Ralph Magnuson, PT, conducts a physical therapy telehealth visit Photo credit: VAntage Point

Group exercises combined with instruction on the neuroscience of pain helped older veterans increase their mobility, reduce chronic pain and improve quality of life, a Veterans Affairs physical therapy program has shown.

Pain neuroscience education, or PNE, promotes understanding of the brain’s role in producing pain. In use since 2002, PNE has been shown to change a patient’s perception of pain, reducing fear avoidance behaviors and increasing participants’ willingness to move, according to Physiopedia. Participants may also be gradually re-exposed to exercise to help decrease the sensitivity of the nervous system.

To that end, the VA program was designed to increase participants’ engagement in their own care using a whole person model rather than a biomedical model of care only, said study lead Ralph Magnuson, PT, and colleagues from the Redding VA Clinic in Northern California.

“We assess that shoulder or back and try to identify the pain generator. When we find it, we try to fix it,” Magnuson said. “Therapeutic neuroscience is more on the biopsychosocial model, where we focus on the whole person. We’re moving towards patient-focused goals versus the primary care physician or therapist-driven goals.”

In the VA study, participants initially were asked about their pain management aims, which elicited answers such as, “I want to be able to go out to dinner with my wife and shop in the community,” or “I just want to walk with my grandkids,” the program leaders said.

Participants were assessed for chronic pain and pain intensity before and after the program. Pain scores improved by 20%, on average, amongst all participants, Magnuson reported.

“We saw a significant change as a group. When they worked together, with camaraderie that was exercise-based, they just in general felt better,” he said. “They were observed moving better. I think that relates to, ‘If I feel better, and I move better, my pain must be better.’ ”

The program was inspired by Magnuson’s participation in the VA Geriatrics Scholars Program, a national workforce development program that trains primary care providers in geriatric medicine and teaches fundamental skills in quality improvement.