​Does education hinder learning in patients with chronic pain? Considerations on prediction errors, learning, and expectancy violation   September 6th, 2021
Every time we experience something new, we are in the position of learning and memorising the new experience. Learning depends on several factors, including motivation, rewards, self-reflection, saliency, and repetition. One additional important aspect that seems crucial for learning is the presence of a prediction error.
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Obesity hurts: should we consider weight management within pain management?   July 9th, 2021
Before we were all held captive by the COVID-19 pandemic, another pandemic was (and still is) dominating our world. With high prevalence rates, some consider obesity the ‘real’ pandemic of the 21st century.
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Effects of a training program on the autonomic nervous system and innate immune response in autoimmune disease/spondyloarthritis   July 8th, 2021
Excessive or persistent proinflammatory cytokine production plays a central role in autoimmune diseases. Research by Kox M. et al. (1,2) evaluated the effects of a training program on the autonomic nervous system (ANS) and innate immune response.
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Chronic pain during COVID-19: the consequences of social isolation on pain. update   April 30th, 2021
COVID-19, a highly infectious disease that was first reported in Wuhan in China in December 2019, has definitely changed our behaviour. COVID-19 is caused by the SARS-CoV-2 virus.
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Chronic pain during COVID-19: the consequences of social isolation on pain.   December 2nd, 2020
COVID-19, a highly infectious disease that was first reported in Wuhan in China in December 2019, has definitely changed our behaviour. COVID-19 is caused by the SARS-CoV-2 virus. The World Health Organisation has declared COVID-19 as a pandemic on March 11th, 2020 due to the rapid increase in number of confirmed cases (Wang et al. 2020).
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A mechanism-based approach for the management of pain?   December 1st, 2020
It is well known that pain is a complex phenomenon with challenging treatment. The Department of Health and Human Services recently published a National Pain Strategy, highlighting the insufficient training in pain assessment and treatment for many clinicians.
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Expectations and distraction influence pain and (pain) treatment   December 1st, 2020
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1). Pain is considered as a warning system for tissue damage.
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Can we train the chemo-brain?   September 23rd, 2020
“When I meet a friend on the street, I can’t even remember her name.”
 “Where did I leave my keys?”
 “Oh, darn I forgot my doctor’s appointment today!”
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SCARED BEFORE SURGERY? YOUR BELIEFS MIGHT HURT YOU!   July 15th, 2020
By now, it is a well-known fact that low back pain is a very common condition disabling a lot of people during the span of their lives, as well as that many of these people have to undergo lumbar surgery at one point or another.
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Food for thought: “Should we consider nutrition in chronic pain management?”   April 10th, 2020
​For a while now, (healthy) nutrition is a major topic of interest in society. Every day there seems to be a new superfood-hype or need-to-follow diet. All these options can be overwhelming, making it difficult for people to see the wood for the trees. Also within the chronic pain field, the need for clear nutritional guidelines is increasing, with both patients and clinicians asking for specific advise in this area.
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Do you consider using heart rate variability training in your clinical practice?   January 14th, 2020
A normal healthy heart does not tick evenly like a metronome. We know that the normal resting rhythm of the heart is highly variable rather than monotonously regular.
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Pain neuroscience education in the digital era: do we still need therapists?   January 14th, 2020
In this digital era, healthcare services are more and more evolving towards eHealth applications. Especially for educational and behavioral interventions digital applications are becoming very popular in clinical practice but also in research.
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Meta-analyse effecten van pijneducatie voor patiënten met chronische musculoskeletale pijn   December 14th, 2019
De prevalentie van chronische musculoskeletale pijn (CMP) wordt geschat op 20% van alle volwassenen wereldwijd. Verder is CMP één van de meest gerapporteerde redenen om medische zorg te zoeken. Daarenboven blijkt bijvoorbeeld chronische lage rugpijn op globale schaal de belangrijkste reden te zijn voor leven met functieverlies.
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Treatment in different contexts, does it matter?   December 13th, 2019
Did you ever wonder why a specific treatment does not always have the same effect in one person compared to another despite having the same problem?
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Infectious Adverse Effects after Acupuncture   December 12th, 2019
Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. Serious adverse effects continue to be reported.
