Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories

[Dolphin]

This came up in a Google Scholar search for "Chronic Fatigue Syndrome" so it is mentioned somewhere - Jo Nijs is an influential ME/CFS researcher. This sort of talk with regard to ME/CFS would make me uncomfortable.

Manual Therapy

Available online 18 July 2014

Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories

Jo Nijsa, b, c, , 1, , Enrique Lluch Girbésa, d, Mari Lundberge, Anneleen Malflieta, b, c, Michele Sterlingf

DOI: 10.1016/j.math.2014.07.004

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Abstract

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.

Here the authors explain how 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.


Keywords

chronic pain; exercise therapy; sensitization; neuroscience

Corresponding author. Vrije Universiteit Brussel, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium. Tel.: +3224774489; fax: +3226292876.

1

www.paininmotion.be.

 

[Valentijn]

Sounds like a lovely bullshit theory that will pan out to be as useless as CBT and GET are for ME.

 

[alex3619]

The issue here is conscious thought versus innate neurological mechanism. Thought can only do so much. I doubt this will work, but there is a remote chance it might, which would be interersting. Of cource it depends on what the individual patient's problem is - some problems may or may not be amenable to this kind of thing, though as I said I suspect they will fail. The next question then, is how will the results be presented. Will they get failing results and present them as a success? This happens as we know.

 

[GracieJ]

In massage therapy, that is a sound applicable protocol often referred to as muscle re-entrainment. Applying it to emotional aspects, though? Forget it. There is a definite pattern of "muscle memory" for pain syndromes, but it has nothing to do with the person fearing pain, just experiencing pain. I doubt muscle re-entrainment would work with ME. The causes are entirely different than in an athlete who has stressed a muscle group over time. This crosses the line into psychobabble all over again, and this time with a legitimate healing tool.

 

[Marco]

This may not be as wacko as it sounds. Research suggests that there are neural mechanisms underlying neuropathic pain that may be amenable to 'memory reconsolidation' - analogous to treating PTSD :

http://www.ncbi.nlm.nih.gov/pubmed/24997764?dopt=Abstract