From acute musculoskeletal pain to chronic widespread pain and fibromyalgia:
Application of pain neurophysiology in manual therapy practice


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http://www.sciencedirect.com/science/journal/1356689X>
Manual Therapy Preprint 2 juni 08


From acute musculoskeletal pain to chronic widespread pain and fibromyalgia:
Application of pain neurophysiology in manual therapy practice
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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, Van Aertselaerstraat 31, B-2170 Merksem, Belgium.


Abstract

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 characterised
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. (I) In order to
prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to
limit the time course of afferent stimulation of peripheral nociceptors. (II) 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. (III) 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.

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(c) 2008 Elsevier/ScienceDirect B.V.