LEARNING OBJECTIVES
1. Gain understanding of the practicalities and limitations in the science of pain sensitivity as it applies to clinical practice.
2. Provide practical strategies for the patient interview and physical assessment of pain sensitivity, clinical-reasoning related to interpretation of these findings, and the latest thoughts on management for clients where pain sensitivity is a significant factor.
3. Have an evidence informed framework, aligned with the International Association for the Study of Pain curricula, allowing clinicians to understand where pain sensitivity fits within a person-centred approach.
DESCRIPTION
This session will include learning related to state-of-the-art concepts for integrating pain sensitivity into clinical practice. As a clinical term, pain sensitivity refers to a state where responses to somatosensory stimuli suggest altered nociceptive processing. Profiling people with musculoskeletal pain based on their responses to somatosensory stimuli, known as quantitative sensory testing, has escalated in pain research. Implementation of this knowledge into clinical practice for musculoskeletal therapists is emerging. Indeed, recent adoption of the term ‘Nociplastic Pain’ by the International Association for the Study of Pain means assessment for altered nociceptive processing should become more routine. Interestingly, there is not a clear link between pain sensitivity with pain and disability in all musculoskeletal disorders. Heightened pain sensitivity may be more important due to its links with prognosis, and potential for it to effect/modify an individual’s response to everyday treatments for musculoskeletal pain. Here we offer a framework from which clinicians can integrate the concept of pain sensitivity into clinical practice.
A case study of a person with significant pain sensitivity in their presentation will provide the basis for expert discussion.
Patient Interview:
This section applies scrutiny to the patient interview to discern the relative importance of pain sensitivity in the person’s presentation. Research has determined subjective pain descriptors more frequently associated with altered pain sensitivity. Specific questions related to sensitivity may supplement the traditional subjective question battery. The concept of ‘disproportionate’ reactions will be examined. Participant will be provided with a framework to interpret the interview findings for when to prioritise pain sensitivity testing in the physical assessment.

Physical Examination
Quantitative sensory testing used to determine pain sensitivity in the laboratory setting may require expensive equipment and considerable time not affordable to the average clinician. Here participants will be provided with instruction in a paradigm for assessing pain sensitivity in the clinic, with opportunity to practice one element of this assessment.

Diagnosis
This section will cover combining the information gathered from the patient interview and physical assessment, to understand the presence and relevance of pain sensitivity in an individual’s presentation. A model for prioritising pain sensitivity in management will be provided. This section will focus on the explanation of pain sensitivity to the patient within the context of their diagnosis, with opportunity for participants to practice this in a role-playing exercise.

Management
How does the presence of pain sensitivity inform clinical practice? Guideline based interventions for common conditions like spinal pain and knee osteoarthritis are important, but consideration is needed for patients with pain sensitivity who are less likely to respond well. A reasoning paradigm will be explored, with participant engaged in reflective exercise to build understanding of strategies to manage pain sensitivity as part of a person-centred care approach.
The Broader Whole-Person Approach
While pain sensitivity is an important consideration in musculoskeletal disorders, especially for identifying altered nociceptive processing/nociplastic pain, it is no more important than having a whole-person perspective and approach. The Musculoskeletal Clinical Translation Framework provides an integrated, evidence informed guide for clinicians to fit together the biopsychosocial elements on an individual’s presentation. Through the lens of this framework, participants will understand how to integrate the concept of pain sensitivity and nociplastic pain into a whole-person approach.
IMPLICATIONS/CONCLUSIONS
Managing pain sensitivity can be challenging. This session will improve clinician understanding of pain sensitivity from a whole-person approach, providing multiple tools to assist them to incorporate the concept of pain sensitivity into the assessment and management of clients with musculoskeletal conditions. They will have strategies to increase client understanding and make the concept of pain sensitivity meaningful to these clients.