Kann Schmerzneurophysiologieschulung dazu beitragen, funktionelle Fähigkeiten bei chronischen Schmerzpatienten aus physiotherapeutischer Perspektive zu verbessern?

Zusammenfassung

Physiotherapeuten nutzen in Eins-zu-eins-Sitzungen Schmerzneurophysiologie als eine Strategie, um funktionelle Belastbarkeit bei chronischen Schmerzpopulationen zu verbessern. Diese Maßnahme wird oft bei chronischem unspezifischen Lumbalschmerz (CNSLBP) in Kombination mit aktiver, funktioneller Physiotherapie eingesetzt. Der der Schmerzphysiologieschulung zugrunde liegende Mechanismus ist nicht vollständig geklärt. Es besteht limitierte Evidenz dafür, wie spezifische Schmerzphysiologieschulung die in die Schmerzmatrix involvierten verschiedenen Hirnprozesse beeinflusst und wie Patienten von dieser Anwendung profitieren können.

Die vorliegende Fallstudie diskutiert Aspekte der Schmerzphysiologieschulung in der klinischen Anwendung bei einem jungen Mann mit CNSLBP als Folge eines Snowboard-Unfalls.

Abstract

Physiotherapists employ one-to-one pain physiology education as a method of improving functional capacity in chronic pain population. This strategy is often used in chronic non-specific low back pain (CNSLBP) in combination with active functional physiotherapy. The mechanism underpinning the effect of pain-physiology education is not definitively clarified. There is limited evidence concerning how specific pain physiology education influences different brain processes involved in the pain matrix and how patients may benefit from this approach.

This case study discusses aspects of pain physiology education in clinical practice in a young man with CNSLBP following a snowboard accident.

