Join Jo Nijs sharing the One Thing he wants people challenged by pain to know about? Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Jo Nijs.
About Prof Jo Nijs
Prof Jo Nijs is professor at the Vrije Universiteit Brussel (Brussels, Belgium), physiotherapist/manual therapist at the University Hospital Brussels, holder of a Chair on oncological physiotherapy funded by the Berekuyl Academy, the Netherlands, and part of the Visiting Professor program of the University of Gothenburg (Sweden). Jo runs the Pain in Motion international research group. The primary aim of his research is improving care for patients with chronic pain. At the age of 44, he has (co-)authored more than 240 peer reviewed publications (including papers in high impact journals such as The Lancet and JAMA Neurology), obtained €9 million grant income, supervised 16 PhD projects to completion and served more than 270 times as an invited speaker at national and international meetings in 25 different countries (including 31 keynotes). He trained 3k clinicians in 92 courses held in 12 different countries spread over 4 continents. His work has been cited more than 6.5k times (h-index: 44), with 24 citations per article (ISI Web of Knowledge). Jo is ranked 2nd in the world among chronic pain researchers (1st in Europe; expertscape.com), received the 2017 Excellence in Research Award from the JOSPT (USA), and the 2020 Francqui Collen Chair awarded by the University of Hasselt, Belgium.
Transcript
Jo, what’s the one thing you want people who are challenged by pain to know about?
I want them to reflect on their own situation, and whether they prefer themselves to continue relying on short-term pain relief. Because that’s what the majority of people suffering from pain do: they continue to rely on short-term pain killers. And that can be all kinds of short-term pain killers, and I’m not talking about drugs in itself: I’m talking about drugs in itself, but that’s not the only thing I’m referring to: I’m referring to all kinds of passive treatments: All kinds of things that they can do to apply a real passive coping strategy: relying on hands-on manual therapy, relying on dry needling, relying on massage therapy, acupuncture… All kinds of short-term painkillers. That’s what we call it in the clinic when we’re treating pain patients.
And of course it’s not us deciding what they should do, it’s them deciding, you know? But we discuss it with them, and we explain to them that that it makes sense for them to think that those therapies are a relief to them, because in most cases they are. But only in the short-term. And when you confront a patient with that: that it’s only a short-term pain relief, and it doesn’t make them better in the long-term. They support that idea. They acknowledge the fact that it’s only a short-term pain relief that they get from these types of treatments and that in the long-term it’s probably making the situation worse because it’s preventing them from investing in long-term pain relief, and even probably more important than long-term pain relief is getting the control back in their own life, and increasing their quality of life.
And there’s only one way to do that. And that is investing in their lifestyle. And of course investing in their lifestyle is a highly individual, tailored thing because not all chronic pain patients have the same lifestyle. Their lifestyle changed because of their chronic pain as well: they reduce the amount of physical activity, they often try to change their diet because there are trying to anticipate what kind of food is increasing or decreasing their pain, again in the short-term, which is not a good idea. They often develop sleep problems, making their sleep a big issue which is aggravating or at least sustaining their chronic pain problem. So their lifestyle is a big issue but it’s always highly individually different. So it needs to be tailored individually. That’s why therapists are out there to coach them to a system in adopting a much more adaptive lifestyle to combat their chronic pain problem. The main thing about adopting a healthier lifestyle is increasing their quality of life, and getting control on their life, because also the passive treatments, the short-term painkillers, are not allowing them to control their own life, and that’s such a huge thing for chronic pain patients.
And that’s also something they should know from the beginning: that if they change from short-term painkillers to long-term control in their own life by investing in a lifestyle change. That you can only get results from that in the long-term. The two go hand in hand: it’s not that they can continue with the short-term painkillers, and also start investing in lifestyle. Theoretically, that’s possible, but in the real life of patients with chronic pain, that’s often not realistic, because it will it requires too much effort for them. Because even though many of the short-term painkillers are passive treatments, it still takes a lot of effort to make your appointment with a therapist, just to go and see the therapist, and to also recover from the treatment in itself. And in the long-term that’s not making them much better, and often makes situation worse.
We didn’t mention stress yet, but stress is a big thing. Patients often think when they hear about stress they sometimes get like scared that you’re thinking that it’s all in their head, and it’s a mind thing, but stress is a biological thing in itself, you know? A lot of hormones are produced in response to action taken by the brain. I’m just referring to the hypothalamus pituitary adrenal axis is one of the major stress axes in our body. And in many patients with chronic pain, we see that this stress axis is no longer functioning properly. In those patients, their only solution is to get them on a stress management program, often as part of a lifestyle approach. And those kind of stress management programs are out there, included in behavioral therapy programs like cognitive behavioral therapy (CBT), or acceptance and commitment therapy (ACT). But they can also access stress therapists or therapists who are focusing on teaching them stress management skills. Many physios are able to do that. So it’s out there, you know? But patients should have an open mind, and not think of those type of therapies as just being a psychological treatment because they have a very strong physiological background and foundation.
So it’s a gradual progression from short-term treatments across to long-term treatments. But do they need to have shifted their focus away from pain intensity and onto function, or is there any shifts in mindset that are required?
Yeah that’s a very good one and I think the main thing there is to change and increase their understanding about pain: that’s very key to making that switch. And that’s also the one thing that is needed to make the right decision, because we’re never telling patients “OK you should do this or should do that” – no it’s up to them to make a decision. And we always give choices to them. And what we do in our clinic is: the first thing we do is we explain pain to them. Explaining pain and explaining that chronic pain is not just a purely psychological thing but it’s a physiological problem including, often hypersensitivity orchestrated by the brain, and other issues including the malfunctioning of many of the stress response systems. And as soon as they ‘get’ that, then we provide the options for them in terms of treatments.
And when we ask them “why are you seeing me as a therapist?” all of them say “I want pain relief”. But then I ask a second question. I ask them: “Okay but let’s imagine that tomorrow you wake up and you don’t have any pain, what will you do differently tomorrow as compared to today?” Then they talk about how they will organize their life differently and what kind of fun activities that they would do, instead of today. And then also you know what they expect in terms of increased quality of life. Then you can start to focus from the early beginning on quality of life, and also you get the more functional limitation straightaway as well. And the most important, most significant functional limitations that the patient has in his or her life are interviewed this way, are assessed this way, in a much more comfortable way, and also in a way that creates hope to the patient.
Thank you so much for your time Jo it’s been excellent.
It’s my pleasure.