Table 3.

Example of the patient–therapist communication during hands-on interventions in patients with chronic pain and CS.

Therapist (T): ‘Could you lie down on your back on the treatment couch so I can treat your knee? I will apply manual techniques on your knee to activate the analgesic system orchestrated by the brain that we explained last time. Do you remember that?’

Patient (P): ‘Are you referring to the “spam filter” that is malfunctioning in my nervous system? Yes, I remember.’

T: ‘Exactly! Applying manual techniques on your knee will temporally strengthen your spam filter, allowing you to have less pain and to move your knee better. Are you OK with that?’

P: ‘Sounds good – I have to do nothing besides lying down here?’

T: ‘For now that’s true, but remember that my hands-on treatment can only temporally activate the analgesic system. This will last no longer than 45 minutes at best. However, there is a way to activate it longer and you can do it yourself. Do you have any idea how you can keep the spam filter activated?’

P: ‘We talked last time about exercises to activate the spam filter?’

T: ‘Absolutely – how do you feel about doing exercises yourself at home?’

P: ‘I was expecting to do exercises as part of the physical therapy treatment anyway, so yes I’m happy to invest time in that.’

T: ‘That’s great. It’s up to you to start doing exercises after the treatment. After I’ve treated you on the couch, I’ll show you how the exercises work. We can try a few exercises together and design the home exercise program together. Let me start the manual treatment first.’

Notes: The therapist does not mention any possible peripheral effects of the hands-on treatment. In case patient questions the therapist about possible peripheral effects of the hands-on treatment, the therapist explains that such effects are possible but unproven, and that in any case, the brain effects (i.e. pain-relieving effects orchestrated by the brain) are far more important.

The therapist does not prepare the patient for possible side effects of the hands-on treatment (like possible pain flares). In case the patient reports pain increases during or following the treatment (either during this or the following treatment), it will be crucial to discuss them with the patient using the ideas and principles provided during the PNE.