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Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions
Open accessAbstract
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.31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [32]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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Self-citation
Flagged first, then by citations
1 of the 52 references couldn’t be matched to a known paper.
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“Development of more powerful new non-pharmacologic pain management techniques is a national and international priority (Keefe et al., 2018), and Virtual Reality has strong potential as a new direction for behavioral medicine (Keefe et al.”
Background
Metadata
- Authors
- Keefe, F. J., Main, C. J., & George, S. Z.
- Affiliations
- Duke University (US)
- Keele University (GB)
- Corresponding author
- Keefe, Francis J
- 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
- 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
- hybrid
- doi.org
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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