​Trait characteristics and pre-morbid contexts may contribute to the development of central sensitisation in chronic low back pain: results from a mixed methods study.   September 23rd, 2020
At the start of this research series, we were asking the clinical question as to why central sensitisation (CS) develops in some people and not in others. Is it something to do with their personal characteristics of sensitivity? Here, I want to outline what we did to begin investigating this and summarise for you the proposals we came up with.
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A need of subgroups within the large group of people with (chronic) low back pain   June 10th, 2020
As a physiotherapist, I see many patients with low back pain (LBP). The type of intervention varies from patient to patient, and moderate treatment effects are observed. LBP is a well-known health problem with high socioeconomic costs (Hoy et al., 2012).
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Associations between central sensitization and cognitive behavioral factors in chronic low back pain   May 2nd, 2018
​Chronic low back pain (CLBP) is a major problem in today’s society, and often no specific medical cause can be found for the patient’s complaints.
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Differences between recurrent and chronic pain and their clinical implications   December 11th, 2017
In low back pain there are clear clinical differences seen between recurrent and chronic low back pain patients.
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INVITED BLOGPOST: Mindfulness Training for the Treatment of Chronic Back Pain   December 8th, 2017
When patients with chronic back pain present with poor body awareness, high stress levels, catastrophic thinking and fear-avoidance behaviors, physical therapists need biopsychosocial treatment interventions in addition to standard practices based on structural impairment to achieve pain relief and functional improvement.
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Diagnosing pain mechanisms in low back pain: mission possible?   July 14th, 2017
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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What you see, is what you get … but you ain’t seen nothing yet!   March 27th, 2017
Within the biomedical model, pain is considered a consequence of tissue damage. However, we all know now that a precise biomedical diagnosis cannot be given in the majority of the low back pain (LBP) patients. Enter: the biopsychosocial perspective.
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​Sensorimotor incongruence, a true contributor to chronic pain?   March 16th, 2017
Musculoskeletal pain is a highly prevalent disorder. People often seek help from a physiotherapist to relieve their pain and related limitations.
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Pain neuroscience education for patients undergoing lumbar surgery?   November 26th, 2016
On October 3rd 2016 a (Dutch) blog post was published on our website concerning a study comparing ‘back school’ and ‘brain school’ in patients undergoing surgery for lumbar radiculopathy, titled “Rugschool of pijneducatie bij chirurgie voor lage rug- en beenpijn”.
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Chronic stress affects brain morphology and functioning: relevance to cancer survivors and chronic pain?   April 4th, 2016
Many patients with chronic pain suffer from stress intolerance, and some patients have developed chronic pain during or following a stressful period or (life) event (e.g. motor vehicle accident, trauma exposure). When chronic pain is present, stress typically worsens the pain (severity). Taken together, stress and chronic pain are closely connected. In this blog post fascinating research findings regarding the effect of chronic stress on the brain are presented, providing a neuroscientific explanation why chronic stress may lead to the development of chronic pain.
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Which outcome domains should be measured in clinical trials conducted in patients with non-specific low back pain?   January 1st, 2015
​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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Case Study: Central Sensitisation, Sensory Processing and Trait Anxiety profiles in two Chronic Low Back Pain patients   January 1st, 2015
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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Potentiating placebo-analgesia in clinical practice   January 1st, 2015
Manchikanti and colleagues (2011) make in their paper entitled ‘placebo and nocebo in interventional pain management: a friend or a foe – or simply foes?’ an argument for a revaluation of placebo effects in clinical practice. They make the claim that clinicians should not try to avoid the placebo effect, but should try to potentiate it, as this effect isn’t just unethical and mythical but must seen as a very real phenomenon, which can be understood from a vast body of both psychological and neurophysiological research.
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Innovative Brain Imaging Study: Smoking increases Risk of Pain Chronification in Back Pain Patients   January 1st, 2015
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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Central sensitization pain : Where are we now and which options do we have for treatment?   January 1st, 2015
Conventional rehabilitation for people with chronic pain is often unsuccessful and frustrating for clinicians. What it is becoming clear more and more is that new therapeutic approaches are needed in view of current understanding of neural mechanisms underpinning chronic pain. In this regard, three papers aiming to summarize the role of central sensitization in chronic musculoskeletal pain and looking for guide clinicians in the rehabilitation of patients with chronic pain have been recently published.
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Low back pain: Criteria for differentiating between nociceptive, neurophatic and central sensitization pain in clinical practice   January 1st, 2015
​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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Wandering about the effects of visual feedback on pain   January 1st, 2015
​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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The balancing exercise of exercise prescription in chronic pain?   January 1st, 2015
​In a very recent review and clinical guideline of Heather Kroll, a nice overview is given about how exercise affects pain. But besides listing possible mechanisms of exercise induced analgesia, she reviews the therapeutic modalities and benefits for a wide variety of chronic pain diagnoses.
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History taking during the first consultation of patients with low back pain: What do physiotherapists ask?   January 1st, 2015
​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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The inclusion of personality type highlights differences in the experience of pain and response to pain management   January 1st, 2015
​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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Can pain neurophysiology education improve exercise effects in chronic low back pain patients?   January 1st, 2015
Research has suggested that exercise is effective in the treatment of chronic low back pain (CLBP), regardless the characteristics of the exercise selected. Although it’s effective, exercise as intervention alone does not seem to take into consideration the maladaptive pain cognitions and illness behavioural characteristics frequently identified in CLBP patients.
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Myofascial trigger points: fact or myth? Let the battle continue   January 1st, 2015
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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Exercise therapy for rewriting pain memories? Applying graded exposure in vivo principles during exercise therapy for targeting the brain circuitries orchestrated by the amygdala   January 1st, 2014
Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories.
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Treatment Options for Central Sensitization Pain in Clinical Practice   January 1st, 2014
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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Low back pain: Simultaneous top-down + bottom-up approach for treating central sensitization?   January 1st, 2014
The study by Schabrun et al. published in Brain Stimulation 2014 is one of the most interesting papers I have read last year. This might be due to the fact that I am not at all an expert in neuromodulation, but even so the study is highly innovative and has amazing findings. The paper reports a placebo-controlled cross-over study investigating the effect of transcranial direct current stimulation (tDCS) combined with peripheral electrical stimulation (PES) treatment on pain, cortical organization, sensitization and sensory function in 16 patients with chronic low back pain. It was found that a combined tDCS/PES intervention is more effective for improving not only chronic low back pain symptoms, but also for improving the mechanisms of cortical organization and central sensitization than either intervention applied alone or a sham control.
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The Psychological Flexibility Model: A basis for integration and Progress in Psychological Approaches to Chronic Pain Management   January 1st, 2014
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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Tea with discussions about combining manual therapy with pain neuroscience education   January 1st, 2014
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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WILL COMPUTERS REPLACE THERAPISTS? THERAPEUTIC PAIN NEUROSCIENCE EDUCATION VIA E-MAIL   January 1st, 2014
Therapeutic pain neuroscience education (TPNE) is becoming increasingly popular as (part of) the treatment of (chronic) pain and aims at altering the patient’s thoughts and beliefs about pain. Previous research has demonstrated the efficacy of TPNE in the treatment of chronic pain. TPNE is mostly given in one-on-one sessions, which has limitations, as it is time intensive, cost intensive and limited to patients in remote areas. Pain in Motion previously showed that written TPNE does little to alter pain, pain cognitions or illness perceptions in patients with fibromyalgia.
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