuroscience education” concept in the management of patients with persistent low back pain: A scoping review

“…Of the 54 publications from the literature search, 41 had been published since 2015 (76%) [2,6,7,12,14,[17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33][34][35][36][37][38][39][40]48,49,51,[54][55][56][57][60][61][62][69][70][71]73] with 7 published since 2010 (13%) [5,27,31,53,[57][58][59]62], and 6 published since 2002 (11%) [41,42,…”

“…In his conceptual paper, Moseley defines PNE as an educative strategy that aims to reconceptualize someone's meaning of pain from a neurophysiological point of view [42] (also covered by [2,8,13,19,26,27,38,39,41,[43][44][45][46][47]). Educational material is described in the Explain Pain book [8] and includes detailed information on the neurophysiology of pain (also covered by [2,12,13,17,19,23,27,28,30,36,38,46,[48][49][50][51]). Information is presented accurately (rather than being diluted for the sake of simplicity) and in a respectful manner that acknowledges the patient's suffering.…”

“…Moseley distinguishes superfical learning and deep learning; in the latter case, information is remembered and also understood, integrated in someone's belief and attitude, and applied to solve problems (also covered by [2,8,28,43]). To support deep learning, metaphors (also covered by [5,13,17,[23][24][25]27,28,[32][33][34]36,43,44,52,53,56,[58][59][60][61]) and pictures (also covered by [5,13,17,23,32,43,44,53,58,61,62]) are used to present educational material. In Moseley's publication, PNE is integrated into a multimodal approach (several treatment modalities that target different mechanisms or factors) based on its own theoretical model: the pain neuromatrix also described in Explain Pain (also covered by [2,8,13,27,27,39]).…”

“…Researchers have variously defined PNE as a cognitive [13,23,32,38,71], cognitive-behavioral [48,53,58,68] and/or educational [2,12,14,[17][18][19]28,31,33,37,38,40,46,48,57,60] approach for explaining pain to patients from a neurophysiological viewpoint [2,12,13,17,19,23,27,28,30,31,36,38,46,[48][49][50][51]. Moseley and Butler stated that PNE can refer to a set of educational strategies that aim to change someone's understanding of what pain is and what its purpose is [2] (also covered by [40]).…”

“Pain Neuroscience Education as an Adjunct to Physiotherapy Protocol in Knee Osteoartritis”- A Case Report

“…5 Pain Neuroscience Education (PNE) has been shown to help patients change their perceptions of their pain and discomfort, potentially reducing terror, anxiety, and catastrophization. 6,7,8 The aim of PNE is to make patients aware about the biology and physiology of their pain. 9 Pain neuroscience education is a promising instructional strategy that can be used in combination with a robust multimodal recovery programme to alleviate pain, increase function, decrease fear of movement, and reduce catastrophizing.…”