This is a question most clinicians dealing with people in pain must have asked themselves many times before. We have too.
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Objectively classifying and diagnosing different pain conditions remains a challenge for scientific research and clinical practice. Currently, self-report measures of pain and psychosocial factors are considered the gold standard for pain measurement and these measures perform well.
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Unravelling low back pain remains a clinical challenge and the ideas about what can count as proper and necessary judgements are still a topic for debate.
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Working in a rehabilitation centre means that you have to deal with pain every day. Actually, it is quite frank to notice that someone’s pain is an everyday part of my job.
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In this blogpost, the most important elements of this systematic review and meta-analysis are highlighted.
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A wide range of human brain imaging techniques has provided the opportunity to explore in vivo the neurophysiological processes of the brain. This neuroimaging research has shown neuronal plasticity, which refers to the possibility of the central nervous system including the brain to adapt but also to maladapt structure, function and organization.
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The current definition of central sensitisation (CS) pain describes CS as manifesting in a generalised hyper-sensitivity of the somatosensory system.
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Traditionally the clinical manifestation of entrapment neuropathies (e.g., carpal tunnel syndrome, cervical and lumbar radiculopathy) is considered to be driven by local mechanisms and signs and symptoms should follow a clear anatomical pattern limited to the structures innervated by the affected peripheral nerve, or restricted to the corresponding dermatome, myotome and sclerotome.
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​One important aspect of dealing with patients with central pain syndromes is that no two patients are the same. Patients with persistent pain differ in their complaints and pain characteristics. Besides their pain related symptomatology, also their coping-style is different.
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The role of the periaqueductal gray (PAG) has been described in many studies regarding pain processing. This structure, located in the midbrain around the cerebral aqueduct, is mainly known as a key region in descending pain modulation.
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​There is wide international consensus on the need of having agreed and standardised sets of outcomes, better known as ‘core outcome sets’ (COSs). A COS represents the minimum that should be measured and reported in all clinical trials for a specific health condition, and that can also be suitable for use in other types of studies or clinical practice.
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Chronic back pain (CBP) is an important clinical, social, economic, and public health problem. Many risk factors are associated with CBP. However, the evidence is often cross-sectional. In an innovative study, researchers from the Northwestern University of Chicago explored the relationship between smoking, transition to chronic pain and functional characteristics of the brain.
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​Pain is the number one reason for patients visiting a physiotherapist. Chronic pain is the most costly condition affecting the Western world. This comes as no surprise: pain is omniprevalent among a wide variety of medical disciplines, ranging from oncology, pediatrics, geriatrics, rheumatology, orthopedics, neurology and internal medicine. For reducing the costs associated with chronic pain, correct mechanism-based classification of the pain type is the first step.
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​Remembering an event reactivates at least part of the cortical and subcortical regions that were engaged during the original experience of that event. This is termed “reinstatement” of brain activity during memory retrieval. German and UK researchers have conducted a fascinating study showing reinstatement of pain-related brain activation during viewing of neural images that had previously been paired with heat pain.
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​Scapular dyskinesia has been widely accepted in the literature as associated with glenohumeral joint pathology. Clinicians who manage patients with shoulder pain need to have the skills to assess static and dynamic scapular positioning. At this point, clinicians can use reliable (and valid) clinical tests for the assessment of both static and dynamic scapular positioning in patients with shoulder pain.
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​Some months ago I came across a novel study by Harvie and colleagues (2015); they used virtual reality to investigate the effect of overstated or understated visual information on cervical rotation in patients with neck pain. This empirical study shows that we might need to reconsider how we interpret diagnostic provocation tests in daily care, e.g. that it is not a solid measurement for primary nociceptive information or tissue provocation.
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​Several studies demonstrated the importance of assessing the perceptions of patients regarding their illness (i.e. the illness perceptions) as they are of prognostic value.
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​During the last decade there has been much discussion about pain and its manifestations, their presence and, naturally, their absence. As physiotherapists and health care professionals we have taken tools from other disciplines to advance in our own; we adopted neuroscience (for understanding the functioning of our nervous system) and philosophy (for understanding how the mind works). In theory everything is clear to us, but in reality our knowledge does not always correlate with clinical outcomes.
