title: Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories.
abstract: Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories. Here the authors explain how musculoskeletal therapists can alter pain memories in patients with chronic musculoskeletal pain, by integrating pain neuroscience education with exercise interventions. The latter includes applying graded exposure in vivo principles during exercise therapy, for targeting the brain circuitries orchestrated by the amygdala (the memory of fear centre in the brain). Before initiating exercise therapy, a preparatory phase of intensive pain neuroscience education is required. Next, exercise therapy can address movement-related pain memories by applying the 'exposure without danger' principle. By addressing patients' perceptions about exercises, therapists should try to decrease the anticipated danger (threat level) of the exercises by challenging the nature of, and reasoning behind their fears, assuring the safety of the exercises, and increasing confidence in a successful accomplishment of the exercise. This way, exercise therapy accounts for the current understanding of pain neuroscience, including the mechanisms of central sensitization.
authors.affiliation: Pain in Motion Research Group(1); Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium. Electronic address: Jo.Nijs@vub.ac.be.
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
authors.affiliation: Pain in Motion Research Group(1); Department of Physical Therapy, University of Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Lluch Girbés
authors.affiliation: Department of Orthopaedics, University of Gothenburg, Sweden.
authors.forename: Mari
authors.initials: M
authors.lastname: Lundberg
authors.affiliation: Pain in Motion Research Group(1); Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.
authors.forename: Anneleen
authors.initials: A
authors.lastname: Malfliet
authors.affiliation: Centre of National Research on Disability and Rehabilitation Medicine (CONROD), Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
mesh_terms: D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005239:Fear; D006801:Humans; D059352:Musculoskeletal Pain / Q000523:psychology* / Q000628:therapy*; D010147:Pain Measurement
keywords: Chronic pain; Exercise therapy; Neuroscience; Sensitization