Schlüsselwörter

Schmerzphysiologieschulung - Physiotherapie - funktionelle Belastbarkeit

Key words

pain physiology education - physiotherapy - functional capacity

Literatur

• 1 Adams H, Ellis T, Stanish W D. et al . Psychosocial factors related to return to work following rehabilitation of whiplash injuries.  J Occup Rehabil. 2007;  17 305-315
• 2 Andersen L L, Kjaer M, Sogaard K. et al . Effect of two contrasting types of physical exercise on chronic neck muscle pain.  Arthritis Rheum. 2008;  59 84-91
• 3 Bandura A. Self-efficacy: toward a unifying theory of behavioral change.  Psychol Rev. 1977;  84 191-215
• 4 Bandura A, Adams N E, Beyer J. Cognitive processes mediating behavioral change.  J Pers Soc Psychol. 1977;  35 125-139
• 5 Birbaumer N, Flor H, Lutzenberger W. et al . Chaos and order in the human brain.  Electroencephalogr Clin Neurophysiol. 1995;  Suppl 44 450-459
• 6 Blanchard E B, Hickling E J, Devineni I T. et al . A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors.  Behav Res Ther. 2003;  41 79-96
• 7 Boersma K, Linton S J, Overmeer T. et al . Lowering fear-avoidance and enhancing function through exposure in vivo. A multiple baseline study across six patients with back pain.  Pain. 2004;  108 8-16
• 8 Boersma K, Linton S J. Screening to identify patients at risk: profiles of psychological risk factors for early intervention.  Clin J Pain. 2005;  21 38-43; discussion: 69 – 72
• 9 Bostik G P, Ferrari R, Carroll L J. et al . A population-based survey of beliefs about neck pain from whiplash injury, work-related neck pain, and work-related upper extremity pain.  Eur J Pain. 2009;  13 300-304
• 10 Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing.  Neurosci Lett. 2004;  366 63-66
• 11 Buckelew S P, Parker J C, Keefe F J. et al . Self-efficacy and pain behavior among subjects with fibromyalgia.  Pain. 1994;  59 377-384
• 12 Buitenhuis J, Jaspers J P, Fidler V. Can kinesiophobia predict the duration of neck symptoms in acute whiplash?.  Clin J Pain. 2006;  22 272-277
• 13 Carroll L J, Cassidy J D, Cote P. The role of pain coping strategies in prognosis after whiplash injury: passive coping predicts slowed recovery.  Pain. 2006;  124 18-26
• 14 Chien A, Elieav E, Sterling M. Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash – further evidence of a neuropathic condition.  Man Ther. 2009;  14 138-146
• 15 Curatolo M, Arentdt-Nielsen L, Petersen-Felix S. Central hypersensitivity in chronic pain: mechanisms and clinical implications.  Phys Med Rehabil Clin N Am. 2006;  17 287-302
• 16 De Jong J R, Vlaeyen J W, Onghena P. et al . Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction?.  Clin J Pain. 2005;  21 9-17; discussion: 69 – 72
• 17 Falla D, O’Leary S, Fagan A. et al . Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting.  Man Ther. 2007;  12 139-143
• 18 Flor H, Elbert T, Knecht S. et al . Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation.  Nature. 1995;  375 482-484
• 19 Flor H, Braun C, Elbert T. et al . Extensive reorganization of primary somatosensory cortex in chronic back pain patients.  Neurosci Lett. 1997;  224 5-8
• 20 Flor H, Knost B, Birbaumer N. Processing of pain- and body-related verbal material in chronic pain patients: central and peripheral correlates.  Pain. 1997;  73 413-421
• 21 Flor H, Denke C, Schaefer M. et al . Effect of sensory discrimination training on cortical reorganisation and phantom limb pain.  Lancet. 2001;  357 1763-1764
• 22 Forbes D, Creamer M, Phelps A. et al . Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder.  Aust N Z J Psychiatry. 2007;  41 637-648
• 23 Garcia D M, Pimenta C A, da Cruz A. Validation of the Survey of Pain Attitudes-Professionals.  Rev Esc Enferm USP. 2007;  41 636-644
• 24 Goubert L, Francken G, Crombez G. et al . Exposure to physical movement in chronic back pain patients: no evidence for generalization across different movements.  Behav Res Ther. 2002;  40 415-429
• 25 Grimmer-Somers E A. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain.  Journal of Pain Research. 2008;  1 18-25
• 26 Guzman J, Esmail R, Karjalainen K. et al . Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain.  Cochrane Database Syst Rev. 2002;  CD000963
• 27 Hasenbring M I, Plaas H, Fischbein B. et al . The relationship between activity and pain in patients 6 months after lumbar disc surgery: do pain-related coping modes act as moderator variables?.  Eur J Pain. 2006;  10 701-709
