Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
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Randomized Controlled Trial Clinical Trial
Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial.
To evaluate the short-term effect of physical exercise and a cognitive intervention in low back pain. ⋯ Cognitive intervention improved disability and may be feasible for most patients sick-listed in the sub-acute phase. Physical exercise reduced patients' symptoms, but requires high motivation by patients. Despite positive effects in intervention groups on variables considered as negative prognostic factors for long-term disability and sickness absence, interventions had no effect on sick-listing.
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According to the classification criteria proposed by the American College of Rheumatology, fibromyalgia is a long-standing multifocal pain condition combined with generalised allodynia/hyperalgesia. It is the generalised allodynia/hyperalgesia that distinguishes fibromyalgia from other conditions with chronic musculoskeletal pain. ⋯ Chronic stress and chronic sleep disturbance are not specific for fibromyalgia but could be the causes of symptoms like fatigue, cognitive difficulties and other stress-related symptoms. They may also cause neuroendocrinological and immunological aberrations.
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Referred muscle pain, resulting from algogenic conditions in viscera or other deep somatic structures (another muscle, a joint), is most often accompanied by secondary hyperalgesia and trophic changes (hypotrophy). Referred pain/ hyperalgesia from viscera is partly due to central sensitisation of viscero-somatic convergent neurons (triggered by the massive afferent visceral barrage) but also probably results from a reflex arc activation (the visceral input triggers reflex muscle contraction in turn responsible for sensitisation of muscle nociceptors). Referred pain/hyperalgesia from deep somatic structures is not explained by the mechanism of central sensitisation of convergent neurons in its original form, since there is little,convergence from deep tissues in the dorsal horn neurons. It has been proposed that these connections, not present from the beginning, are opened by nociceptive input from skeletal muscle, and that referral to myotomes outside the lesion results from the spread of central sensitisation to adjacent spinal segments.
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Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in such areas as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. ⋯ These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the somatosensory system as well as its effects on the motor system. Cortical plasticity related to chronic pain can be modified by behavioural interventions that provide feedback to the brain areas that were altered by somatosensory pain memories or by pharmacological agents that prevent or reverse maladaptive memory formation.
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It is now widely recognized that the cerebral cortex of adult human and non-human mammals is capable of widespread functional and structural plasticity. During the learning of new skills, cortical regions associated with sensorimotor function of the body parts most utilized for the skilled task come to be represented over larger cortical territories. ⋯ Thus, after cortical injury, the structure and function of undamaged parts of the brain are remodeled during recovery, shaped by the sensorimotor experiences of the individual in the weeks to months following injury. These recent neuroscientific findings suggest that new rehabilitative interventions, both physiotherapeutic and pharmacotherapeutic, may have benefit via modulation of neuroplastic mechanisms.