A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education With Cognition-Targeted Motor Control Training

A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education With Cognition-Targeted Motor Control Training Skærmbillede 2015-05-18 kl. 06.53.38This blogpost is writting by a good friend and inspirering colleague in the field of physiotherapy, Alexander Hummelshøj Kringelbach, who has summerize an article prior to a moderne neuroscience path for chronic back pain and how it can be combined with motor Control. See the article here.

You can get in touch with Alexander on LinkedIn through this link: linkedin.com/pub/alexander-kringelbach/65/56a/639/en

Go to my webpage for more info about treatments and rehabilitation in Copenhagen: SøernesFysioterapi.dk.

Skærmbillede 2015-05-18 kl. 06.43.05

Central sensitization encompasses altered sensory processing, leading to generalized hypersensitivity of the somatosensory system.

There is compelling evidence for impaired motor control in patients with Low Back Bain (LBP) and Chronic Spinal Pain (CSP). Intriguingly, these dysfunctions do not spontaneously resolve when spinal pain dissipates and these dysfunctions are observable in patients with recurrent low back pain.

Studies demonstrated a loss of grey matter volume in the somatosensory cortex in patients with chronic low back pain which was strongly correlated with pain duration and pain intensity.

Therefore impaired motor control of spinal muscles in recurrent LBP and CSP implies a reversible but maladaptive brain neuroplasticity of the somatorsensory cortex. The disturbance of proprioception by impaired motor control and altered pain sensation caused by changes in central mechanisms, leading to hypersensitivity of the somatosensory system builds the foundation for chronic pain.

A modern neuroscience approach to Chronic Spinal Pain (CSP) using a comprehensive rehabilitation program comprising of pain neuroscience education followed by cognition-targeted motor control training have recently been shown effective as sole treatments for people with Chronic Spinal Pain (CSP). This suggests a strong synergistic effect of neuroscience education and exercise therapy for spinal motor control.

Rehabilitation of Chronic Spinal Pain (CSP) should therefore not only address the peripheral dysfunctions of spinal muscles and joints, nor should it only address the process of central sensitization and cortical re-organization (58), but combine both into an individualized treatment approach.

A 3-Phased treatment approach is suggested.

  • Skærmbillede 2015-05-18 kl. 06.43.54Phase 1: Therapeutic Pain Neuroscience Education Challenge and change pain beliefs – reconceptualize pain sensation – reduce central nervous system hyperexcitability.
  • Phase 2: Cognition-Targeted Neuromuscular Training Introduce movements using motor imagery following the principles of motor learning – progress into sensorimotor control training – it is mandatory that motor control training is cognition-targeted and seeks to normalize proprioception and pain sensation.
  • Phase 3: Cognition-Targeted Dynamic and Functional Exercises Exercises to normalize function targeting coordination and improvement of posture and movement patterns with emphasis on the maintenance of optimal trunk stability and flexibility.

Reference

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