Core Curriculum for the European Diploma in Pain Physiotherapy (EDPP)

Section 1. Pain science

3 sub-sections · learning objectives on page 11 of the curriculum PDF

Pain is arguably the most frequent and distressing experience patients report, and every physiotherapist should have a comprehensive understanding of biological mechanisms as well as of the pain experience, to allow adequate treatment.

• 1.1 Theories and mechanisms of pain. Contemporary and evolving theories of pain, their historical context, and their relative usefulness in clinical practice; philosophical aspects of pain theory, such as monism versus dualism, reductionism versus holism, and embodied predictive processing; the transduction, transmission, perception, and modulation of nociception and pain, including the characteristics of sensory neurons and relevant pathways, structures, receptors, ion-channels, and neurotransmitters; the distinction between nociception and pain; mechanistic descriptors and classifications of pain, such as nociceptive, neuropathic, and nociplastic pain, and their relevance to assessment and management; and the concepts and neurobiological mechanisms underlying peripheral and central sensitisation, primary and secondary hyperalgesia, and the transition from acute to chronic pain.
• 1.2 The language of pain science. Common pain and neuroscience-related phenomena as defined by IASP terminology, such as hyperalgesia, allodynia, and sensitisation, and by WHO classifications such as ICD-11 and the ICF; and other contemporary pain-related terminology, including lived experience of pain, stigmatisation, person-centredness, and diagnostic uncertainty.
• 1.3 The complex, variable and multidimensional nature of pain. The pain science underlying the complexity, variability, and multidimensionality of pain, including the evolution, application, and limitations of the biopsychosocial model; the lived experience of pain and how the person in pain can be included in assessment and management; the cognitive dimensions of pain, such as beliefs, self-stigmatisation, fear-avoidance, catastrophising, and conditioning; the role of lifestyle factors including physical (in)activity, obesity, sleep, substance misuse, stress, and trauma; modifiable and non-modifiable risk factors linked to the development of chronic pain, including genetic, socioeconomic, occupational, and educational factors, multimorbidity, emotional well-being, health literacy, and social stigmatisation; and the role of contextual factors such as placebo, nocebo, the therapeutic alliance, and healthcare culture.

Section 2. Principles of assessment and measurement

2 sub-sections · learning objectives on page 11 of the curriculum PDF

Assessment and measurement of patients with acute and chronic pain must be considered critically across the life span, including infants, children, adolescents, older adults, patients from linguistically or culturally diverse backgrounds, patients who are cognitively impaired, and patients with behavioural issues.

• 2.1 Assessment. Planning and undertaking a comprehensive assessment of the person in pain across the lifespan using a biopsychosocial and person-centred perspective; linking theory and evidence-based practice; the role of cultural, societal, economic, and institutional influences; identifying patient and healthcare provider factors that may influence treatment; clinical reasoning based on history and assessment across biological, functional, psychological, work-related, and social factors; excluding suspicion of serious pathology and identifying radiculopathies, painful neuropathies, and specific musculoskeletal injuries where appropriate; understanding modifiable and unmodifiable prognostic factors; understanding specialist assessment by other professionals and when to refer; the principles and practice of quantitative sensory testing and its bedside equivalents, for phenomena such as temporal summation, hyperalgesia, allodynia, and conditioned pain modulation; and differentiating patients who require an individual, multidisciplinary, or interdisciplinary approach, or referral to medical specialists or other allied healthcare professionals.
• 2.2 Outcome measures. Selecting and interpreting valid and reliable pain-specific biopsychosocial outcome measures across ICF domains to assess, monitor, and modify treatment; undertaking a physical assessment including levels of physical activity, function in daily life, and sleep; and providing the patient with a prognosis based on individual, clinical, and empirical risk factors.

Section 3. Principles of treatment

9 sub-sections · learning objectives on page 11 of the curriculum PDF

Treatment is developed, justified, and negotiated with the patient as an individually tailored, evidence-based plan, built on a positive therapeutic alliance and shared decision-making, and delivered with awareness of both its effects and its limits.

