Chronic pain affects approximately 20% of the population worldwide (Breivik et al., 2006). Chronic pain has a tremendous personal and socioeconomic impact: it causes the highest number of years lived with disability (Global Burden of Disease Study, 2015) and is the largest cause of work-related disability (Andersson, 1999; Waddell & Burton, 2001). The intensity, functional impact and persistence of pain are influenced by biopsychosocial factors (Fillingim, 2005; Lumley et al., 2011; McLean et al., 2005; Meeus & Nijs, 2007; A. J. Wijma et al., 2016). Factors such as comorbidities, physical well-being, behaviour, psychosocial well-being and environmental aspects can all influence the pain a person experiences (Fillingim, 2005; Lumley et al., 2011; McLean et al., 2005; Meeus & Nijs, 2007; A. J. Wijma et al., 2016). This understanding of chronic pain has shifted management strategies from pure biomedical treatments to multimodal approaches acknowledging the complex biopsychosocial nature of chronic pain.
Pain science has taught us that pain can be present without tissue damage, that pain is often disproportionate to tissue damage, and that tissue damage (and nociception) does not per se result in the feeling of pain(Raja et al., 2020). Transferring this knowledge to people with pain is a cognitive-behavioural therapy intervention called pain science education (PSE)(Tegner et al., 2018). This approach incorporates contemporary pain science to educate a patient about the nature of the pain experience and associated contributing factors, so that the patient can reconceptualise the meaning of the pain experience(Moseley & Butler, 2015). PSE facilitates the patient to gain a broader biopsychosocial understanding of his pain experience, including the role of neurophysiological, psychological, social and environmental factors in addition to biomedical factors(Moseley & Butler, 2015; Nijs et al., 2011).
Clinical guidelines for the treatment of chronic pain emphasise the importance of a biopsychosocial approach and recommend PSE to improve maladaptive pain beliefs, decreasing pain and disability in patients with various chronic pain disorders(Louw et al., 2011; Moseley, 2002; G.L. Moseley, 2003; Moseley, 2004; Moseley, 2005; Moseley et al., 2004; Nijs et al., 2011; Van Oosterwijck et al., 2011). More specifically, in patients with chronic low back pain, chronic neck pain, fibromyalgia, chronic fatigue syndrome, osteoarthritis and postsurgical pain, PSE appears to result in favorable outcomes(Louw et al., 2011; Nijs et al., 2011). It has proven to be effective in changing pain beliefs and coping strategies and improving health status(Louw et al., 2011; Moseley, 2002; G. Lorimer Moseley, 2003; Moseley, 2004; Moseley, 2005; Moseley et al., 2004; Nijs et al., 2011; Van Oosterwijck et al., 2013; Van Oosterwijck et al., 2011). However, implementation of the biopsychosocial model and PSE is complex. Currently, many applied treatments are biomedically oriented and defined as low-value care(Hartvigsen et al., 2022), resulting in poorer pain, activity and work-related outcomes(Chibnall et al., 2006; Christe et al., 2021; Darlow, 2016). In addition, patients often consider their treatment to be inadequate(Breivik et al., 2006; Smalbrugge et al., 2007; van Herk et al., 2009; Voerman et al., 2015). With decades of education, dozens of guidelines and many good intentions to improve care, the gap between science and clinical care remains, which limits the implementation of the biopsychosocial model and PSE in clinical practice. There are multifactorial reasons why clinical guidelines are poorly adhered to by HCPs, e.g. lack of knowledge regarding pain and pain management(Darlow et al., 2012; Gardner et al., 2017; Gheldof et al., 2005; Holden et al., 2009; Linton et al., 2002; Pain, 2010; Recommendations by the International Association for the Study of Pain), HCPs feel that their skills and confidence are insufficient to change their behaviour, which is sometimes also not applicable in their clinical practice(Driver et al., 2017; Richmond et al., 2018; Synnott et al., 2015; Zangoni & Thomson, 2017). Furthermore, patient ability and preferences also affect HCPs’ guideline adherence(Gardner et al., 2017; Lugtenberg et al., 2011; Roussel et al., 2016).
Postgraduate training programs could lower these barriers by improving their knowledge, skills and confidence to facilitate behavioural change. Studies showed that educational interventions resulted in more guideline adherend’ recommendations and intentions than solely providing clinical guidelines, although there were no significant differences in behaviour change(French et al., 2013; Schectman et al., 2003). In addition to improved guideline adherence, training programs are effective to improve HCPs’ knowledge and skills regarding the management of pain with effect sizes ranging from small to large(Gaupp et al., 2020; Ghandehari et al., 2013; Jacobs et al., 2016; Stevenson et al., 2006; Synnott et al., 2016; Zhang et al., 2008). However, this effect can decline over time(Achaliwie et al., 2023). Most educational training programs were applied for monodisciplinary groups of HPCs, while there is a need for interdisciplinary training to improve interdisciplinary collaboration within healthcare(Hammick et al., 2007; Petit et al., 2019; Recommendations by the International Association for the Study of Pain). In return, interdisciplinary collaboration in clinical practice is associated with higher psychosocial attitudes and might therefore benefit the mid- and long-term effectiveness of training programs(Misra et al., 2009; Petit et al., 2019; Thompson et al., 2018). However, little is known about the effectiveness of interdisciplinary postgraduate pain educational training programs, especially when focusing on chronic pain. Given the established need for interdisciplinary educational training programs to improve interdisciplinary collaboration within healthcare(Hammick et al., 2007; Petit et al., 2019; Recommendations by the International Association for the Study of Pain), the lack of studies examining the effectiveness of interdisciplinary postgraduate chronic pain training educational programs represents a significant knowledge gap. Such interdisciplinary postgraduate chronic pain training programs are also challenging, as they have to be applicable for all HCPs. Here, we aimed to address the significant knowledge gap by developing an interdisciplinary training program about chronic pain for HCPs.
For the reasons outlined above, within this study, we describe the development of an interdisciplinary training program about chronic pain for HCPs. First, an interdisciplinary expert panel was organised to identify barriers and needs expressed by HCPs for such an interdisciplinary chronic pain training program. Second, the identified barriers and needs of HCPs for a chronic pain training program were used for the development of an interdisciplinary training program regarding the management of patients with chronic pain. Third, the paper also describes the planned evaluation method to assess the short- and mid-term changes in knowledge, attitudes and guideline adherence among HCPs. This study is part of a type 2 implementation project to evaluate the effectiveness of an interdisciplinary training program about chronic pain on HCPs' knowledge, attitudes, and guideline adherence.