• 28 Holmes N SC. Beyond the body schema: visual, prosthetic, and technological contributions to bodily perception and awareness. Oxford; Oxford University Press 2006
• 29 Jensen M P, Smith D G, Ehde D M. et al . Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain.  Pain. 2001;  91 317-322
• 30 Juottonen K, Gockel M, Silen T. et al . Altered central sensorimotor processing in patients with complex regional pain syndrome.  Pain. 2002;  98 315-323
• 31 Kool J, Bie de R, Oesch P. et al . Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis.  J Rehabil Med. 2004;  36 49-62
• 32 Kool J, Oesch P R, Bachmann S. et al . Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial.  Arch Phys Med Rehabil. 2005;  86 857-864
• 33 Kool J, Bachmann S, Oesch P. et al . Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial.  Arch Phys Med Rehabil. 2007;  88 1089-1094
• 34 Landers M R, Creger R V, Baker C V. et al . The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain.  Man Ther. 2008;  13 239-248
• 35 Lee C E, Simmonds M J, Novy D M. et al . Self-reports and clinician-measured physical function among patients with low back pain: a comparison.  Arch Phys Med Rehabil. 2001;  82 227-231
• 36 Leeuw M, Goossens M E, Linton S J. et al . The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.  J Behav Med. 2007;  30 77-94
• 37 Leeuw M, Goossens M E, Breukelen G J. et al . Measuring perceived harmfulness of physical activities in patients with chronic low back pain: the Photograph Series of Daily Activities – short electronic version.  J Pain. 2007;  8 840-849
• 38 Leeuw van M, Goossens M E, Breukelen G J. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial.  Pain. 2008;  138 192-207
• 39 Lethem van J, Slade P D, Troup J D. et al . Outline of a Fear-Avoidance Model of exaggerated pain perception. I.  Behav Res Ther. 1983;  21 401-408
• 40 Linton S J, Hallden K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.  Clin J Pain. 1998;  14 209-215
• 41 Lundberg M, Styf J. Kinesiophobia among physiological overusers with musculoskeletal pain.  Eur J Pain. 2008;  13 655-659
• 42 Mc Cabe C S, Blake D R. Evidence for a mismatch between the brain’s movement control system and sensory system as an explanation for some pain-related disorders.  Curr Pain Headache Rep. 2007;  11 104-108
• 43 Mc Cormick K, Zalucki N, Hudson M. et al . Faulty proprioceptive information disrupts motor imagery: an experimental study.  Aust J Physiother. 2007;  53 41-45
• 44 Magid C S. Pain, suffering, and meaning.  JAMA. 2000;  283 114
• 45 Maihofner C, Handwerker H O, Neundorfer B. et al . Patterns of cortical reorganization in complex regional pain syndrome.  Neurology. 2003;  61 1707-1715
• 46 Main C J, Sullivan J L, Watson P J. Pain Management – Practical applications of the biopsychosocial perspective in clinical and occupational setting. Cambridge; Elsevier 2008
• 47 Marhold C, Linton S J, Melin L. A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave.  Pain. 2001;  91 155-163
• 48 Martin L, Nutting A, Macintosh B R. et al . An exercise program in the treatment of fibromyalgia.  J Rheumatol. 1996;  23 1050-1053
• 49 Meyer K, Sprott H, Mannion A F. Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale.  J Psychosom Res. 2008;  64 469-478
• 50 Moseley G L. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain.  Eur J Pain. 2004;  8 39-45
• 51 Moseley G L, Nicholas M K, Hodges P W. A randomized controlled trial of intensive neurophysiology education in chronic low back pain.  Clin J Pain. 2004;  20 324-330
• 52 Moseley G L, Sim D F, Henry M L. et al . Experimental hand pain delays recognition of the contralateral hand--evidence that acute and chronic pain have opposite effects on information processing?.  Brain Res Cogn Brain Res. 2005;  25 188-194
• 53 Moseley G L. Using visual illusion to reduce at-level neuropathic pain in paraplegia.  Pain. 2007;  130 294-298
• 54 Moseley G L, Arntz A. The context of a noxious stimulus affects the pain it evokes.  Pain. 2007;  133 64-71
• 55 Moseley G L. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain.  Pain. 2008;  140 239-243
• 56 Moseley G L. Pain, brain imaging and physiotherapy – opportunity is knocking.  Man Ther. 2008;  13 475-477
• 57 Moseley G L, Gallace A, Spence C. Is mirror therapy all it is cracked up to be? Current evidence and future directions.  Pain. 2008;  138 7-10
