Altering pain memories by using exercise therapy for patients with chronic musculoskeletal pain

ALTERING PAIN MEMORIES BY USING EXERCISE THERAPY FOR PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN

Jo Nijs

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. Musculoskeletal therapists can alter pain memories in patients

with chronic musculoskeletal pain by integrating pain neuroscience

education with exercise interventions. The latter includes applying graded

exposure in vivo principles during exercise therapy, for targeting the

brain circuitries orchestrated by the amygdala (the memory of fear centre

in the brain). Before initiating exercise therapy, a preparatory phase of

intensive pain neuroscience education is required. Next, exercise therapy

can address movement-related pain memories by applying the ‘exposure

without danger’ principle. By addressing patients’ perceptions about

exercises, therapists should try to decrease the anticipated danger (threat

level) of the exercises by challenging the nature of, and reasoning behind

their fears, assuring the safety of the exercises, and increasing confidence

in a successful accomplishment of the exercise. This way, exercise therapy

accounts for the current understanding of pain neuroscience, including the

mechanisms of central sensitization.

CPD Points: 0.5