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Sensitivity of pain mechanisms in spinal pain – does it matter and can we change it?

In the past, several studies have demonstrated that the sensitivity of pain mechanisms is increased in people with spinal pain. The manifestations of this can be seen in different ways such as through increased sensitivity to mechanical or thermal stimuli, reduced ability to modulate nociceptive input via endogenous pain inhibition and a facilitated pain referral from somatic structures. What is unclear however is the interplay between the subjective experience of pain/dysfunction and the sensitivity of pain mechanisms.

To date, a range of methods exist that enable clinicians and researchers to assess various psychometric properties in clinical and healthy populations. Likewise, a range of methods have been developed for mapping the pain sensory profile in humans, including local and widespread pain sensitivity as well as the effectiveness of endogenous pain modulatory mechanisms. Combining such methods may be relevant in research on spinal pain.

It is widely accepted that spinal pain, similar to any other musculoskeletal pain condition, is a multidimensional pain experience. Therefore, it is important that any attempt to improve the clinical representation of spinal pain, needs to be patient-centered where physical, emotional, cognitive and social aspects are accounted for. Recent and emerging data from our group and others, suggest that employing such an approach has as favorable effect in short- and long-term compared to traditional care. What is less clear however, is whether patient characteristics at baseline can be used to predict for treatment effect. This is fruit for though for future research within the field of spinal pain.

Thorvaldur Palsson

  • Associate Professor at the Department of Health Science and Technology, Aalborg University, Denmark
  • Adjunct Research Fellow, The University of Notre Dame, Fremantle, Australia
  • University pedagogy (adjunktpædagogikum) for assistant professors, Aalborg University, Denmark
  • Assistant Professor at the Department of Health Science and Technology, Aalborg University, Denmark
  • PhD in Clinical Science and Biomedicine, Aalborg University
  • Extended research stay (3 months), Curtin University, Australia
  • Specialist in musculoskeletal physiotherapy – Danish Physiotherapy Association
  • Certification as Manual Therapist in Norway
  • Master of Manipulative Therapy from Curtin University, Perth Australia
  • BSc in physiotherapy from the University of Iceland
  • EliteForsk-Travel award in 2012 from the Danish ministry of Science, Innovation and Higher Education. The grant is awarded to talented young researchers for conducting their studies in the best available international research environments
  • Apex Physio: Assessing and managing musculoskeletal pain disorders, Aalborg
  • Arkadens Physiotherapy: Examining and treating spine related disorders, Aalborg
  • Physiotherapist in a multidisciplinary team at the Spine Centre of Southern Denmark
  • Clinical post-graduate training in musculoskeletal physiotherapy, Oslo Norway
  • Clinical work under specialist supervision 120 hours, Perth Australia
  • Afl-Physiotherapy assessing and treating sports-related and other musculoskeletal disorders, Iceland

Thorvaldur Palsson

  • Associate Professor at the Department of Health Science and Technology, Aalborg University, Denmark
  • Adjunct Research Fellow, The University of Notre Dame, Fremantle, Australia
  • University pedagogy (adjunktpædagogikum) for assistant professors, Aalborg University, Denmark
  • Assistant Professor at the Department of Health Science and Technology, Aalborg University, Denmark
  • PhD in Clinical Science and Biomedicine, Aalborg University
  • Extended research stay (3 months), Curtin University, Australia
  • Specialist in musculoskeletal physiotherapy – Danish Physiotherapy Association
  • Certification as Manual Therapist in Norway
  • Master of Manipulative Therapy from Curtin University, Perth Australia
  • BSc in physiotherapy from the University of Iceland
  • EliteForsk-Travel award in 2012 from the Danish ministry of Science, Innovation and Higher Education. The grant is awarded to talented young researchers for conducting their studies in the best available international research environments
  • Apex Physio: Assessing and managing musculoskeletal pain disorders, Aalborg
  • Arkadens Physiotherapy: Examining and treating spine related disorders, Aalborg
  • Physiotherapist in a multidisciplinary team at the Spine Centre of Southern Denmark
  • Clinical post-graduate training in musculoskeletal physiotherapy, Oslo Norway
  • Clinical work under specialist supervision 120 hours, Perth Australia
  • Afl-Physiotherapy assessing and treating sports-related and other musculoskeletal disorders, Iceland

Sensitivity of pain mechanisms in spinal pain – does it matter and can we change it?

In the past, several studies have demonstrated that the sensitivity of pain mechanisms is increased in people with spinal pain. The manifestations of this can be seen in different ways such as through increased sensitivity to mechanical or thermal stimuli, reduced ability to modulate nociceptive input via endogenous pain inhibition and a facilitated pain referral from somatic structures. What is unclear however is the interplay between the subjective experience of pain/dysfunction and the sensitivity of pain mechanisms.

To date, a range of methods exist that enable clinicians and researchers to assess various psychometric properties in clinical and healthy populations. Likewise, a range of methods have been developed for mapping the pain sensory profile in humans, including local and widespread pain sensitivity as well as the effectiveness of endogenous pain modulatory mechanisms. Combining such methods may be relevant in research on spinal pain.

It is widely accepted that spinal pain, similar to any other musculoskeletal pain condition, is a multidimensional pain experience. Therefore, it is important that any attempt to improve the clinical representation of spinal pain, needs to be patient-centered where physical, emotional, cognitive and social aspects are accounted for. Recent and emerging data from our group and others, suggest that employing such an approach has as favorable effect in short- and long-term compared to traditional care. What is less clear however, is whether patient characteristics at baseline can be used to predict for treatment effect. This is fruit for though for future research within the field of spinal pain.