• 58 Moseley G L, Olthof N, Venema A. et al . Psychologically induced cooling of a specific body part caused by the illusory ownership of an artificial counterpart.  Proc Natl Acad Sci USA. 2008;  105 13169-13173
• 59 Moseley G L, Zalucki N, Birklein F. et al . Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain.  Arthritis Rheum. 2008;  59 623-631
• 60 Moseley G L, Zalucki N M, Wiech K. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain.  Pain. 2008;  137 600-608
• 61 Nieto R, Miro J, Huguet A. The fear-avoidance model in whiplash injuries.  Eur J Pain. 2009;  13 518-523
• 62 Novy D M, Simmonds M J, Lee C E. Physical performance tasks: what are the underlying constructs?.  Arch Phys Med Rehabil. 2002;  83 44-47
• 63 Oesch P R, Kool J P, Bachmann S. et al . The influence of a Functional Capacity Evaluation on fitness for work certificates in patients with non-specific chronic low back pain.  Work. 2006;  26 259-271
• 64 Peters M L, Schmidt A J. A comparison of two-point discrimination threshold of tactual, non-painful stimuli between chronic low back pain patients and controls.  Pain. 1991;  44 57-60
• 65 Pineiro R, Pendlebury S, Johansen-Berg H. et al . Functional MRI detects posterior shifts in primary sensorimotor cortex activation after stroke: evidence of local adaptive reorganization?.  Stroke. 2001;  32 1134-1139
• 66 Pleger B, Janssen F, Schwenkreis P. et al . Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I.  Neurosci Lett. 2004;  356 87-90
• 67 Pleger B, Tegenthoff M, Schwenkreis P. et al . Mean sustained pain levels are linked to hemispherical side-to-side differences of primary somatosensory cortex in the complex regional pain syndrome I.  Exp Brain Res. 2004;  155 115-119
• 68 Roland M O. The natural history of back pain.  Practitioner. 1983;  227 1119-1122
• 69 Schaefer M, Flor H, Heinze H J. et al . Dynamic modulation of the primary somatosensory cortex during seeing and feeling a touched hand.  Neuroimage. 2006;  29 587-592
• 70 Shaw W S, Feuerstein M, Haufler A J. et al . Working with low back pain: problem-solving orientation and function.  Pain. 2001;  93 129-137
• 71 Simmonds M J, Olson S L, Jones S. et al . Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.  Spine. 1998;  23 2412-2421
• 72 Simmonds M J. Measuring and managing pain and performance.  Man Ther. 2006;  11 175-179
• 73 Simmonds M J, Moseley G L, Vlaeyen J W. Pain, mind, and movement: an expanded, updated, and integrated conceptualization.  Clin J Pain. 2008;  24 279-280
• 74 Slade P D, Troup J D, Lethem J. et al . The Fear-Avoidance Model of exaggerated pain perception – I.  Behav Res Ther. 1983;  21 409-416
• 75 Smeets R J, Hijdra H J, Kester A D. et al . The usability of six physical performance tasks in a rehabilitation population with chronic low back pain.  Clin Rehabil. 2006;  20 989-997
• 76 Smeets R J, Wade D, Hidding A. et al . The association of physical deconditioning and chronic low back pain: a hypothesis-oriented systematic review.  Disabil Rehabil. 2006;  28 673-693
• 77 Staerkle R, Mannion A F, Elfering A. Longitudinal validation of the fear-avoidance beliefs questionnaire (FABQ) in a Swiss-German sample of low back pain patients.  Eur Spine J. 2004;  13 332-340
• 78 Sterling M, Jull G, Vicenzino B. et al . Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery.  Pain. 2003;  104 509-517
• 79 Trost Z, France C R, Thomas J S. Exposure to movement in chronic back pain: evidence of successful generalization across a reaching task.  Pain. 2008;  137 26-33
• 80 Vangronsveld K L, Peters M, Goossens M. et al . The influence of fear of movement and pain catastrophizing on daily pain and disability in individuals with acute whiplash injury: a daily diary study.  Pain. 2008;  139 449-457
• 81 Vlaeyen J W, Linton S J. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.  Pain. 2000;  85 317-332
• 82 Vlaeyen J W, Jong de J, Geilen M. et al . Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain.  Behav Res Ther. 2001;  39 151-166
• 83 Wall P. The placebo response. Edinburgh; Churchill Livingstone 1999
• 84 Williams J. Principles of psychology. New York; Holt 1980
• 85 Yozgatian J H, Zeredo J L, Hotokezaka H. et al . Emotional stress- and pain-related behaviors evoked by experimental tooth movement.  Angle Orthod. 2008;  78 487-494