Musculoskeletal pain is a highly prevalent disorder. People often seek help from a physiotherapist to relieve their pain and related limitations.
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Chronic fatigue syndrome (CFS) is a complex syndrome with severe and debilitating fatigue. The experienced fatigue is not sufficiently reduced by resting, causing patients to perform less occupational, educational, social or personal activities and consequently restricting their participation.
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Many patients with chronic pain suffer from stress intolerance, and some patients have developed chronic pain during or following a stressful period or (life) event (e.g. motor vehicle accident, trauma exposure). When chronic pain is present, stress typically worsens the pain (severity). Taken together, stress and chronic pain are closely connected. In this blog post fascinating research findings regarding the effect of chronic stress on the brain are presented, providing a neuroscientific explanation why chronic stress may lead to the development of chronic pain.
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Manchikanti and colleagues (2011) make in their paper entitled ‘placebo and nocebo in interventional pain management: a friend or a foe – or simply foes?’ an argument for a revaluation of placebo effects in clinical practice. They make the claim that clinicians should not try to avoid the placebo effect, but should try to potentiate it, as this effect isn’t just unethical and mythical but must seen as a very real phenomenon, which can be understood from a vast body of both psychological and neurophysiological research.
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Conventional rehabilitation for people with chronic pain is often unsuccessful and frustrating for clinicians. What it is becoming clear more and more is that new therapeutic approaches are needed in view of current understanding of neural mechanisms underpinning chronic pain. In this regard, three papers aiming to summarize the role of central sensitization in chronic musculoskeletal pain and looking for guide clinicians in the rehabilitation of patients with chronic pain have been recently published.
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​People with chronic fatigue syndrome (CFS) may be limited in activity performance and role fulfilment to a large extent. A lot of them enter a vicious circle of inactivity, leading to increased levels of fatigue. It is therefore important to break this negative process. One of the approaches is to facilitate people with CFS in self-managing their daily activity levels.
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​In a very recent review and clinical guideline of Heather Kroll, a nice overview is given about how exercise affects pain. But besides listing possible mechanisms of exercise induced analgesia, she reviews the therapeutic modalities and benefits for a wide variety of chronic pain diagnoses.
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The concept of myofascial trigger points keeps on inspiring researchers and clinicians. With the recent publication of an interesting review article in Rheumatology, the concept is really challenged.
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Therapeutic pain neuroscience education (TPNE) is becoming increasingly popular as (part of) the treatment of (chronic) pain and aims at altering the patient’s thoughts and beliefs about pain. Previous research has demonstrated the efficacy of TPNE in the treatment of chronic pain. TPNE is mostly given in one-on-one sessions, which has limitations, as it is time intensive, cost intensive and limited to patients in remote areas. Pain in Motion previously showed that written TPNE does little to alter pain, pain cognitions or illness perceptions in patients with fibromyalgia.
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Interpreting scientific results in clinical practice can be, to say at least, challenging. Especially when it is somewhat contradictory to what you have heard during all those years of extensive training in both physiotherapy education and other courses. As one of my friends recently put it this way: ‘The more I learn about pain, the less I know and the more confused I get.’
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Persistent pain in the absence of structural pathology remains a challenging issue for clinicians. Besides the suffering from the pain itself, chronic ‘unexplained’ pain is often accompanied by other debilitating symptoms such as fatigue, sleep difficulties, dizziness, psychological symptoms, and cognitive problems among others. A growing body of scientific research underlines the involvement of a common pathophysiological mechanism of central sensitization (CS), commonly known as an hypersensitivity of the central nervous system, in overlapping chronic pain conditions such as chronic fatigue syndrome (CFS), fibromyalgia (FM) and chronic whiplash-associated disorders (WAD).
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A recent article by Lance M. Mc Cracken and Stephen Morley published in the Journal of Pain addresses the place of theory and models in psychological research and treatment development in chronic pain. It argued that such models are not merely an academic issue but are highly practical. Such models ought to integrate current findings, precisely guide research and treatment development, and create progress. The dominant psychological approach to chronic pain is cognitive behavioural therapy (CBT).
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Based on a literature study on the effects of relaxation on symptoms and daily functioning in patients with FM, the authors concluded that:
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In 2011, Pain in Motion published a paper explaining to clinicians the various options we have for treating the mechanisms involved in central sensitization.
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Chronic Fatigue Syndrome (CFS), or myalgic encephalomyeltitis (ME), is a severe and underestimated illness. The presence of symptoms like a sore throat, tender lymph nodes, and low-grade fever, as well as flu-like symptoms including widespread muscle pain and severe fatigue, has inspired researchers to search for immune abnormalities in patients with ME/CFS.
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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.
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