This was September’s Journal Club article at the hospital. I picked it after chasing it down in another more recent article’s resource list.
I truly believe after reading this article and learning more about central sensitization that many, many patients seen for physical therapy services have varying degrees of central sensitization by the time they reach us. Because unfortunately, physical therapy is often seen as a last resort for pain management. Physical therapy is often only sought out when covering up the pain with drugs no longer works or other more invasive techniques like surgery have failed. I am truly thankful for the recent movement at the federal level to get physical therapy services moved into a first line treatment option position. However, as I have discussed this national movement with those people that should be seeking out those services, they are not convinced. The internet can be an ugly place and people that are in pain even more so in the relative obscurity it provides. However, those interactions did show me that public perception of these apparently revolutionary ideas have a long way to go before Mr. Joe Schmoe Pain Patient is convinced. And I think the key to getting the public on board lies in this article: education. But before we can educate the public, we must educate ourselves.
So what is pain exactly? Pain occurs as a response to a mechanoreceptors stimulus in the periphery of the body as a signal to the receiving creature to make action to remove itself from the stimulus to preserve its safety. So, pain is a good thing. A life without pain is no life at all. However, when new stimuli cease to come from the periphery, but the pain continues. This is central sensitization. Pathophysiologically, central sensitization is complex and still not fully understood; however, we do know it comes from an interaction of “an alteration of sensory processing in the brain, loss of descending antinociceptive mechanisms, enhanced facilitatory pain mechanisms, increased temporal summation or wind-up and long-term potentiation of neuronal synapsis in the anterior cingulate cortex.” Basically, neuroplasticity works against us in this case to sear a memory of pain in our brains that we can’t let go and gets attached to fear and emotional trauma. Fear is one of our most basic functions, instincts. When pain gets attached to that, it is most difficult to root out. Which is why the article recommended three treatments: education from we therapists on what is going on pathophysiologically along with graded exercise to dissociate the pain from movement and cognitive behavioral therapy from our psychologist friends. It is important to have a psychologist you can trust to refer these folks to. I know I don’t. I need to find one. For the sake of my pained patients.
In this article, there was a reference to a method on how to appropriately educate our patients on the neuroscience of pain. We’ll be covering that article in next month’s Journal Club, so stay tuned!