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Stress and pain perception: a complex phenomenon   October 1st, 2019
The interaction between stress and pain perception is complex. Stress has undoubtedly impact on pain perception.
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​Pain Neuroscience Education: shades of grey   July 15th, 2019
The efficacy of Pain Neuroscience Education (PNE), the explanation of pain to patients with (long-term) pain, has been studied since 2002 (Moseley, 2002).
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What patients possibly learn while ‘under treatment’; some thoughts on the importance of patients perceptions about low back (in)vulnerability’   May 16th, 2019
Some days ago, my car made an uncomfortable sound and I immediately thought ‘something is wrong with my right front wheel’. I went to the garage and told them what, in my opinion, was wrong with my car.
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Nutrition and chronic post-cancer pain: Is nutrition the missing piece of the puzzle?   April 8th, 2019
The development of chronic pain is the one of the most seen sequelae in the cancer survivor population (Leysen et al., 2017). But despite that, it is an entity which is poorly studied and comprehended (Burton et al., 2007).
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One world, one education?   April 7th, 2019
Increasing research all over the world is indicating the importance of giving pain neuroscience education to chronic pain patients (Malfliet et al. 2018). Results have indicated an increase in the level of knowledge of the patient and a decrease of in the level of perceived threat, consequently increasing the quality of life.
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Control over spinal nociception can be learned   April 5th, 2019
There is growing evidence that a state of heightened sensitivity of central pain processing pathways is present in chronic pain patients. Hyperexcitability at the spinal level can be assessed by experimentally inducing a nociceptive flexion reflex (NFR) of the lower limb.
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Brazil and Belgium combining forces to improve exercise prescription for patients with chronic pain? Delphi-study to be launched!   January 30th, 2019
Chronic musculoskeletal pain is one of the conditions responsible for the increase in the number of years lived with disability, absenteeism and health care costs in the world (Andrew et al. 2014, G. B. D 2017).
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Pain in Motion at the World Congress on Pain in Boston, Massachusetts, USA.   December 2nd, 2018
The World Congress on Pain 2018, organized by the International Association for the Study of Pain (IASP) was held in Boston, Massachusetts, USA. This meeting focused on sharing new developments in pain research, treatment, and education.
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Sleep regulation: an important issue?   November 29th, 2018
Sleep problems are frequently seen in several chronic pain populations.
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Sex Differences in Neuroimmunity and Pain   October 3rd, 2018
Sex differences in pain have been a topic of increased interest in recent years. An expansive body of literature in this area clearly suggests that men and women differ in their response to pain. Controlled laboratory studies have revealed overwhelming evidence for increased pain sensitivity, higher pain ratings and lower pain tolerance of female participants compared with males, although the size of the differences were modest and not always statistically significant (Rosen et al., 2017).
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​Was je erbij? Een geweldig Pain in Motion Symposium in Antwerpen!   June 26th, 2018
Het zonnetje schijnt en de zaal is vol! Ondanks alle verleidingen buiten is er aan het mooie bankgebouw van BNP Paribas Fortis aan de Meir een grote groep kinesitherapeuten/fysiotherapeuten, artsen, afgevaardigden van patiëntenverenigingen en onderzoekers samen gekomen om de laatste inzichten over pijnrevalidatie met elkaar te delen.
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Where am I in the central sensitization process? It is not just a matter of time; it is time to take action!   May 3rd, 2018
Central sensitization is an ongoing process in which duration might affect its reversibility.
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Chronic pain management – What is the role of the occupational therapist?   March 1st, 2018
This is a question that all patients, the multidisciplinary rehabilitation team and more importantly all occupational therapists should ask.
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Are there opportunities for hypnosis and other forms of complementary medicine in chronic pain?   January 24th, 2018
About 20% of the European population will tell you they do experience chronic pain every day (Breivik et al., 2006).
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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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Invited blogpost: The efficacy of neurodynamics or neural mobilisation for nerve-related musculoskeletal conditions   November 7th, 2017
Neurodynamics or neural mobilisation is an intervention aimed at restoring the altered homeostasis in and around the nervous system (Coppieters and Nee 2015).
