Pain Science and Psychosocial Considerations
What the candidate must know
Understand nociception versus pain, central sensitization, and the biopsychosocial model. Know how to screen for yellow flags: fear-avoidance, catastrophizing, depression, and work-related distress. Understand the fear-avoidance model and graded exposure. Know pain neuroscience education principles: reconceptualization rather than reassurance alone. Recognize the limits of passive treatment in centralized pain.
Traps
- Equating tissue damage with pain intensity in chronic pain.
- Using reassurance alone instead of active reconceptualization and graded activity.
- Missing psychosocial red flags that predict poor outcomes.
- Overlooking the role of sleep, stress, and activity pacing.
Rule of thumb
In persistent pain, shift from a tissue-focused to a function-focused plan: pacing, graded exposure, and education that reduces threat.
Worked example
A patient with chronic low back pain and high catastrophizing: begin with pain neuroscience education and graded activity rather than repeated passive modalities, which may reinforce fear-avoidance.