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

Braz J Phys Ther. 2017 Sep-Oct;21(5):378-387. doi: 10.1016/j.bjpt.2017.06.019. Epub 2017 Jul 8.

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.

MeSH terms

  • Chronic Pain / physiopathology*
  • Chronic Pain / psychology
  • Chronic Pain / therapy*
  • Clinical Protocols
  • Exercise Therapy*
  • Humans
  • Low Back Pain / psychology*
  • Low Back Pain / therapy*