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From acute musculoskeletal pain to chronic widespread pain and fibromyalgia:
Application of pain neurophysiology in manual therapy practice.
Man Ther. 2008 May 27. [Epub ahead of print]
Nijs J, Van Houdenhove B.
During the past decade,
scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder
towards chronic widespread pain/fibromyalgia (FM).
Chronic widespread pain/FM is characterized by sensitisation 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 in three different ways.
- In order to prevent chronicity in (sub)acute musculoskeletal disorders,
it seems crucial to limit the time course of afferent stimulation
of peripheral nociceptors.
- In the case of chronic widespread pain
and established sensitisation of central pain pathways,
relatively minor injuries/trauma at any locations
are likely to sustain the process of central sensitisation
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 sensitisation.
- 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 sensitisation.
PMID: 18511329 [PubMed - as supplied by publisher]