You probably heard me saying that chronic pain is a malfunctioning of the pain system.
I explained this when I talked about nociplastic pain, central sensitization and fibromyalgia.
When there is nociplastic pain, the person needs to retrain the pain system. But how do we do that?
Basically, there are two ways to retrain the pain system,
exercises for the body and exercises for the mind. We call this mind-body interventions.
Well, where can you find a therapist to do these things?
Does it mean you need to see a psychologist for the mind and a physiotherapist for the body?
But even better, some smart researchers have put together the 2 interventions
into one single treatment. And that is what we will talk about today.
So, let’s talk about a new treatment for chronic back pain called graded sensorimotor retraining.
Before I continue, let me remind you that this video is not intended to replace medical advice.
It is for educational purposes only.
You should contact your doctor for a proper diagnosis and treatment plan for you.
In case of emergency, go to the nearest emergency department or call an ambulance
A recent randomized trial was published by my colleagues in Australia. They tested a
new treatment that combines training the body and the brain together.
This novel intervention alters how people think about their body in pain, how they process
sensations from their back, and how they move their back during activities.
In this randomized trial, they divided 276 participants into 2 groups: one was put through
a 12-week course of this new sensorimotor training approach, and the other received a kind of fake,
or sham treatment that was designed to control for common effects of back pain trials.
People with back pain often are told that their back is vulnerable and needs protecting. This
changes how we filter and interpret information from our backs and how we move our backs. Over
time, the back becomes less fit, and the way the back and brain communicate is disrupted
in ways that seem to reinforce the notion that the back is vulnerable and needs protecting.
The treatment aims to break this self-sustaining cycle.
So what exactly is included in this intervention? This intervention includes 3 components:
1. Pain science education. 2. Pre-movement treatments
3. And precision-focused and feedback-enriched graded movement and loading
Okay, those sound like big words. Let me translate this into English:
The Pain science education included a lot of the education that I also teach in this channel.
They explained that pain is not just a body sensation, but that it involves the
mind and social aspects of life, that is the biopsychosocial nature of pain.
They also taught that moving the body is safe and helpful for recovery.
Participants received links to videos, books, and a website that explains those concepts to them.
Then, the second component involved a mental rehearsal of movements. They used some tools
to touch the skin on the back of the participants like a chopstick sharpened on one end and fitted
with a pencil eraser on the other. And they stimulated the skin on the back to
numbered points arranged in a grid-like pattern. The participant viewed a copy of the grid pattern
and was asked to nominate which point had been stimulated and whether the stimulus was sharp or
blunt. As the participant progressed, more points were added to the grid, from 9 to 12 to 16 points,
so the distance between the points progressively decreased.
Participants were given a chopstick and a set of grid-like images to perform the training at
home. The next progression was training where the participants were first asked to recognize
simple letters drawn on their back. Following this, they needed to recognize simple words
drawn on the back and finally calculate simple sums drawn on the back. This also progressed
to decreasing the size of the drawn symbols. Still in this second phase, participants were
asked to mentally rehearse movements that involved left/right recognition training
using an app that shows photos of the back rotated into different directions. This task
progressed to more complex images and decreased the time that the images were presented to them.
The next step involved watching a series of videos of low back movements and the participants were
asked to closely observe the backs as the model performed the movements. They progressed by
increasing the complexity and perceived load of the observed tasks. And last, participants
were asked to imagine themselves performing the movements as they watched the video. They
progressed from simple to complex back movements. 3- The third component, of precision-focused
and enriched movement and loading program, was achieved in 3 stages.
The first stage involved smooth movements of the spine and hips. They had to pay attention
to movements that were not painful. Initially, the movements were done without resistance.
The second stage involved the practice of some movements that were identified as problematic by
each participant. And they were still asked to pay attention to movements that did not cause pain.
In the final stage the participants were asked to perform movements that were relevant to their
goals and values. They had to integrate what they learned and practice activities that were
important to them, but that would usually cause pain. Once participants could successfully perform
a previously difficult movement and task without pain, they would progress to more intense exercise
to match levels that would be important for their fitness and aerobics levels.
Central sensitization involves neural pathways and synapses in the brain that perpetuates a
memory of pain. These pathways and synapses can be undone with brain and body exercises.
And this will decrease the central sensitization. Does it really work?
Let’s see the results. Before the intervention, the 138 people who had been randomized
to this new treatment and the 138 people who were randomized to the sham control group had similar
levels of pain intensity and disability. Then, they received 12 weeks of therapy.
At 18 weeks they measure pain and disability again. There was a drop in both groups,
as there is always the case. People are people, and when you do something to treat their symptoms,
there is always a placebo response, this is because the brain anticipates some benefit
and it does change in response to that expectation. The pain ratings at 18 weeks
were 3.1 in the intervention group and 4.0 in the control group. A difference of 1 point on
a scale that goes from 0 to 10 is a small difference. But the difference in disability
scores was more impressive. Even at 52 weeks, which is 1 year, the group that received the
intervention had a score of 4.1 while the group that received the control intervention had 6.1.
These results are exciting because this intervention is easy to deliver,
and has no serious adverse events. This novel intervention was delivered
by trained physiotherapists in Australia. This new intervention needs to be
replicated in other settings and by other people, but the results are promising,
that it is possible to retrain the pain system and reduce pain and disability.
You can find the link to this trial in the description of the video below.
Thank you for watching. Bye