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​This is short case study with observations from the clinic which may raise interesting research questions.
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​In November 2015 a short summary of our review in Manual Therapy (Leysen et al. 2015) will be published in FysioPraxis (Fysiopraxis Nov. 2015, p39), the monthly magazine of physiotherapy in the Netherlands.
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​Chronic musculoskeletal pain is a complex problem and has significant psychological, physical, social and economic implications. There is inevitable pressure for hospitals to reduce waiting times and improve treatment outcomes. Given the significant burden upon the individual, society and the economy, it is important to identify more effective management strategies.
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​Osteoarthritis (OA) is traditionally considered a progressive disorder of articular cartilage in the joint, yet increasing evidence suggests that at least in an important subgroup of patients with OA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain (reviewed by Lluch et al. 2013).
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Trait anxiety is an enduring (i.e. relatively stable) personality trait, or characteristic, indicative of differences in an individual's proneness to reactions of state anxiety when faced with a perceived psychological threat. (Compare this with state anxiety which is transient, in the present.)
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Clinically it is important to distinguish between the three main pain mechanisms that may present with our patients experiencing chronic pain (Nijs et al 2014). Here I describe my clinical findings in two chronic low back pain patients, one with chronic nociceptive pain and the other with chronic central pain mechanisms.
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The concept of myofascial trigger points keeps on inspiring researchers and clinicians. With the recent publication of an interesting review article in Rheumatology, the concept is really challenged.
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There is strong evidence that patients with chronic pain show decreased cognitive task performance, including decreased sustained selective attention, processing speed and memory. Pain in Motion recently reported on Kelly Ickmans’ PhD findings, showing that in patients with various central sensitization pain disorders (fibromyalgia, chronic whiplash associated disorders, chronic fatigue syndrome), cognitive performance is closely related to physical activity levels and endogenous analgesia.
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Interpreting scientific results in clinical practice can be, to say at least, challenging. Especially when it is somewhat contradictory to what you have heard during all those years of extensive training in both physiotherapy education and other courses. As one of my friends recently put it this way: ‘The more I learn about pain, the less I know and the more confused I get.’
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Persistent pain in the absence of structural pathology remains a challenging issue for clinicians. Besides the suffering from the pain itself, chronic ‘unexplained’ pain is often accompanied by other debilitating symptoms such as fatigue, sleep difficulties, dizziness, psychological symptoms, and cognitive problems among others. A growing body of scientific research underlines the involvement of a common pathophysiological mechanism of central sensitization (CS), commonly known as an hypersensitivity of the central nervous system, in overlapping chronic pain conditions such as chronic fatigue syndrome (CFS), fibromyalgia (FM) and chronic whiplash-associated disorders (WAD).
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A recent article by Lance M. Mc Cracken and Stephen Morley published in the Journal of Pain addresses the place of theory and models in psychological research and treatment development in chronic pain. It argued that such models are not merely an academic issue but are highly practical. Such models ought to integrate current findings, precisely guide research and treatment development, and create progress. The dominant psychological approach to chronic pain is cognitive behavioural therapy (CBT).
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In 2011, Pain in Motion published a paper explaining to clinicians the various options we have for treating the mechanisms involved in central sensitization.
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The April issue of Pain reports a sound study examining self-perceived pain changes during walking in patients with osteoarthritis. Pain in Motion previously reported that up to 30% of osteoarthritis patients have central sensitization, and this new study from U.S. researchers suggests a role for central sensitization in explaining pain changes during daily physical activities like walking
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Why does my shoulder hurt?   January 1st, 2014
Dean et al. recently reviewed the neuroanatomical and biochemical basis of shoulder pain. Shoulder pain is often a very challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. As shoulder pain is very common in the physiotherapeutic clinical practice, a vast understanding of pain processing could enlarge the specificity of the patients’ diagnosis and steer treatment.
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The prevalence of tendinopathies is high both in athletes and in the general population. Despite a wealth of literature, the pain mechanisms of tendinopathies are not well understood. Currently, some studies have described whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies.
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