IASP defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage".
Based on duration pain is classified as acute pain, which is of sudden onset, occurs immediately after an injury, and is usually severe. Chronic pain is a pain that continues beyond the normal healing process. It can start as acute pain but lasts for more than 3 months. Episodic or recurrent pain occurs intermittently over a long period and the patient can be pain-free in-between episodes. Breakthrough pain is an exacerbation of pain that are variations in the level of severity of chronic pain .
In the near future, 5.0% to 10.0% of cases will develop chronic low back pain (CLBP), which will cause high treatment costs, sick leave, and individual suffering and will be the leading cause for the patient seeking healthcare services .
In 2015, the prevalence of chronic low back pain was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Aged 18 and above, six reported chronic low back pain, which was between 3.9% and 10.2% of the population .
Across the world, it is the leading cause of activity limitation and work absence, imposing a high economic burden on individuals, families, communities, industry, and governments .
The mechanism of chronic low back pain is structural abnormalities that occur at spine-associated tissues like disc herniation .
Along with these, there is also a psychological perspective psychosocial factors are potentially contributing to emotional distress in patients with chronic low back pain. Factors such as job dissatisfaction, poor social support, and the influence of chronic pain-related behavior on work and family anatomical or dynamics. A key component of pain-related behavior is the fear of pain with a consequent decrease in physical activity .
Pain subjective phenomenon involving more cognitive processing rather than a purely sensory phenomenon .
As the holistic approach considers the physical or say tissue abnormality structure but not the psychological structure, which forms a reminder of pain treatment, so this case report emphasizes the use of pain neuroscience education. The primary associated factor is the fear of pain and catastrophizing the “pathological fear of pain is defined as algophobia”.
Catastrophizing has been broadly defined as an exaggerated negative orientation toward pain stimuli and pain experience. It can also be considered a negative mindset toward pain. Many articles suggest that the exaggerated response of pain is due to catastrophizing. This also often leads to emotional distress in patients .
These two components broadly affect patients perception toward pain.
Pain neuroscience education (PNE) helps patients understand more about their pain from a biological and physiological perspective .
PNE when used in chronic musculoskeletal (MSK) disorders is effective in reducing pain and improving patient knowledge of pain leads to improving function and lowering disability also enhancing psychosocial factors, enhancing movement, and minimizing healthcare usage. .
This case report is of a 60-year female with chronic pain the intervention administered was PNE and a conventional mode of treatment.
Patient inforrmation-This case report is reporting a 65-year female complained of low back pain on the left side for 6 months onset was gradual and was dull aching in nature pain gets aggravated during bending activities and is relieved with rest medicines, but the pain was temporarily relieved. Patient’s sleep is normal appetite is reduced patient lives in an urban area on the first floor in a well-ventilated area.
Has a History of Hypertension for 6 years and diabetes for 4 years. The patient is on angiotensin receptor blockers and diuretics for 4 years and metformin for 4 years.
Clinical findings-Pain, when measured on NPRS, was 6 on NPRS at work and 4 on NPRS at rest.Also, scores of fear-avoidance beliefs were FABQw, and were 35 and FABQpa was 18, and score pain-coping inventory was 94 the patient also on observation on forwarding head posture was seen, and lumbar lordosis was present examination piriformis muscle tightness was present. The figure of the 4 test and slump test was positive. The muscle strength when measured using MRC iliopsoas was 3 gluteus Medius was 3 and gluteus maximus was 3, respectively. All ranges were complete and pain-free ranges were calculated using sober test. Diagnostic assessment- Included Lumbar Anteroposterior and lateral view X-ray revealed the reduced gap between the disc and osteoporotic changes in the spine.
Diagnostic challenges were the socioeconomic status of the patient’s family, so cost-effective investigation was taken into consideration and more reliance was on physical findings and Physio therapeutic assessment.
Table-1 includes day wise protocol of PNE intervention in treatment of pain this protocol includes explanation of pain biology
In figure 1 it, has been represented how PNE was administered to the patient. With PNE ,20 min the transcutaneous electrical nerve stimulation (TENS),20 min moist pack was applied for 7 days also resisted lumbar isometric were applied before the application of exercises stretching of piriformis quadriceps and hamstring was performed 5 repetitions each 30 second hold and 10 second relax.
Follow up and outcomes-Once a week follow-up was arranged. And pain-coping inventory and fear-avoidance beliefs and NPRS scores were taken as outcome measures post 7 days of treatment and during the follow-up visit the scores were reduced the scores were, respectively.
Pain coping inventory-35
Fear-avoidance belief- FABQW-15
NPRS-2 on NPRS
Table-2 includes result and day wise scores of outcome measures used