Abstract
Introduction: Chronic pain affects approximately one third of the UK population. It is a condition of biopsychosocial origin; its management should be biopsychosocially- centred but frequently it is biomedically-centred. This has partly been attributed to an absence of biopsychosocial-focused pain education in pre-registration healthcare curricula. The overall aim of this thesis was to explore pain education across multiple health professions.Methods: Studies 1 and 2 were observational studies of pre-registration healthcare professionals’ (HCPs) knowledge and/or attitudes about pain from first to final year of study. Studies 3 and 4 were a systematic review and RCT, investigating the effectiveness of biopsychosocial education for pre and/or post-registration HCPs on pain knowledge, attitudes and behaviours.
Results: Studies 1 and 2, found that diagnostic radiography, midwifery, nursing, occupational therapy and paramedic students showed little change in their pain knowledge and attitudes over the course of their degree programme, whilst physiotherapy and medical students showed small but clinically relevant improvements in knowledge and/or attitudes. The systematic review found that, compared to a control education, biopsychosocial pain education improved pain knowledge [Mean Difference (95% Confidence Interval)] (18.83%, 95%CI 9.07 to 28.58) but its impact on attitudes (-10.97%, 95% CI -22.8 to 0.87) was less clear. The RCT showed that, compared to a control education, Pain Science Education (PSE) had a significant effect upon students’ pain knowledge in the short-term (3.7, 95% CI 2.4 to 5.0) and attitudes in both the short (-10.4, 95% CI -16.3 to -4.6) and medium-term (-5.8, -11.5 to -0.2). Qualitative exploration revealed that participants
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who received PSE showed partial reconceptualization of pain, greater empathy, and guideline-consistent recommendations.
Discussion: This research found that current students’ pre-registration training had little impact on pain knowledge and attitudes outside physiotherapy and medicine. This limits multi-disciplinary input for pain patients. In addition, biopsychosocial education, such as PSE, can improve multi-disciplinary students’ pain knowledge and attitudes. It provides a strong case for inserting such educational approaches into pre-registration healthcare programmes on an international level.
| Date of Award | 9 May 2021 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Cormac Ryan (Supervisor), Paul Taylor (Supervisor) & Denis Martin (Supervisor) |