central sensitization pain in physical therapy practice around the world

116 Pages·2017·7.86 MB·English

by  Jo Nijs

29-6-2017
CENTRAL SENSITIZATION PAIN IN PHYSICAL
THERAPY PRACTICE AROUND THE WORLD
http://www.wcpt.org/wcpt2017/COURSE-11
CENTRAL SENSITIZATION PAIN IN PHYSICAL
THERAPY PRACTICE AROUND THE WORLD
http://www.wcpt.org/wcpt2017/COURSE-11
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29-6-2017
Romy Parker
• Associate Professor University of Cape Town
• Director of Train Pain Academy
www.trainpainacademy.co.za
• chronic pain management team Groote
Schuur Hospital
• President-elect of PainSA
• Chair of the Pain, Mind and Movement
Special Interest Group of IASP
CENTRAL SENSITIZATION PAIN IN PHYSICAL
THERAPY PRACTICE AROUND THE WORLD
http://www.wcpt.org/wcpt2017/COURSE-11
2
29-6-2017
Michele Sterling
• Professor Griffith University
• Director NHMRC Centre of Research
Excellence in Road Traffic Injury
• Chair Scientific Program Committee Australian
Pain Society
• ranked #1 whiplash injury researcher in the
world www.expertscape.com
• > $13M competitive research funding
• > 150 scientific papers
CENTRAL SENSITIZATION PAIN IN PHYSICAL
THERAPY PRACTICE AROUND THE WORLD
http://www.wcpt.org/wcpt2017/COURSE-11
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29-6-2017
Kelly Ickmans
• Visiting & research professor
• Postdoctoral researcher
• PT - clinician
• Pain in Motion kids
• PhD supervisor
• > 30 papers
Medical diagnosis Medical discipline Estimated % predominant
central sensitizationpain
Low back pain Orthopedics 25%
Pediatricpain Pediatrics ?
Post-cancerpain Oncology 11%
Osteoarthritis Rheumatology 30%
Whiplashassociateddisorders Emergencymedicine 90%
Nontraumaticneckpain Physicalmedicine 10%
Shoulderpain Physicalmedicine 10%
Fibromyalgia Rheumatology 100%
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Medical diagnosis Medical discipline Estimated % predominant
central sensitizationpain
Low back pain Orthopedics 25%
Pediatricpain Pediatrics ?
Post-cancerpain Oncology 15%
Osteoarthritis Rheumatology 30%
Whiplashassociateddisorders Emergencymedicine 90%
Nontraumaticneckpain Physicalmedicine 10%
Shoulderpain Physicalmedicine 10%
Fibromyalgia Rheumatology 100%
Medical diagnosis Medical discipline Estimated % predominant
central sensitizationpain
Low back pain Orthopedics 25%
Pediatricpain Pediatrics ?
Post-cancerpain Oncology 15%
Osteoarthritis Rheumatology 30%
Whiplashassociateddisorders Emergencymedicine 90%
Nontraumaticneckpain Physicalmedicine 10%
Shoulderpain Physicalmedicine 10%
Fibromyalgia Rheumatology 100%
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Content overview
• Introduction
• Central sensitization: maladaptive neuroplasticity in patients with
chronic pain (Kelly)
• Neuropathic central sensitization pain in physical therapy practice: HIV-
related neuropathic pain as an example (Romy)
• Neuropathic central sensitization pain in physical therapy practice:
assessment (Romy & Michele)
• Non-neuropathic central sensitization pain in physical therapy practice:
Neck pain as an example (Michele & Jo)
• Non-neuropathic central sensitization pain in physical therapy practice:
case study (Kelly & Jo)
Content overview
• Introduction
• Central sensitization: maladaptive neuroplasticity in patients with
chronic pain (Kelly)
• Neuropathic central sensitization pain in physical therapy practice: HIV-
related neuropathic pain as an example (Romy)
• Neuropathic central sensitization pain in physical therapy practice:
assessment (Romy & Michele)
• Non-neuropathic central sensitization pain in physical therapy practice:
Neck pain as an example (Michele & Jo)
• Non-neuropathic central sensitization pain in physical therapy practice:
case study (Kelly & Jo)
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Pain
Nociceptors
Nociceptiveneurons
andWDR neurons in DH
Thalamus
Corticalregions
Corticaloutput
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Nociceptive pain
Inflammation
Tissue injury
Growingmass
…
distension
rupture
stimulationmech. receptors
activationnociceptors
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↓ threshold Nerve PrimaryHYPERALGESIA
↑ firingrate impulses↑↑ ALLODYNIA
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Why?
Primary hyperalgesia = adaptive response of the nervous system, preventing
further damage and hence facilitating tissue healing.
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Nociception vs. pain
• There’s a direct link between the amount of tissue
damageandthelevelofpainexperienced
• All pain is caused by injury and increased pain means
moredamage
• Painiseitherphysicalorpsychological
• In chronicpaintissues didnot healand damage is still
ongoing
• Nociceptionandpainaresynonyms
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• There’s a direct link between the amount
of tissue damage and the level of pain
experienced(patientstrulybelievethis!)
• All pain is caused by injury and increased
painmeansmoredamage
• Painiseitherphysicalorpsychological
• In chronic pain tissues did not heal and
damageisstillongoing
• Nociceptionandpainaresynonyms
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Pain vs. Nociception
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Nociception ≠ Pain & Pain ≠ Nociception
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