A World of Hurt: A Guide to Classifying Pain Overview Course

COURSE DESCRIPTION

This two-day course introduces information critical to the assessment and treatment of patients with acute, sub-acute and chronic musculoskeletal pain. Utilizing pain science research regarding pain mechanisms this course teaches pain clinicians how to assess and treat pain as it relates to the peripheral and central nervous system mechanisms. A musculoskeletal Pain Mechanism Classification System (PMCS) will guide selection of patient education and active care interventions for each mechanism.  The PMCS demonstrated through live patient demonstrations when available, video and paper pain case studies will aid application to pain clinicians practice. This course presents a sub grouping method, PMCS, which addresses musculoskeletal pain throughout the continuum from acute, subacute and chronic phases covering chemical, structural, mechanical, cognitive, emotional, psychological and cortical mechanisms.  This course integrates pain science research into a biopsychosocial approach.  Promoting a common language for pain education between pain clinicians and patients. Peripheral nervous system neurodynamic evaluation, treatment, and central nervous system sensory and motor evaluation, patient rated outcome measures, and psychometrics tools outlined and discussed. The PMCS patient education and active care interventions support all patient ages and diagnoses suffering from pain.

WHO SHOULD ATTEND

Physical and Occupational Therapists, Chiropractors, Osteopaths, Physical Therapist Assistants, Occupational Therapy Assistants, Medical Doctors, Psychologists, Athletic Trainers, Massage Therapists, Personal Trainers and any other practitioners who are involved in treating musculoskeletal pain

COURSE OBJECTIVES

Upon completion of the course, participants will be able to apply the principles directly into their clinical practice:  

At the conclusion of this course, participants should be able to:

1)  Differentiate subjective and objective characteristics for nociceptive, peripheral neurogenic, central sensitization, affective and motor/autonomic pain mechanisms.

2)  Apply pain mechanism & mechanical classification principles to pain patients via paper, video and live demonstrations.

3)  Apply patient education and active care intervention using PMCS and Yellow Flag Risk Form    (YFRF).

4) Identify patient rated outcome measures and psychometric questionnaires using PMCS and YFRF.

5) Effectively communicate pain education for Peripheral and Central Nervous System pain mechanisms.

6) Effectively prescribe therapeutic exercise for Peripheral Nervous System, Neurodynamic, and Central Nervous System Sensorimotor Dysfunctions.

FACULTY

Course Instructor:

Annie O’Connor, MSPT, OCS, Cert. MDT is Corporate Director of the Musculoskeletal Practice and Clinical Manager of the River Forest Outpatient Center at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago.  Annie has co-authored 2018, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach 3e, Liebenson C (ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection.  She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice”. Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings.  She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS), and McKenzie Institute. She serves on the 10X25 tactile coalition task force to reduce spine related disability by 10 % in year 2025 sponsored by the Spine Foundation a national group of the NASS. She continues to treat orthopedic, neurological patients, and canines with musculoskeletal pain to achieve the best life possible.

Melissa Watson, MSPT, Cert. MDT received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Willow brook Outpatient Center with 17 years of clinical experience in neurological rehabilitation. Melissa has been helping to lead RIC’s Clinical Ladder Program for over 7 years where she mentors other clinicians on their professional and clinical development. She is a certified clinical instructor and consistently mentors students in clinical practice. She is practicing clinically in the Day Rehabilitation setting with an interest in musculoskeletal pain and applying both MDT and pain classification principles within the neurological population for spasticity. She is currently leading a Day Rehab Pain Group Committee where she is mentoring other Day Rehab clinicians on running pain groups that are focusing on pain education and active care treatment for patients with centrally dominated pain throughout 6 sites of care and facilitating a standard for education through Inpatient clinicians. She certified in Mechanical Diagnosis and Treatment – McKenzie Method. She has been training the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” for last 4 years and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

Disclosures

Financial:

The presenters Annie O’Connor and Melissa Watson will receive an honorarium and expenses for teaching this course.

Nonfinancial:

Annie O’Connor and Melissa Watson have no relevant financial relationships.

Course Book:   “A World of Hurt: A Guide to Classifying Pain”

References:

·       Kolski M, O’Connor A. World of Hurt: A Guide to Classifying Pain, Chapters 1-8. Thomasland Publishers Inc, 2015

·       Kolski M, OConnor A, VanDerlaan K, Jungwha A, Koslowski A, Deutch A. (2016) Validation of a pain mechanism classification system (PMCS) in physical therapy practice. Journal of Manual and Manipulative Therapy; 08 September, 1-8.

