Nijs J.1, Parker R.2, Ickmans K.3, Sterling M.4
1Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology & Anatomy, Brussels, Belgium, 2University of Cape Town, Division of Physiotherapy, Department of Health & Rehabilitation Sciences, Faculty of Health Sicences, Cape Town, South Africa, 3Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology & Anatomy, Faculty of Physical Education & Physiotherapy, Brussels, Belgium, 4Griffith University, Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute of Queensland, Parklands, Australia
- Applying evidence-based guidelines for chronic pain management to physical therapy practice in a patient-tailored manner (i.e. accounting for the underlying pain mechanism).
- Devising an effective physical therapy program to remediate pain that considers the underlying pain mechanism as well as the social and cognitive/affective/emotive aspects of the pain experience.
- Adopting physical therapy skills to the unique features of neuropathic and non-neuropathic central sensitization pain, taking into account the social aspects that may differ substantially between parts of the world.
Contemporary pain neuroscience has advanced our understanding about pain, including the role of central sensitization (CS). CS implies increased neuronal response to stimuli in the central nervous system (i.e. central hyperexcitability) (1). The course will be dedicated to applying science into physical therapy practice around the world. This will be done using different examples of pain patients, including (HIV-related) neuropathic pain and whiplash as example of non-neuropathic CS pan.
First, assessment and treatment of HIV-related neuropathic pain will be presented (2-4). Designing biopsychosocial treatments to address underlying pain mechanisms will be discussed with an emphasis on addressing barriers to treatment in resource poor settings. Evidence-based treatment options applicable to managing HIV-related neuropathic pain including pain neuroscience education, stress management and exercise using a cognitive behavioural framework will be explored.
Second, sensory signs indicative of CS have been shown to be present soon after injury in patients and predict those who do not recover well but who develop chronic pain (5). The CS seen in whiplash is associated with stress related responses to the road traffic crash (6) and to levels of serum inflammatory biomarkers (7) indicating multifactorial processes contributing to the central pain disturbances. Investigations are underway to test if the modulation of these processes in the early injury stage can prevent the later development of chronic pain and disability and the results of these studies will be presented (8).
In general, the presence of CS implies that central mechanisms are dominating the clinical picture (9). Such patients may require treatment targeting CS. A variety of evidence-based treatment strategies target hold the capacity to desensitize the central nervous system (10, 11).
Implications / Conclusions
Physical therapists around the globe are at the front line for implementing contemporary pain neuroscience in clinical practice. This course will focus on one aspect of contemporary pain neuroscience: the mechanism of CS and how to account for it in clinical practice, both in neuropathic and non-neuropathic chronic pain patients. It is concluded that physical therapists should account for the presence of CS in chronic pain patients by adopting their evidence-based skills to the underlying pain mechanism. This applies to treatment as well as clinical reasoning skills.
K. Ickmans is funded by the Agency for Innovation by Science and Technology (IWT) – Applied Biomedical Research Program (TBM), Belgium
Practitioners from all parts of the world (including Africa), educators and researchers
Level of learning
Programme subject to change