Applying contemporary neuroscience in exercise interventions for chronic spinal pain: treatment protocol

Anneleen Malfliet, Jeroen Kregel, Mira Meeus, Barbara Cagnie, Nathalie Roussel, Mieke Dolphens, Lieven Danneels, Jo Nijs, Anneleen Malfliet, Jeroen Kregel, Mira Meeus, Barbara Cagnie, Nathalie Roussel, Mieke Dolphens, Lieven Danneels, Jo Nijs

Abstract

Background: Nonspecific chronic spinal pain is a common problem within the chronic pain population and is characterized by high social, economic and personal impact. To date, therapists are still struggling in adequately treating these types of patients, as seen in the small and short-term benefits of frequently applied primary care treatments. It is remarkable that despite the well-documented presence of abnormalities in central nociceptive processing in nonspecific chronic spinal pain patients, the implementation of this knowledge in clinical practice is still nearly non-existent.

Methods: This paper provides the treatment protocol used in a large randomized controlled trial that aimed to assess the effectiveness of a modern neuroscience approach compared to usual care evidence-based physiotherapy. This comprehensive pain neuroscience treatment program combines pain neuroscience education and cognition-targeted exercise therapy.

Conclusion: Based on previous small-scaled studies, this treatment protocol is expected to normalize central alterations by addressing central nervous system dysfunctions, psychological factors, as well as peripheral dysfunctions in a broader biopsychosocially-driven framework.

Keywords: Chronic spinal pain; Exercise therapy; Pain neuroscience education; Patient communication; Treatment protocol.

Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Pelvic tilt. This exercise was used in chronic low back pain patients as standardized exercise to move the lower back every 30 min during prolonged sitting or standing.
Figure 2
Figure 2
Shoulder shrugs. This exercise was used in chronic neck pain patients as standardized exercise to move the neck every 30 min during prolonged sitting or standing.
Figure 3
Figure 3
Head swings. This exercise was used in chronic neck pain patients as standardized exercise to move the neck every 30 min during prolonged sitting or standing.
Figure 4
Figure 4
Example of a basic exercise for chronic neck pain patients: neck extension. Specific exercises should be individually-tailored and depending on the fearful movements of the patient. Communication to change inappropriate cognitions and expectations regarding the exercises is as important as providing individualized therapy.
Figure 5
Figure 5
Example of an advanced exercise for chronic neck pain patients: unstable base, patient keeps his/her head in extension while performing an arm exercise with weights. Exercises should be individually-tailored and progressing towards fearful movements. Communication to change inappropriate cognitions and expectations regarding the exercises is as important as providing individualized therapy.
Figure 6
Figure 6
Example of a basic exercise for chronic low back pain patients: exercises that induce some flexion of the back, without raising an association with the actual fearful/painful movement (e.g. bending forward). Communication to change inappropriate cognitions and expectations regarding the exercises is as important as actually performing the exercise.
Figure 7
Figure 7
Example of a basic exercise for chronic low back pain patients: exercises that induce some flexion of the back, without raising an association with the actual fearful/painful movement (e.g. bending forward). Communication to change inappropriate cognitions and expectations regarding the exercises is as important as actually performing the exercise.
Figure 8
Figure 8
Example of an advanced exercise for chronic low back pain patients: unstable base, patient performs a flexion and extension of the back with weights without ‘safety behaviour’. Exercises should be individually-tailored and progressing towards fearful movements. Communication to change inappropriate cognitions and expectations regarding the exercises is as important as providing individualized therapy.

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Source: PubMed

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