Ep 215: Assessing pain in athletes, with Ciarán Purcell
Feb 10, 2025
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Ciarán Purcell is a sports physiotherapist and researcher from the University of Limerick, focusing on refining pain assessment in athletes. He explains the limitations of traditional pain assessment tools and advocates for a holistic approach that accounts for psychological and socio-environmental factors. Ciarán discusses a collaborative project aimed at developing consensus guidelines in pain assessment, emphasizing the need for comprehensive tools in sports medicine. He also invites listeners to engage with this important research initiative.
Ciarán Purcell emphasizes the need for a comprehensive pain assessment in athletes by integrating cognitive and socio-environmental factors into traditional methods.
The development of a consensus framework led to the identification of 64 essential pain assessment items, refining the tools available for clinicians.
Deep dives
Need for Improved Pain Assessment in Athletes
The episode addresses the need for a better understanding of how to assess pain in athletes, highlighting the limitations of traditional pain measurement tools, such as asking athletes to rate their pain on a scale. Kieron Purcell, a sports physiotherapist and researcher, emphasizes that while basic tools can provide some insight, they often fail to capture the multifaceted nature of an athlete's pain experience. He notes that the International Olympic Committee's 2017 consensus statement identifies five key domains of pain assessment, which include neurophysiological, biomechanical, cognitive, emotional, and socio-environmental factors. By focusing primarily on the first two domains, clinicians overlook important contextual factors that can significantly impact an athlete's perception and management of pain.
Conducting Focus Groups for Pain Assessment Insights
To gather insights into improving pain assessment methodology, Purcell conducted focus groups with both athletes and physiotherapists, revealing that athletes experience pain in a way that differs from traditional understandings of pain. These focus groups highlighted a collective recognition of existing tools while pointing out significant gaps in addressing cognitive and socio-environmental factors related to pain. As a result of these discussions, a nominal group technique was employed to generate and prioritize new pain assessment ideas, ultimately leading to the identification of six domains relevant to athlete pain assessment. This collaborative approach ensured that the voices of both clinicians and athletes were acknowledged, paving the way for a more comprehensive assessment framework.
Establishing a Consensus Framework for Pain Assessment
Purcell details the development of a consensus framework involving a diverse group of experienced sports physiotherapists, aimed at refining pain assessment techniques for athletes. The process resulted in the identification of 64 essential pain assessment items across the established domains, significantly narrowing down the initial 176 tools identified in earlier scoping reviews. This comprehensive framework allows clinicians to select and apply relevant assessment tools tailored to their specific athlete interactions while providing practical guidance for implementation. By ensuring a rigorous process for establishing consensus, the framework aims to enhance clinicians' trust in the assessment tools they choose while promoting improved athlete care.
How do you approach assessing pain when you're working with athletes? What tools do you find most helpful?
Today, sports physiotherapist and researcher, Ciarán Purcell (University of Limerick, Ireland) describes the project he is leading to gather consensus from athletes and sports medicine & rehabilitation clinicians about how best to assess athletes' pain. Listen to the end to learn about how you can get involved in the consensus!
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RESOURCES
IOC consensus on managing pain in elite athletes: https://pubmed.ncbi.nlm.nih.gov/28827314/
Framework for assessing upper and lower limb pain in athletes: https://www.jospt.org/doi/10.2519/jospt.2024.12807
Scoping review of tools for assessing pain in athletes: https://pubmed.ncbi.nlm.nih.gov/36759138/
To get in touch with Ciarán about the consensus project, email ciaran.purcell@ul.ie
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