Comments on Theoretical Considerations for Chronic Pain Rehabilitation in APTA Journal

October 3, 2015

The APTA Journal’s September 2015 issue had a great article on Theoretical Considerations for Chronic Pain Rehabilitation by authors Martin Lotze, and G. Lorimer Moseley.
How very timely for the above article to come across my desk.
I will briefly summarize the points in it for you.
There is a new paradigm developing in the field of chronic pain relevant to Physical Therapy treatment.  The explanation is changing from a model based on structural-pathology to altered perceptual processing.
In the altered perceptual processing model, pain signals are associated with the perception of a need to protect in some manner. There is a shift towards understanding the pain issues in danger versus safety constructs.  This model certainly has validity for some kinds of chronic pain.
The article discusses the need for clinicians to be much more attuned to:
1.)  Clinician observations and recognition that behaviors and dialogue reflect neural representation. ( i.e. What you see and observe can add to a cohesive sense of what the client’s brain is processing in relationship to their pain.)
2.)  Clinical inquiry into the patient’s framing of their pain in a biopsychosocial manner. This ties into a need for improving the client narrative aspect therapy.
3.) Then, as clinicians we are to attend to the importance of our relationship with the client. We help redirect and create measures of safety.  We are to help reduce the client’s need to protect which is associated with their pain. We need to include education about their pain, “Explaining Pain”.
The “Explaining Pain” model seems to me to be a very concious process of mental reframing to quell pain signals. This is a top-down approach.
I recommend also including my methods of bottom-up processing involving restoration of the perception of safety in a manner uniquely relevant to each patient.
The authors note that there may be maladaptive neuroplasticity involved “…whereby body-related neural representation become less precise, an abnormality thought to be important in some of the multiple system dysfunctions that are seen in people with chronic pain”.
This article supports in a clear way the need for new ways to interface with our clients for treatment.  It does not talk in specific ways how to accomplish the above. And, if you’re like I was as I began to delve into these concepts, I really didn’t know how to get started doing something different in my clinic.
The manual therapy methods I will be sharing directly relate to rehabilitation of maladaptive- neuroplasticity which I usually term negative neuroplasticity.  There is more info on negative neuroplasticity coming up in later segments of the lecture you will shortly have access to.
Are you interested in addressing concretely how to do a better patient narrative, how to work with issues of safety on multiple levels, how to evaluate and therefore “see”  what’s in front of you better, and how to sort out what is a right course of rehab for chronic pain?

Please feel free to send me clinical questions. I work so much better when I have something specific to address.

Warm regards,

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