Hoe denkt u over pijn?   January 1st, 2015
​In juli 2015 heeft retrain pain een educatieve tool gelanceerd die u als professional kan ondersteunen bij het geven van pijneducatie aan uw patiënten.Sindsdien zijn wij bezig geweest met de Nederlandse vertaling. Wij zijn enthousiast om te kunnen melden dat deze af is!​
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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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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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Experts van vijf universiteiten en behandelcentra pleiten samen voor multidisciplinair onderzoek ter verbetering van de zorg voor CVS-patiënten   January 1st, 2015
Het chronische vermoeidheidssyndroom (CVS) is een erg onderschatte en nog te weinig bestudeerde aandoening. Naar schatting treft CVS 0.5 tot 2.5% van de bevolking. De aandoening gaat gepaard met een zeer hoge medische, economische en sociale kost. Experts van vijf Belgische universiteiten trekken met een open brief aan de alarmbel.
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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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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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Findings from a recent systematic review and meta-analysis: evidence suggests pain sensitization in people with knee osteoarthritis   January 1st, 2015
​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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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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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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EIPQ-R or brief IPQ: Can we safely use it in patients with musculoskeletal disorders?   January 1st, 2015
​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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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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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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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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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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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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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 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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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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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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Scapular assessment and its place within clinical reasoning   January 1st, 2015
​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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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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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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Artrose: thinking beyond muscles & joints Online lezing van het E-Wise symposium in Domus Medica te Utrecht (8 november 2014)   January 1st, 2015

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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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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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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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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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