Mission:

Our mission is to promote excellence in pain education, research, and clinical practice for the physical therapy profession.

Vision:

Our vision is that all physical therapists will have a progressive understanding of pain and use this knowledge to provide evidence-based, effective treatment options for individuals seeking care in relieving or preventing pain.

Purpose:

Our purpose is to bring together educators, researchers and clinicians from multiple physical therapy specialties to advance pain education, research and clinical practice.

Rationale:

Pain is a leading reason for patients seeking physical therapy treatment. It is complex, multidimensional and affects all aspects of a person’s life, whether acute or chronic. The cost of persistent pain in America, including decreased productivity at work and healthcare, is estimated between 560 and 635 billion dollars; greater than cardiovascular disease, cancer and diabetes combined [1]. Due to the high prevalence of chronic pain, approximately 100 million Americans, the Department of Health and Human Services published a National Pain Strategy in 2016, highlighting insufficient training for many clinicians in pain assessment and treatment [7]. It is becoming increasingly recognized that physical therapy and rehabilitation play a significant role in the management of people with both acute and chronic pain. As an example, the Centers for Disease Controls Opioid Prescription Guidelines emphasize the use of non-pharmacological treatments as a preferred therapy for chronic pain which places physical therapy as a key provider [2]. The recent emphasis nationally by federal agencies on pain, including management that includes rehabilitation and non-pharmacological strategies, supports the need for a stronger emphasis in the American Physical Therapy Association on pain education, research, and practice.

Pain is ubiquitous. It is associated with conditions commonly seen in populations for orthopedic, sports, women’s health, wounds, acute care, cardiovascular and pulmonary, geriatrics, hand and upper extremity, home health, neurology, oncology, and pediatrics. The assessment and treatment of pain in each of these conditions, while unique, also has similarities that include knowledge of peripheral and central sensitization, identification of psychosocial risk factors, and an interdisciplinary and multimodal plan of care [8-10]. Further, research on underlying mechanisms of pain and physical therapy treatments, as well as implementation of novel treatment approaches, have many similarities across these different disciplines. As such, pain treatment does not have a home in any one section and is a foundational skill.

There are unique issues related to pain education, research, and practice that cannot be directly addressed by any existing section. For education, there is a lack of pain education in entry-level programs [5]. In 2013, an interprofessional panel developed core competencies for pain education for all entry-level professionals [3;6], and the International Association for the Study of Pain has curriculum guidelines for physical therapy pain education that parallel the competencies (www.iasp-pain.org). While the American Council of Academic Physical Therapy has endorsed these competencies, the implementation into current curricula are limited.

For research, funding of pain by national organizations is out of proportion with the frequency and prevalence of the condition [4]. For example, the National Institutes of Health funds total approximately 1.2% of the total budget, while 30% of individuals in the US experience chronic pain. As a comparison, 431 dollars per affected person are spent on cancer research, while only 4 dollars per affected person are spent on chronic pain. A pain research strategy was released in 2014 by the American Pain Society [4], and a federal pain research strategy is currently being developed (to be released in 2017) by an interagency coordinating committee includes a strong emphasis on non-pharmacological management for pain. The profession of physical therapy is ideally suited to fill this need.

For practice, there is an unwarranted variation in care providing by physical therapists, including the use of dated models and approaches. The National Pain Strategy emphasizes self-management programs that improve patient’s knowledge, coping skills, and function. The National Pain Strategy also highlights a comprehensive, multimodal, and interdisciplinary approach to pain management [7]. The physical therapy profession is a key component to acute and chronic pain management.

We propose to use the academy to 1) provide education and resources to support incorporation of pain into entry-level education that are based on accepted national/international core competencies and curriculum guidelines, 2) ensure physical therapy research initiatives appropriately accounts for the burden of pain and align with the national pain research strategy, and 3) facilitate incorporation of guideline-based practice patterns by physical therapists managing pain.

Pain Section Development Executive Committee:

Kathleen Sluka

Steven George

Carol Courtney

Katie McBee

Laura A. Frey Law

Marie Bement

Greg Hicks

Reference List

[1] Committee on Advancing Pain Research CaEIoM. Reliveing Pain in America: A blueprint for transforming prevention, care, education and research. Institute of Medicine of the National Academies, 2011.

[2] Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States. MMWR Recomm Rep, Vol. 65(No. RR-1) 2016. pp. 1-49.

[3] Fishman SM, Young HM, Lucas AE, Chou R, Herr K, Murinson BB, Watt-Watson J, Carr DB, Gordon DB, Stevens BJ, Bakerjian D, Ballantyne JC, Courtenay M, Djukic M, Koebner IJ, Mongoven JM, Paice JA, Prasad R, Singh N, Sluka KA, St MB, Strassels SA. Core competencies for pain management: results of an interprofessional consensus summit. Pain Med 2013;14:971-981.

[4] Gereau RW, Sluka KA, Maixner W, Savage SR, Price TJ, Murinson BB, Sullivan MD, Fillingim RB. A pain research agenda for the 21st century. J Pain 2014;15:1203-1214.

[5] Hoeger Bement MK, Sluka KA. The current state of physical therapy pain curricula in the United States: a faculty survey. J Pain 2015;16:144-152.

[6] Hoeger Bement MK, St Marie BJ, Nordstrom TM, Christensen N, Mongoven JM, Koebner IJ, Fishman SM, Sluka KA. An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Physical Therapy. Phys Ther 2014;94:451-465.

[7] Interagency Pain Researcg Coordinating Committee. National Pain Strategy: A comprehensive population health-level strategy for pain. National Institutues of Health 2016.

[8] Interagency Pain Researcg Coordinating Committee. National Pain Strategy: A comprehensive population health-level strategy for pain. National Institutues of Health 2016.

[9] Nicholas MK, George SZ. Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther 2011;91:765-776.

[10] Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states--maybe it is all in their head. Best Pract Res Clin Rheumatol 2011;25:141-154.