What does YouTube offer on pain education videos?
- Seven principles of neuroscientific pain education
- Principles are rarely discussed
- Increased popularity, but reliability hard to determine
YouTube offers of wide variety of pain education videos, but only few discuss at least one of the seven principles of neuroscientific pain education in a fascinating way. American and Australian researchers who analysed 106 YouTube videos conclude that more research is necessary to determine the clinical usability of these videos: what do patients learn from the videos and do they change their behaviour as a result?
Researchers determined as to what extent the videos corresponded with the seven principles of neuroscientific pain education. These are as follows: there are many factors which can contribute to someone’s pain; we are all ‘bioplastic’, meaning we are capable of altering pain sensations; pain is not a good indicator of tissue damage; pain education is a treatment; pain is a signal from the brain; pain protects; pain can be overprotective or oversensitive.
The seven principles of neuroscientific pain education were rarely discussed in the 106 videos. The researchers found only 17 videos in which at least one of the seven principles came in the spotlight, and only one video provided adequate attention to all seven aspects. The principle that was discussed most was ‘pain is a signal from the brain’, while ‘we are all bioplastic’ and ‘pain can be overprotective or oversensitive’ got the least attention. According to the researchers, these principles could use some extra attention.
Luckily, there were few videos that claimed views that were conflicting with the seven principles. Researchers suspect that their own criteria to include or exclude the video in the review were – at least partially – debit to this. They excluded videos that did not offer any information about the role of the brain or the nervous system or in pain sensation. Therefore, the review lacked videos which viewed pain as a local sensation following tissue damage: a viewpoint that conflicts with the principle that pain is not a good indicator of tissue damage.
The results point out that YouTube gains popularity as a means to spread knowledge about pain: researchers retrieved three times as much videos from the last five years in their search (January 2018) than from the five years before that. Unfortunately, it turns out that more recent videos have a poor connection with the pain education principle: the majority of videos that covered at least one of the seven principles was posted more than three years ago.
Whether the videos are reliable and contain the right information is hard to determine. The origin of the videos was not always clear or hard to track down, and information about the creators of the videos was scarce. This makes it difficult to determine the reputation of the source. Fifteen percent of the videos was originally uploaded by an academic or medical research institute or an organisation of medical professionals, and almost twenty percent was posted by an individual health professional or researcher.
Interesting and informative
To qualify as an educational instrument, the videos must not only provide correct information, but also be interesting for the viewer. Researchers judged the videos themselves, but the number of views on YouTube also gave an indication. This shows that particularly animation videos are very popular. According to the researchers, the video ‘Tame The Beast – It’s time to rethink persistent pain’¹ did not only cover all seven principles, but was also very interesting. Besides that, the TED-Ed video ‘How does your brain respond to pain?’² scored high among researchers and viewers on YouTube.
Although only one video covered all seven principles about pain education, videos that cover less aspects may be relevant if they address a specific gap in the knowledge of the patient. According to the scientists, the extent to which patients learn from the videos and modify their behaviour as a result should be further investigated.
The researchers conducted a sort of ‘systematic review’ of online videos. With predetermined search criteria, they searched for English spoken videos of ten minutes maximum, that provided information about the neuroscientific aspects of pain. Videos that exclusively addressed coping skills or treatments, or that did not provide any information about the role of the brain or the nervous system in pain sensation, were excluded.
1. Tame The Beast - It's time to rethink persistent pain:
2. Karen D. Davis - How does your brain respond to pain?:
Expert opinion by John Bos, MSc.
This article is interesting because it provides insight in the available video material about pain education that is directly useful for daily practice. The videos are weighted to the seven principles of Pain Neuroscience Education (PNE). The name PNE has recently been changed to Pain Science Education (PSE). This change of name is a more nuanced representation of the fact that pain cannot be completely traced back to or does not fully equate with brain activity. Pain turns out to be a complex state of consciousness, an unpleasant feeling, with protection of the body as main purpose. It goes hand in hand with complex integrative biological (neural, endocrine and immunological) activity. Pain can not be understood from a purely neuroscientific perspective!
Physiotherapists regularly spend time on (aspects of) pain education with patients who present with musculoskeletal pain complaints. Particularly in patients with persistent or chronic pain, but also in prevention of these conditions, pain education is regarded as a valuable therapy. Pain education is most commonly combined with exercise, so that patients gain positive movement experiences and experience physically that pain can be modulated and controlled.
Pain education is not the goal, but rather a therapeutic tool that gets a prominent place in a larger therapeutic plan, most of the times in a therapeutic goal regarding pain reconceptualisation. In pain reconceptualisation, three themes are important:
- Pain is a relative unreliable indicator for what is going on pathoanatomically or pathophysiologically (damage) – pain is strongly context dependent and influenced by expectations (previous experiences and concepts) – “there must be something wrong with my back, because it hurts.”
- Pain as a protective function of the body: pain can get an overprotective character and result in the feeling that anatomically or physiologically, something is wrong and needs protection – “it feels like something is broken or wrong in my back because this is the umpteenth time I pulled my back.”
- Bioplasticity of pain: plasticity allows pain to biologically (yet subconsciously) grow in a person and result in persistent or chronic pain – utilising the same plasticity, that same person can grow out of pain or the pain can at least become controllable and manageable.
Unfortunately, this article shows that exactly those last two topics are underexposed in the video material available up to now.
> De: Heathcote, PeerJ 7 (2019) e6603. Todos los derechos reservados: The Author(s). Pincha aquí para acceder al resumen. Traducido por Casper Martens.