Prevention and Management of Chronic Pain

From Chronicity…… to Performance

Mark SextonChartered Physiotherapist

The Plan

Learning Plan

Early IdentificationEarly Management

PreventionTreatmentRehabilitation

OutcomesCase Studies

Movement

Nociception

Tissue Pathology

Central Sensitisation

Neurogenic Pain

PeripheralNeuropathic Pain

PsychoEmotionalSocial

Plasticity

Lorimer Moseley

Central Sensitisation

• Trauma

• Emotional Response, Fear

• Initial Injury severity

• Flaring of old scars

• Maladaptive

– Psychological

– Emotional

– Movement

Central Sensitisation

• Pain

– Severity, Hypersensitivity

– Latency

– Allodynia

– Pattern – Unpredictable Agg/Easing factors

– Palpation non-differential

– Neural involvement

CRPS

• Pain Severity, Hypersensitivity

• Swelling

• Skin Shine, Sweat

All Movement has Effect…

…and Vice-Versa

Langevin HM and Sherman KJ,

Pathophysiological Model for cLBPIntegrating

Connective Tissueand

Nervous System Mechanisms

Med. Hyp. 2006

Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

Neural Tissue

Plasticity

Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

Neural Tissue Plasticity

Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

Connective Tissue

Plasticity

Pathogenic Mechanism

Langevin 2006

Pathogenic Mechanism

Langevin 2006

Pathogenic Mechanism

Langevin 2006

Pathogenic Mechanism

Langevin 2006

Pathogenic Mechanism

Langevin 2006

MovementPostureExercise

Treatment

Tissue Pathology

Dysfunction

Direct Tissue Mechanical Stimulus

Cognitive/BehaviouralMovementTreatment

Placebo

PsychosocialGenetic

Pathogenic Mechanism – Therapeutic interventions

Langevin 2006

Movement

Nociception

Tissue Pathology

Central Sensitisation

Neurogenic Pain

PeripheralNeuropathic Pain

PsychoEmotionalSocial

Learning Plan

Early IdentificationEarly Management

PreventionTreatmentRehabilitation

OutcomesCase Studies

Chronicity…… to Performance

Mark SextonChartered Physiotherapist

Thank You!

References

• Smart KM, Blake C, Staines A, et al. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with nociceptive, peripheral neuropathic and central sensitisation pain. The discriminant validity of mechanism-based classification of low back (+-leg) pain. Manual Therapy 2012: 17; 119-125.

• Nijs J, Van Boudewijn H, Oostendrop RAB. Recognition of central sensitization in patients with musculoskeltal pain: application of pain neurophysiology in manual therapy practice. Manual Therapy 2010: 15; 135-141.

• Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Manual Therapy 2009:14; 3-12.

Web