From acute musculoskeletal pain to chronic widespread pain and Fibromyalgia: Application of pain neurophysiology in manual therapy practice – Source: Manual Therapy, June 3, 2008

During the past decade, scientific research has provided new insight into the development from an acute, localized musculoskeletal disorder toward chronic widespread pain/Fibromyalgia (FM).

Chronic widespread pain/FM is characterized by sensitization of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients.

It is explained that manual therapy might be able to influence the process of chronicity [of becoming chronic] in three different ways.

1. In order to prevent chronicity [pain becoming chronic] in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. [Limit the time the nerve endings at a local source of pain may stimulate or sensitize central pain pathways.]

2. In the case of chronic widespread pain and established sensitization of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitization and should be treated appropriately with manual therapy – accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitization.

3. However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitization.

Source: Manual Therapy, May 27, 2008. [Epub ahead of print] PMID: 18511329, by Nijs J, Van Houdenhove B. Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Belgium; Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, University College Antwerp Merksem, Belgium. [E-mail: Jo.Nijs@vub.ac.be]

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