Dr Anneleen Malfliet talks pain neuroscience, graded exposure and addressing adiposity to help with pain
Mar 26, 2024
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Dr Anneleen Malfliet discusses pain neuroscience, graded exposure, and managing adiposity for pain relief. Topics include time contingent exercise, reframing motor control exercises, and the challenges of weight loss in pain management. The podcast dives into the integration of cognitive training for chronic spinal pain, gradual introduction of feared movements, and lifestyle modifications for better patient outcomes.
Pain neuroscience education with graded exposure can help chronic spinal pain by detaching pain from tissue damage.
Integrating weight reduction and lifestyle modifications can impact pain intensity and functional abilities for chronic low back pain patients.
Deep dives
Combining Pain Neuroscience Education with Motor Control Training in Chronic Spinal Pain
In a study on chronic spinal pain, a combination of pain neuroscience education and cognition-targeted motor control training was evaluated. Both the intervention and control groups received equal therapist time to rule out non-specific factors like attention and therapeutic alliance. The experimental group received pain neuroscience education explaining the neurophysiology of pain, the role of the nervous system, and factors influencing pain perception. This education aimed to provide understanding and detach pain experience from tissue damage, preparing patients for functional exercise therapy.
Gradual Approach to Exercise Therapy in Chronic Pain Patients
The exercise therapy in the study focused on gradually increasing functionality despite pain for chronic spinal pain patients. An initial emphasis on activating specific muscles without emphasizing weakness, followed by gradual progression to feared and avoided movements like bending forward. The patient's individual fear hierarchy was used to tailor exercises, incorporating gradual exposure to feared activities, and linking them to functional movements to reduce pain-related fear.
Incorporating Weight Reduction in Chronic Pain Management
The importance of integrating weight reduction with pain management for chronic low back pain patients was highlighted. Addressing lifestyle factors like nutrition, stress, and sleep can impact pain intensity and functional abilities. An ongoing trial focuses on combining weight reduction interventions with pain education and exercise therapy in obese or overweight chronic low back pain patients to address the interrelationships between body composition, pain intensity, and functional limitations.
Training Clinicians on Lifestyle Modifications for Chronic Pain Patients
Pain and Motion Research Group conducts local and regional courses to train clinicians on lifestyle modifications for chronic pain patients. These courses cover lifestyle factors beyond weight, such as stress and sleep, to provide a comprehensive approach to pain management. Specific trainings on sleep-related issues and incorporating lifestyle modifications into pain neuroscience education aim to enhance clinicians' skills in addressing the complex nature of lifestyle factors in chronic pain management.
Dr Malfliet was on today discussing her PhD thesis paper which deserves a lot of attention. We discussed her RCT entitlted "Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial" where we focused on the importance of nudging into pain (Time Contingent Exercise), reframing motor control exercises as movements that you get comfortable and confident in moving and how to progress these exercises with a graded exposure/activity approach.
We also talked about the role of losing weight (specifically adipose tissue) and its potential role in managing persistent pain. Weight loss is a difficult topic to broach with patients and providers and we touched on these issues. We didn't spend too much time on this contentious topic and its certainly worth exploring more in detail
Our Guest - Anneleen Malfliet Anneleen Malfliet is an assistant professor and postdoctoral researcher at the Vrije Universiteit Brussel. She is also a member of the Pain in Motion international research group. Her research and clinical interest goes out to chronic pain with a special interest in chronic spinal pain, pain rehabilitation, central sensitization, nutrition and diet. More info at our Pain in Motion website: www.paininmotion.be
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