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Resilience in the face of pain   October 31st, 2017
Readers of this blogpost are all aware of the huge impact that chronic pain has on both personal lives and society as a whole. The numbers speak for themselves and point to the urgent need for improvements in the ways we conceptualize pain in our theoretical frameworks and how this works out in clinical practice.
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The dark side of exercise: when physical activity is perceived as threatening   October 26th, 2017
The effect of exercise therapy has been extensively studied in health and disease. While it is broadly agreed that a program of exercises is beneficial, the same cannot be said for a single session. Symptoms worsening following exercise is indeed a common feature in people with chronic pain.
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Pain Neuroscience Education: are we ready for the psychologist?   August 16th, 2017
Since the Cartesian model and the understanding of ‘a nervous system’, there has been a dualistic approach of pain. Especially in Western societies, a strong focus on ‘the bodily part’ of pain still exists today, as many (Western) healthcare professionals are of the opinion that pain needs a bodily onset.
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Context effect in physiotherapy Is it time to potentiate our clinical practice by integration of placebo responses?   March 15th, 2017
Patient’s pain and disability improvement is an everyday challenge for physiotherapists.
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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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Pain Treatment in Temporomandibular Disorders and Orofacial Pain: LESS IS MORE   November 25th, 2016
Temporomandibular Disorders (TMD) and orofacial pain are conditions that have been drawing more attention from Physical Therapists (PTs) in the recent years.
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What pain education programs can learn from teachers and their class with 6-year olds…   October 11th, 2016
In Belgium nearly every hospital has a specialized pain center to treat patients with chronic and/or debilitating pain. These pain centers developed and evolved over the years and became multidisciplinary teams.
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Pneumogastric (Vagus) Nerve Activity Indexed by Heart Rate Variability in Chronic Pain Patients Compared to Healthy Controls: A Systematic Review and Meta-Analysis   October 1st, 2016
In this blogpost, the most important elements of this systematic review and meta-analysis are highlighted.
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Psychosocial factors play an important role in the course of shoulder pain   August 31st, 2016
Shoulder complaints are common in physiotherapy practice and consist of pain and functional limitations.
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Five Requirements for Effective Pain Neuroscience Education in physiotherapy practice   June 1st, 2016
Pain neuroscience has taught us that pain can be present without tissue damage, is often disproportionate to tissue damage, and that tissue damage (and nociception) does not necessarily result in the feeling of pain.
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The patient with pain is central not the therapist   May 9th, 2016
​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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Moving on to movement in patients with chronic joint pain   May 9th, 2016
In the new edition of ‘Pain: Clinical Updates’ we published in connection with the ‘2016 IASP Global Year Against Pain in the Joints’ an overview paper to help clinicians prescribing/developing exercise programs for patients with chronic joint pain.
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Reappraising entrapment neuropathies: Mechanisms, diagnosis and management   May 9th, 2016
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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The nocebo effects of communication   March 21st, 2016
I once was told by a former colleague that I would most definitely get back pain if I didn’t stop slumping in my L1 vertebra. Of course today I am still ‘slumping in my L1 vertebra’ and no, I don’t believe that it will ever cause me back pain.
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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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Pain affects cognition: the role of gabapentin and noradrenergic signaling in the brain   January 1st, 2015
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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Can we retrain the brain? Yes we can! Evidence from pediatric complex regional pain syndrome   January 1st, 2015
A new fascinating study from the Harvard Medical School (Boston, U.S.A.) adds to the evidence that conservative interventions can retrain the brain (ref. 1). Laura Simons and her colleagues reported marked differences in functional brain connectivity between pediatric complex regional pain syndrome patients and age-sex matched control subjects, but also normalization of such differences following in-house rehabilitation.
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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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Exercise therapy reduces aromatase inhibitor-induced arthralgia in breast cancer survivors   January 1st, 2015
​Postmenopausal women with hormone receptor-positive breast cancer receive hormone therapy as part of their cancer treatment. One of the most frequently used and evidence-based hormone treatments are aromatase inhibitors (= inhibitors of the enzyme aromatase) that inhibit the conversion of androgens to estrogens. This results in decreased availability of estrogens and slowed progression of breast cancer.