·       Smart KM, Curley A, Blake C, Staines A, Doody C. (2010)The reliability of clinical judgments and criteria associated with mechanisms-based classifications of pain in patients with low back pain disorders: a preliminary reliability study. Journal of Manual and Manipulative Therapy, Volume 18, No. 2: 102-110.

·       Smart KM, Blake C, Staines A, Doody C. (2010) Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Manual Therapy; 15:80-87.

·       Smart, K., Blake, C., Staines, A., & Doody, C. (2011) The Discriminative validity of “nociceptive”, “peripheral neuropathic”, and “central sensitization” as mechanisms-based classifications of musculoskeletal pain.  Clin J Pain; 27(8), 655-663.

·       Butler DS. The Sensitive Nervous System. Adelaide, Australia: Noigroup, 2000.

·       Baron R. Peripheral neuropathic pain: From mechanisms to symptoms. Clin J Pain, 2000:S12-S20.

·       Melzack R. Evolution of the neuromatrix theory of pain. Pain Pract. 2005; 5:85-94.

·       Moseley G. A pain neuromatrix approach to patients with chronic pain. Manu Ther. 2003; 8:130-140.

·       Moseley G. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004:8:39-45.

·       Werneke MW, Hart DL, George SZ, Deutscher D, Stratford PW. Change in psychosocial distress associated with pain and functional status outcomes in patients with lumbar impairments referred to physical therapy services. J Orthop Sports Phys Ther, 2011; 41:969-980

·       Morales-Espinoza EM, Kostov B, Salami DC, et al. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care. Pain. 2016;157:818-826.

·       Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129.

·       Hung M, Bounsanga J, Voss MW, et al. The relationship between family support: pain and depression in elderly with arthritis. Psychol Health Med. 2016;22:1-12.

·       Louw A, Puentedura EJ, Nijs J. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther. 2017; 25(3): 160-168.

A World of Hurt: A Guide to Classifying Pain Course

AGENDA

Day 1

8:00 am            Registration / Continental Breakfast

8:20                 Course Introduction – Musculoskeletal Pain Lessons -[WoH: Forward xi]

8:30                 Lecture: Risk Factor Assessment for Musculoskeletal Pain – A collaboration of classification systems – Introduce Yellow Flag Risk Form -[WoH: pg 258]

9:15                 Lecture: Pain Continuum - Pain Mechanism Classification System (PMCS) –  Definitions [WoH: pg 21-23] – Similarities with other Classification Systems (ie MDT, TBC, CPR, MSI, NOI, etc) [WoH: pg 28-31]

9:45      Break

10:00                Lecture: Peripheral Nervous System (PNS) Pain Mechanisms Subgroups Subjective, Objective Characteristics - Similarities with other Classification Systems (ie MDT, TBC, MSI, etc) [WoH: pg 102-10]

10:45                Lecture: PNS Patient Education and Active Care Intervention [WoH: pg 77-79,104]

11:15                Lecture:  Peripheral Neurogenic Pain Mechanism (PNPM) Objective Neurodynamic Evaluation [WoH: pg 102-103, 150-157]

12:00    Lunch 

1:00                  Workshop: Neurodynamic Evaluation Upper and Lower Limb Active Tests [WoH: pg 158-166]

2:15                  Lecture: Peripheral Neurogenic Pain Mechanism Intervention MSK & Neuro [WoH: 104, 135-144]

2:45      Break

3:30                  Case Study or Live Patient Demonstration: PNS

4:30                  Case Study or Live Patient Demonstration: Peripheral Neurogenic Pain Mechanism

5:30      Adjourn

Day 2:

7:30 am Continental Breakfast

8:00                  Lecture: You don’t get pain without a brain

8:45                 Lecture: Central Nervous System (CNS) Subgroups Subjective and                                                             Objective Characteristics [WoH: pg 222-223]

9:30                 Workshop: Psychometric Testing / Scoring –FABQ [WoH: pg 198-199], PASS [WoH: pg 257], PHQ-9 [WoH: pg 257], Readiness Questionnaire [WoH: pg 44-49]

10:00    Break

10:15                Words Workshop: Patient Pain Education using the Yellow Flag Risk Form – Individual to Group Model [WoH: pg ix, Documentation Guidelines and Goal Recommendation]

12:00    Lunch

1:00                  Case study: CNS Pain Mechanisms CS, Affect, A/M

2:00                  Lecture: CNS Mechanisms patient education and active care intervention [WoH: pg 236]

2:30                  Lecture: CNS Sensory and Motor Evaluation Objective Tests Demonstration: CNS Left / Right Discrimination - Spine and Extremity

3:00                   Workshop: CNS Sensory and Motor Objective Tests  [WoH pg 328-335]

4:00                  Summary of Pain Mechanisms – Lamp Analogy  

4:15                  Questions / Answers

4:30                  Adjourn