• 3.1 Foundations of treatment. The professional responsibility of treating all patients with dignity and respect; developing, justifying, and negotiating an individually tailored treatment plan based on evidence, clinical reasoning, and patient preferences; applying evidence-based practice and research; promoting healthy lifestyle and self-management through motivational and behavioural change techniques; the framework of risk for transition to chronic pain, including the flag system and screening methods; the difference between stepped, stratified, and matched care and subgrouping/phenotyping; managing diagnostic uncertainty; and critically discussing indications, efficacy, complications, management, and follow-up for treatment modalities related to pain management.
• 3.2 Treatment effects. Adapting and modifying management based on treatment response, changes in patient preferences and context, and new knowledge; and understanding the role of contextual factors, placebo, and nocebo in patients' responses to treatment.
• 3.3 Communication. Establishing and maintaining a positive therapeutic alliance through respectful and sensitive verbal and non-verbal communication; developing, justifying, and negotiating an individualised, evidence-based management plan based on the patient's lived experience of pain and their goals; and shared decision-making and a collaborative approach that accounts for patient preferences, values, and health literacy.
• 3.4 Education. Using contemporary science-based explanations, such as neurophysiology, in communication with patients and families/carers; discussing a range of pain management interventions and service delivery modes, including online, group, and face-to-face; applying educational and communication strategies that promote active self-management, motivation, and coaching; identifying and modifying barriers to self-management; variables such as health literacy, self-efficacy, beliefs, culture, and comorbidities that may impact patient knowledge; the impact of healthcare providers' own attitudes and beliefs on patient management; teaching patients and families about the pain mechanisms underpinning their condition; and understanding the learning needs of other health professionals and setting realistic educational goals.
• 3.5 Behavioural therapies. Evidence-based behavioural therapies including cognitive and behavioural therapies, mindfulness-based cognitive therapy, Acceptance and Commitment Therapy, mindfulness-based stress reduction, systemic (couple and family) therapy, hypnosis/guided imagery, biofeedback and relaxation techniques such as progressive muscle relaxation and autogenic training, and graded exposure to feared movement or activities.
• 3.6 Physical activity and exercise prescription. Applying evidence-based physical activity and exercise prescription in chronic pain management; barriers to, and health benefits of, physical activity; modifying physical activity based on factors such as pain state, age, comorbidities, psychosocial factors, pregnancy, cognitive or neurodevelopmental impairment, and psychiatric conditions; addressing psychosocial factors affecting compliance, such as fear-avoidance and catastrophising; incorporating patient education in exercise prescription around goal-setting, coping, pacing, and graded activity/exposure; and appropriate follow-up, managing flare-ups, and maintaining long-term gains.
• 3.7 Digital health management. Evidence-based approaches to telemedicine, artificial intelligence, and remote consultation in pain management, including patient education and self-management through digital platforms; the potential of emerging technologies such as e-health, m-health, and virtual and augmented reality; and the benefits, limitations, and use of appropriate digital health management tools, such as wearables, for pain assessment, monitoring, and treatment.
• 3.8 Work. The role of work, occupational factors, career, finances, housing, and recreational and leisure activities in relation to the patient's pain; the factors associated with work loss and facilitating early return-to-work strategies in collaboration with the pain team and employers; and work adaptation and removal of barriers that facilitate return to work.
• 3.9 Referral to multidisciplinary medical and other relevant health professional colleagues. The importance of consulting and collaborating with colleagues and other multidisciplinary teams across health and social care to optimise patient well-being and outcomes, including return to work; the indications, efficacy, complications, and management of procedural treatment modalities related to pain medicine; the categories of pharmacological options for neuropathic and nociceptive pain, such as NSAIDs, opioids, antidepressants, anticonvulsants, capsaicin, cannabinoids, and corticosteroids; and the limitations of medications and the importance of combining them with other multidisciplinary strategies that include active self-management.

Section 4. Populations in pain

2 sub-sections · learning objectives on page 11 of the curriculum PDF

Pain assessment and management must be adapted to the biopsychosocial characteristics of specific populations and the clinical features of specific conditions, informed by their epidemiology and by relevant clinical guidelines.

• 4.1 Epidemiology. The epidemiology of chronic pain, including its incidence, prevalence, and impact; the influence of socio-demographic factors such as age, gender, ethnicity, and socio-economic status on health inequalities and the lived experience and management of pain; and risk, prognostic, and predictive factors relevant to the development, assessment, and management of chronic pain.
• 4.2 Pain assessment and management for specific populations. Adapting assessment and management for specific populations, including infants, children and adolescents, older adults, pregnant women, people living with cognitive impairments and intellectual disability, mental health and psychiatric conditions, physical disabilities, or neurodiversity, people from linguistically and culturally diverse backgrounds, victims of torture and war, and people who are homeless or displaced; adapting assessment and management for specific clinical populations, including those living with obesity, cancer, neurological disorders, long-term conditions and multimorbidity, or life-limiting conditions; awareness of pain-related clinical guidelines for general and specific populations and their relevance to physiotherapy theory and practice; and knowledge of assessing and managing pain in common and rarer specific conditions, including musculoskeletal pain, osteoarthritis, inflammatory and autoimmune-mediated arthropathies, chronic widespread pain, chronic post-surgical pain, complex regional pain syndrome, pelvic pain conditions, headache/migraine, peripheral and central neuropathic pain conditions, and cancer pain.

Section 5. Interprofessional working and learning

1 sub-section · learning objective on page 11 of the curriculum PDF

Pain management draws on the expertise of various professionals working together, and an effective interprofessional team recognises the interdependence of its members and shares goals with patients.

The objectives cover the importance of interprofessional working and its barriers and facilitators; working respectfully and in partnership with patients, families, carers, and other team members and agencies; creating and engaging in regular opportunities for interprofessional education and supervision; critically reflecting on one's own contribution to the team and continually improving interpersonal and team skills such as communication, negotiation, problem solving, and decision-making; understanding the perspectives, skills, goals, and priorities of all team members; negotiating overlapping and shared responsibilities for episodic or ongoing care; respecting professional differences and acknowledging misunderstandings or limitations that contribute to interprofessional tension; reflecting, negotiating, and collaborating with others to resolve conflict when it arises; and participating in team discussions and implementing strategies that improve team-based care and interprofessional working.