title: Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature.
abstract: Teaching people with chronic low back pain (CLBP) about the neurobiology and neurophysiology of their pain is referred to as pain neuroscience education (PNE). There is growing evidence that when PNE is provided to patients with chronic musculoskeletal pain, it can result in decreased pain, pain catastrophization, disability, and improved physical performance. Because the aim of PNE is to shift the patient's focus from the tissues in the low back as the source of their pain to the brain's interpretation of inputs, many clinicians could mistakenly believe that PNE should be a "hands-off," education-only approach. An argument can be made that by providing manual therapy or exercise to address local tissue pathology, the patient's focus could be brought back to the low back tissues as the source of their problem. In this narrative literature review, we present the case for a balanced approach that combines PNE with manual therapy and exercise by considering how manual therapy can also be incorporated for interventions with patients with CLBP. We propose that as well as producing local mechanical effects, providing manual therapy within a PNE context can be seen as meeting or perhaps enhancing patient expectations, and also refreshing or sharpening body schema maps within the brain. Ideally, all of this should lead to better outcomes in patients with CLBP.
authors.affiliation: a Department of Physical Therapy , University of Nevada, Las Vegas , Las Vegas , NV , USA.
authors.forename: Emilio J
authors.initials: EJ
authors.lastname: Puentedura
authors.affiliation: b School of Physical Therapy , South College , Knoxville , TN , USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Flynn
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods*; D016896:Treatment Outcome
keywords: Body schema; exercise; manual therapy; neuroscience; pain; patient expectations