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Neutral images can reinstate pain-related brain activation: Experimental evidence for a memory-based mechanism of pain amplification   January 1st, 2015
​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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Activity pacing self-management program helps in optimizing participation in desired life activities in women with CFS   January 1st, 2015
​People with chronic fatigue syndrome (CFS) may be limited in activity performance and role fulfilment to a large extent. A lot of them enter a vicious circle of inactivity, leading to increased levels of fatigue. It is therefore important to break this negative process. One of the approaches is to facilitate people with CFS in self-managing their daily activity levels.
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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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Altered central pain modulation pre-surgical might influence outcome after total knee replacement: a systematic review   January 1st, 2015
​Even though a total knee replacement is an effective surgical treatment for end-stage knee osteoarthritis and the majority of patients report significant pain relief and functional improvement post-surgical, literature shows that up to 20% of patients undergoing a total knee replacement are dissatisfied and complain of persisting pain, functional disability and poor QoL ( Scott et al. 2010).
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Where is the pain? The teachings of philosophy and neuroscience   January 1st, 2015
​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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Anxiety and central sensitisation (CS) but without CS pain?   January 1st, 2015
​This is short case study with observations from the clinic which may raise interesting research questions.
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Why does my knee still hurt after knee arthroplasty? Because they only treated your knee, not your central nervous system!   January 1st, 2015
​Osteoarthritis (OA) of the knee has long time been considered as a structural pathology with a clear nociceptive explanation, resulting from joint degeneration. Nevertheless, recently awareness is growing for the involvement of the central nervous system in the amplification of pain in OA. This may explain why many patients still suffer chronic pain after surgery, long time after removal of the source of nociception.
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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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Brain-derived neurotrophic factor (BDNF) as a driving force behind central sensitization pain: a new therapeutic target?   January 1st, 2015
The awareness is growing that neurotrophic factors, like brain-derived neurotrophic factor (BDNF), have a cardinal role in initiating and/or sustaining the hyperexcitability of central neurons in chronic pain patients. For example, microglial-derived BDNF contributes significantly to neuropathic pain. Therefore, potential pharmacological or conservative (e.g. exercise) treatment of neurotrophic factors like BDNF provides important new treatment avenues.
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Neurophysiological aspects of trait anxiety and possible links with sensory processing alterations and central sensitisation   January 1st, 2015
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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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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Combining pain neuroscience education with hands-on manual therapy in patients with osteoarthritis and central sensitization pain   January 1st, 2014
A systematic literature review recently showed that approximately 30% of patients with osteoarthritis have central sensitization pain, implying that their pain is dominated by central factors (i.e. the increased hyperexcitability of the central nervous system) rather than peripheral (i.e. joint) factors.
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Effect of relaxation in patients with Fibromyalgia: a literature study   January 1st, 2014
Based on a literature study on the effects of relaxation on symptoms and daily functioning in patients with FM, the authors concluded that:
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Severe STRESS reduces the BRAIN’s capacity to control PAIN   January 1st, 2014
Stress is often a powerful pain killer. Stress activates several brain-orchestrated pain inhibitory actions, including the activation of the hypothalamus-pituitary-adrenal axis (HPA-axis) resulting in the release of cortisol. The latter is often regarded as the major stress hormone in the human body, and besides its powerful anti-inflammatory action it also exerts endogenous analgesia.
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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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In the subacromial space or in the brain? Central nervous system sensitization in patients with shoulder pain   January 1st, 2014
Hyperexcitability of the central nervous system, or central sensitization, is considered to be a maladaptive type of neuroplasticity often seen in patients with chronic pain. Central sensitization is frequently seen in patients with osteoarthritis, fibromyalgia, whiplash, neuropathic pain and chronic fatigue syndrome. Up to recently, shoulder pain was considered to be a pure ‘local’ problem. Tissues that are frequently linked to shoulder pain include (rotator cuff) muscles, ligaments, subacromial bursa and joint capsules.
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Pain neuroscience education for treating Cyberchondria. Is Google really your friend?   January 1st, 2014
The internet is nowadays a popular information source for the general public when it comes to medical advice. It is an easy to use and very cheap source of information, which may lead to less medical consults. On the other hand, it can have several negative effects, like an overload of information, increased anxiety, distress, and compulsive search for medical information. Recently, this phenomenon has been referred to as “Cyberchondria”.
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