Core Curriculum for the European Diploma in Pain Psychology (EDPPsy)

Section 1. Pain science and knowledge

5 domains · 24 learning objectives

The scientific foundation. Psychologists working in pain need to understand the biological and neurophysiological mechanisms of acute and chronic pain well enough to collaborate with other professions, to explain pain to the people they work with, and to reason clinically about it.

• 1.1 The IASP definition of pain and related phenomena. Pain terminology and classification, including the distinctions between acute, recurrent, and chronic pain, and between nociceptive, neuropathic, and visceral pain; terms used in quantitative sensory testing; and the differences between pain, pain behaviour, disability, and suffering.
• 1.2 Conceptual models of medicine and psychology. The history of pain science from Cartesian dualism through gate control and sensitisation theory to the bio-psycho-social perspective; critical appraisal of psychological approaches to pain; and the mechanisms underlying placebo and nocebo responses.
• 1.3 Neurophysiology and psychobiology of acute and chronic pain. Mechanisms of nociceptive, inflammatory, neuropathic, referred, and phantom limb pain, and nociplastic pain syndromes; transduction, transmission, and modulation in nociceptive pathways; ascending and descending modulation; the neuroanatomical basis of the perceptual, cognitive, and affective dimensions of pain; brain changes in chronic pain; and genetic and epigenetic aspects.
• 1.4 Ethical and legal aspects. Informed consent, confidentiality, data protection, and patient rights; justice, equity, autonomy, beneficence, and non-maleficence in pain practice; relevant national law; and the handling of ethical dilemmas in assessment and treatment.
• 1.5 Evidence-based principles. Study designs relevant to pain research; statistical and clinical significance and effect size; systematic reviews, meta-analysis, and risk of bias; and the ability to judge the quality of evidence.

Section 2. Interprofessional working and learning

9 learning objectives

Pain assessment and management draws on the expertise of several professions working to a shared bio-psycho-social perspective. This section distinguishes genuinely interprofessional working, in which the team shares goals and recognises the interdependence of its members, from parallel working in which each profession acts separately.

The objectives cover the barriers to and facilitators of team-based care; working respectfully and in partnership with people living with pain, their families, and carers; creating opportunities for interprofessional education and supervision; reflecting critically on one's own contribution to the team; understanding the perspectives, skills, and priorities of other team members; negotiating overlapping responsibilities; and resolving interprofessional conflict.

Section 3. Principles of assessment and measurement in pain

3 domains · 23 learning objectives

The largest single body of competencies. Assessment is treated as a complex clinical procedure requiring both a trusting relationship and a command of assessment strategies, with self-report, direct observation, and reports from others all valid sources.

• 3.1 Assessment. Classification systems including DSM, ICD, the WHO International Classification of Functioning, Disability and Health, and the IASP system; the goals of assessment, from case formulation and risk screening to treatment selection and outcome measurement; barriers to assessment at the level of the person, the family, the professional, and the health system; cultural, societal, economic, and institutional influences; culturally sensitive assessment where the person and the clinician do not share a language; the range of pain-related outcomes to be assessed, including activity and participation, sleep, sexual activity, affect, medication overuse, and quality of life; the psychological and social factors that contribute to pain, distress, and disability, including beliefs, expectations, self-efficacy, catastrophising, coping, psychological flexibility, and the responses of significant others; shared decision-making on goals; work loss and barriers to return to work or school; and indications and contra-indications for treatment based on psychological factors.
• 3.2 Measurement. Psychometric properties including reliability, validity, and responsiveness; available self-report instruments and their limitations; the rationale for measuring experimental pain, including quantitative sensory testing; selecting instruments on the basis of evidence; and awareness of newer approaches such as wearables and actigraphy, online and computerised adaptive testing, brain imaging, and biomarkers.
• 3.3 Approaches from other disciplines. Recognising that bio-psycho-social assessment operates at several levels of analysis and draws on several professions, and understanding what assessment by medical and allied health colleagues involves.

Section 4. Treatment and pain management

2 domains · 24 learning objectives

Intervention is framed as individualised and tailored to the person's preferences and values, with self-management promoted to build confidence, resilience, and problem-solving skills. Selection of interventions is expected to rest on evidence, with the strengths and limitations of each considered.

• 4.1 Psychological interventions. Developing and negotiating an individualised management plan; the limits of medication alone and the value of combining approaches; promoting healthy lifestyle and self-management through motivational and behaviour change techniques; psycho-education within a bio-psycho-social framework; the influence of clinicians' own attitudes and beliefs; early intervention and prevention, including the flag system and screening for the transition to persistent pain; managing pain in the community and workplace and supporting return to work or retraining; operant methods; relaxation and biofeedback; the principles and evidence of cognitive-behaviour therapy, covering behavioural reactivation and pacing, cognitive restructuring, coping skills, emotional regulation, engagement with meaningful activity, exposure, and relapse prevention; mindfulness-based therapy and Acceptance and Commitment Therapy; hypnosis, family, child, and dyadic interventions; e-health and digital interventions; follow-up and outcome measurement; stepwise and stratified treatment strategies; and emerging technologies such as virtual and augmented reality.
• 4.2 Approaches from other disciplines. Basic working knowledge of the most common pharmacological interventions for pain, of procedural interventions including peripheral injections, transcutaneous electrical nerve stimulation, neuromodulation techniques, and surgery, and of physiotherapy principles including exercise therapy, manual therapy, and reactivation.

Section 5. Subgroups and clinical conditions

2 domains · 34 learning objectives

People living with pain come from different backgrounds and present with different needs, and some may live with more than one painful condition. This section addresses the groups and conditions where assessment and management require something specific.

• 5.1 Subgroups. The influence of socio-demographic characteristics on pain, distress, and disability; barriers to assessment and management in infants, children, older adults, people with developmental disorders or cognitive impairment, and people who have experienced physical or mental trauma; pain in childhood, adolescence, and young adulthood, including the role of family and school and the longer-term consequences of early pain; identifying children at risk of chronic pain; pain in older age; sex and gender differences, including awareness of one's own gender-based assumptions; socio-economic status and health inequalities; race, ethnicity, and culture; and cultural sensitivity in practice.
• 5.2 Subgroups based on clinical conditions. Five condition groups, each with its own set of objectives: postoperative pain; musculoskeletal pain, including back and neck pain; tension-type headache and migraine; widespread chronic pain, including fibromyalgia; and disease-related pain, covering arthritis, HIV, cancer-related pain, and end-of-life care.