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Cited by 180Musculoskeletal pain and rehabilitationPain Management and TreatmentPediatric Pain Management Techniques

Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions

Open access
Keefe, Francis J, Main, Chris J, George, Steven Z·2018·Physical Therapy
DOI 10.1093/ptj/pzy024PMC PMC7207297
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Abstract

There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples’ responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.

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  • Typical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.

    “Typical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.31-34”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [32]

    Table 1 in “Growing evidence base” (page unavailable) lists educational, cognitive-behavioral, and psychophysiological PIP interventions, linking the latter to stress reduction and mindfulness. The paper supports the broad categories, but the cited passages do not identify body awareness or mindful movement as typical components, or say these categories are typically combined. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The inclusion of patient-centered communication, such as motivational interviewing, aids in supporting a healthy therapeutic alliance and self-efficacy for change.

    “The inclusion of patient centered communication (e.g. motivational interviewing) aid in supporting a healthy therapeutic alliance and self-efficacy for change.31-34”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [32]

    The Interview Methods section (page not provided) says patient-centered interview skills can strengthen the therapeutic alliance. It does not say that they build patients’ self-efficacy for change, and motivational interviewing appears only in the cited references rather than as a demonstrated example of that combined effect. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Challenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion or exclusion of specific components.

    “Challenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion, or exclusion, of specific components.22,31-34”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [32]

    The Training Strategy Summary reports wide variability in PIP training approaches and no minimum standards for training time or assessing therapist competence. The Unanswered Questions section also calls for further appraisal of treatment specification. Neither passage says that PIP programs vary in their components or lack a rationale or framework for including or excluding particular components; page numbers were not available in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The success of delivery of PiPT and PNE has been shown to be impacted by the PT's confidence and comfort with the program as well as the therapist having the qualities necessary to implement patient-centered care.

    “The success of delivery of PiPT and PNE has been shown to be impacted by the PT’s confidence and comfort with the program as well as the therapist having the qualities necessary to implement patient-centered care.20,28,32,35,44,52”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [32]

    The “Spectrum of PIP Techniques” section says some physical therapists lack confidence in implementing psychologically informed practice (PIP), and “Interview Methods” links patient-centered communication skills to better outcomes. The paper also says therapists with little PIP experience are likely to have little success. These passages support the PIP portion, but do not establish the same claim for pain neuroscience education (PNE) or specifically identify comfort with a program as a factor. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Keefe, F. J., Main, C. J., & George, S. Z.
Affiliations
  • Duke University (US)
  • Keele University (GB)
Corresponding author
Keefe, Francis J
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2018-04-16
Volume
98
Issue
5
Pages
398-407
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.1093/ptj/pzy024
PMC
PMC7207297
OpenAlex
W2799875742
Cited by
180
References
52
Citations by year
2026: 15 · 2025: 15 · 2024: 18 · 2023: 28 · 2022: 28 · 2021: 32 · 2020: 26 · 2019: 14 · 2018: 4
FWCI
2.22
Type
journal article
Language
en
Open access
Licence
Locations
  • Physical Therapy (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Institute for Arthritis and Musculoskeletal and Skin Diseases (AR055899)
  • NIH
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
chronic musculoskeletal pain, chronic pain, low back pain, pain beliefs, pain anticipation, pain-related disability, non-pharmacological pain management, stratified care, primary care, pain management
MeSH terms
Disability Evaluation, Humans, Pain Measurement, Psychophysiology, Psychotherapy, Risk Assessment, Physical Therapy Modalities, Musculoskeletal Pain, Pain Management

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