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Pain and neuroplasticity

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Presenter: Siddall P

Over the last 25 years, there has been a huge shift in the way that we

see pain. From a view that saw pain largely as a message that had to be

eliminated or at least reduced, we now recognise that the periphery is

much less important in our perception of pain than once thought. There

has been a steadily growing recognition of the importance of central

nervous system processes such as pain modulation and neuroplasticity

in our experience of pain. Although the process of pain modulation has

been recognised and studied for over a century, there are more recent

findings that indicate that pain modulation is the defining element for many

people with chronic pain. The development of brain imaging techniques

has also opened up a new vista for understanding the complex and at

times confusing world of the brain and pain. We now know that there is

a vast array of brain changes that occur in association with chronic pain.

These findings have thrown up interesting and important questions

regarding the role of the physiotherapist in treating and managing pain. Is

pain management still about finding and treating the source of pain? Or is

treating pain now more about treating the central nervous system? Or yet

again, should the role of the physiotherapist be less about treating pain

and more about helping people achieve their functional goals? What do the

findings from pain neuroscience tell us? What is their relevance and what

do they mean for physiotherapists today?

Key Practice Points:

• Refresh knowledge regarding the relative contribution of peripheral and

central processes contributing to pain

• Understanding of the implications of this knowledge for the role of

physiotherapists in trying to identify and treat a source of pain

• Appreciation of the potential to influence other aspects of the pain

experience through strategies directed at the central nervous system

CPD Points: 0.25

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