How Pain Neuroscience Education Can Be Used to Improve Manual Therapy

There seems to be some discourse when it comes to the effectiveness of pain neuroscience education (PNE) and traditional biomedical models (specifically manual therapy). A study 1 in the ‘Journal of Manual & Manipulative Therapy’ argued that PNE could be beneficial when used in a manual therapy model to address pain.

What was the Context?

It has been estimated that approximately 25.3 million adults living in the US experience daily chronic pain. Of course, these numbers are higher around the world. Chronic pain can be a continuing deterrent against a person’s psychological and physical wellbeing. That’s why proper methods to address such pain need to be developed. Due to chronic pain being challenging to treat, numerous clinicians report struggles.

Over the years, the interest in PNE has increased in the realm of physical therapy. Pain neuroscience education has been scientifically proven to help decrease disability, pain, limitations in movement, and more when treating patients. PNE focuses on handling pain from a biological and physiological perspective. It includes processes such as inhibition, neuroplasticity, central sensitization, and more.

PNE seems to in contrast to biomedical models (which focuses on biomechanics, pathoanatomy, and anatomy). Take note; biomedical models might play a role in elevating pain catastrophization and fear-avoidance.

Manual therapy uses the biomedical model a lot. Also, due to the contrasting natures, PNE is regarded as a ‘hands-off’ approach and different from manual therapy.

The current study set out to explore whether or not manual therapy and pain neuroscience education could exist together. The team also wanted to find out if PNE could be used in a manual therapy model to treat someone with an increasingly hypervigilant nervous system.

The Importance of Central Sensitization

When analyzing chronic pain, it has an association with increased levels of vigilance in the Central Nervous System. Such an occurrence is called central sensitization or CS. This type of sensitization can be simply described as an elevated response (by the CNS’s nociceptive neurons) to a normal input. This means that a typical touch is perceived as threatening and increases the amount of pain a person experiences.

In clinical terms, a hypervigilant nervous system covers hyperalgesia and allodynia. Hyperalgesia is when a normally pain-inducing stimulus gives rise to an increased level of pain. Allodynia is when pain is caused by a stimulus that isn’t supposed to normally cause pain.

As the existence of pain can lead from hyperalgesia to allodynia, even pain-free techniques during manual therapy can lead to a patient feeling pain.

Dynamic spine models educate patients about their own anatomy to reduce psychological spillover.


Helping Patients Understand Their Pain

Of course, pain tends to be more complicated than merely limiting it to CS. Pain is linked to the changes in a person’s immune system, brain functioning, and neglecting injuries. However, the importance of helping the patient understand their pain can’t be ignored.

Recent studies, involving low back pain or LBP, have shown that when manual therapists also incorporate PNE (specifically a neuroplasticity educational model) to educate patients, significantly positive results for managing pain were observed.

Educating patients during the initial phases of their injury can have a substantial impact on their recovery timeline. However, further research regarding these factors needs to be conducted to help transform manual therapy into a model that can effectively use PNE to help patients suffering from chronic pain.



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