The Titling credential is awarded by the Australian Physiotherapy Association (APA) to a physiotherapist who has completed further study and a formal assessment in their field of practice. An APA Titled Pain Physiotherapist has done this in the management of complex and persistent pain. Titling is Milestone 3 in the APA’s career pathway. To become a Titled Pain Physiotherapist, a physiotherapist must pass a strict selection process. This process assesses their knowledge and clinical practice in persistent pain against the APA’s standards.

There are two pathways to Titling. One is educational, in which the physiotherapist will have completed a Master’s degree or equivalent postgraduate qualification in the field of persistent pain. The second is through an evidence portfolio. The physiotherapist submits a written portfolio and two video recordings of a patient assessment, to show their skills and experience in persistent pain.

What is the difference between a physiotherapist and a Titled Pain Physiotherapist?

Every physiotherapist learns about pain as part of their degree, and many keep building on that through ongoing professional development. Titling does not replace that. It is a formal recognition, assessed by the APA, of further study and a body of experience in one field. For pain, that means postgraduate study in pain management, or an assessed portfolio, plus the selection process described above. Providing individualised and easy-to-understand pain education is a skill developed through education, experience and peer review. It also takes time, so it works best in an appointment set aside for it.

Through Titling, the APA recognises a physiotherapist’s further education in assessing complex pain and in providing pain education. A pain-focused appointment usually includes:

• A comprehensive assessment, with plenty of time for you to tell your story
• Evaluation of the biological, psychological and social factors related to your ongoing pain
• Interpretation of the results of any imaging or testing, including exploring what you understand the investigations to mean
• Collaboratively discussing the assessment findings and contributing factors with you, often by mapping it out together
• Providing an explanation of your pain that is specific to you, incorporating contemporary pain science
• Providing a tailored management plan including an exercise program, goal setting, graded activity, management of sleep disruption, pacing and flare-up management planning
• Exploring the impact that thoughts and emotions have on your experience of pain
• Communicating with other clinicians involved in your care so that your care is co-ordinated

In April 2020, WorkSafe Victoria launched a pain education pilot program with APA Titled Pain Physiotherapists, providing pain education sessions for injured workers with complex persistent pain. The program aimed to improve outcomes for injured workers, particularly those at risk of delayed recovery and return to work, or who were on a waiting list for surgery. The sessions were offered in addition to the worker’s current treatment. This recognised the different roles of the treating physiotherapist and the pain physiotherapist in improving treatment and recovery outcomes (Daly, 2022).

How can pain education help me?

Learning about your pain is a crucial step towards managing it yourself. Many studies have looked at whether helping people understand their pain improves pain and function (Moseley et al., 2024). Where education is personalised and relevant to you, and changes what you believe about the cause of your pain, people report less pain, better coping and better physical function (King et al., 2018; Moseley et al., 2024). Where education did not change the way people thought about their pain, there was little or no change in pain or function (King et al., 2018). Pain education works best when it is personalised, makes sense to you, and changes how you understand your pain. That is why it usually takes a conversation and your questions, not a handout.

Kirsten Walker is our APA Titled Pain Physiotherapist and works from our Footscray clinic. If persistent pain is limiting what you can do, book an appointment and we can work out where to start.

References:

Australian Physiotherapy Association. (n.d.). APA Titling. https://australian.physio/pd/acp-titling

Australian Physiotherapy Association. (2024). Titled Pain Physiotherapist: Guidelines for submission of evidence portfolio and clinical exam (Version 1.0). https://australian.physio/sites/default/files/College/EPP/Titling_EPP_Clinical_Practice_Domains_Pain_Physiotherapy.pdf

Daly, A. (2022, March). Physios and WorkSafe team up for pain education. InMotion. Australian Physiotherapy Association. https://australian.physio/inmotion/physios-and-worksafe-team-pain-education

King, R., Robinson, V., Elliott-Button, H. L., Watson, J. A., Ryan, C. G., & Martin, D. J. (2018). Pain reconceptualisation after pain neurophysiology education in adults with chronic low back pain: A qualitative study. Pain Research and Management, 2018, Article 3745651. https://doi.org/10.1155/2018/3745651

Moseley, G. L., Leake, H. B., Beetsma, A. J., Watson, J. A., Butler, D. S., van der Mee, A., Stinson, J. N., Harvie, D., Palermo, T. M., Meeus, M., & Ryan, C. G. (2024). Teaching patients about pain: The emergence of pain science education, its learning frameworks and delivery strategies. The Journal of Pain, 25(5), Article 104425. https://doi.org/10.1016/j.jpain.2023.11.008