A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training.
Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.
J. Nijs, PT, MT, PhD, Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, and Department of Physical Medicine and Rehabilitation, University Hospital Brussels, Brussels, Belgium. Mailing address: Vrije Universiteit Brussel, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
Jo
J
Nijs
Mira
M
Meeus
Barbara
B
Cagnie
Nathalie A
NA
Roussel
Mieke
M
Dolphens
Jessica
J
Van Oosterwijck
Lieven
L
Danneels
D001284:Atrophy; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D059350:Chronic Pain / Q000628:therapy*; D003142:Communication; D005081:Exercise Therapy / Q000379:methods*; D055111:Failed Back Surgery Syndrome / Q000628:therapy; D006801:Humans; D017116:Low Back Pain / Q000628:therapy; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology / Q000628:therapy; D009488:Neurosciences; D010353:Patient Education as Topic; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology; D014911:Whiplash Injuries / Q000150:complications