Pain: chronic (FS-19)

Critical updates in our understanding of chronic pain

G. Lorimer Moseley (Australia), Michael Thacker (United Kingdom), David Walton (Canada)

Focused symposium

Monday 4 May 2015, 08:30-10:00, Hall 406

Critical updates in our understanding of chronic pain

Moseley G.L. 1, Thacker M. 2, Walton D. 3

1University of South Australia & PainAdelaide, Adelaide, Australia, 2Institute of Psychiatry, King's College London, London, United Kingdom, 3Western University, London, Canada

Learning objectives

  1. To understand the latest developments concerning brain changes in chronic pain and their implications for physiotherapy practice.
  2. To understand the latest developments concerning neuro-immune interactions in chronic pain and their implications for physiotherapy practice.
  3. To understand the latest developments concerning the psychology of chronic pain and their implications for physiotherapy practice.

Description

Chronic pain is perhaps the most burdensome health issue facing the planet, with the cost to developed countries comparable to that of diabetes and cancer combined (1).

Physiotherapists are at the forefront of bridging the gap between developments in pain science and clinical practice, and physiotherapists can play a leading role in promoting more effective prevention and treatment of chronic pain. Most of the recent developments in pain science that have direct relevance to clinical management relate to our understanding of the role of the brain, the role of the immune system or the role of cognitive and behavioural factors. This session brings together recognised leaders in each of these fields, each of whom are also clinical physiotherapists. They will summarise the developments in their field and the implication of those developments for physiotherapy practice.

With regard to the role of the brain, Professor Lorimer Moseley (Australia) will use evidence from brain imaging studies and behavioural experiments to implicate adaptations in brain function in problems commonly associated with chronic pain, for example: disruption of movement, proprioception, autonomic control, immune regulation and the perceived size and shape of body parts. He will present the cortical body matrix theory (2) as a framework with which to integrate these developments with the assessment and management of people in pain, and will provide a clear account of the evidence associated with treatments that are based on this research.

With regard to the immune system, Dr Mick Thacker (UK) will use evidence from animal and basic human studies to implicate adaptations in the immune system in the increased sensitivity, to dangerous and non-dangerous stimuli, that characterizes chronic pain. He will provide an account of the intimate connection between immune cells and nerve cells in the spinal cord and brain and an update on the mechanism by which sensory stimuli are transmitted to the brain and processed by multiple neural loops under immune-system regulation. He will make clear recommendations for the physiotherapy management of people in pain including appraisal of the evidence associated with treatments that are based on this research.

With regard to cognitive and behavioural factors, Dr David Walton (Canada) will use evidence from cross sectional and longitudinal clinical studies to suggest that fear, although relevant to chronic pain-related disability, is probably not the key variable we thought it was even just five years ago. He will present a range of new psychological constructs that might mediate the relationship between pain and disability, and mediate the risk of chronic pain and disability after an acute episode. He will argue that the evidence clearly shows that catastrophic thought processes associated with pain increase risk, and that novel cognitive factors, such as the sense of victimization and trauma-specific distress, appear to also be involved. He will also suggest however, that important mechanistic questions remain unanswered: is chronic pain simply a condition of the weak-willed or ill-informed? Are there other mechanisms that might better explain risk of chronic problems? Are we confident that catastrophizing causes chronic pain, or might chronic pain cause catastrophising? Finally, Dr Walton will present the current evidence for treatments that are based on this research. The session will emphasise the clear articulation of implications of these developments for physiotherapy practice and research.

1. T. Vos et al., Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380

2. G. L. Moseley, A. Gallace, C. Spence, Bodily illusions in health and disease: physiological and clinical perspectives and the concept of a cortical ´body matrix´. Neurosci. Biobehav. Rev. 36

Implications / Conclusions

This symposium will be positioned within the context of chronic pain representing the world´s most burdensome health issue and the potentially central role that physiotherapists can play in reducing this immense burden. By focussing on the most recent and important developments, this symposium will give attendants an account of current concepts in chronic pain, in a way that should influence their clinical reasoning, and thereby their clinical practice, immediately.

Keywords

Brain; Neuro-immune; Biopsychosocial

Funding acknowledgements

National Health & Medical Research Council of Australia Project and Fellowship grants.
Welcome Trust Grants

Relevance to WCPT and expected audience

Physiotherapists are key players in the modern approach to pain rehabilitation and management, from primary care to tertiary care, public health and preventative medicine. Better understanding pain from the perspective of basic and clinical sciences is of fundamental relevance to physiotherapists all over the world.

Target audience

All physiotherapist researchers and clinicians who work in an area in which pain is a component of someone's presentation.