Persistent Pain and Neuroplasticity: A Physical Therapist’s Perspective
My name is Chad Durboraw, PT, OCS. I’m a physical therapist with a special interest in treating patients with persistent pain conditions. When treating persistent pain, we must take into consideration the phenomenon known as neuroplasticity. Neuroplasticity is defined as the changes that occur throughout the nervous system. In persistent pain conditions, neuroplasticity can contribute to the increased arousal of the nervous system. This creates an environment in which the nervous system may overreact to innocuous stimuli such as movement, touch and changes in temperature.
The good news is that we have the ability to harness neuroplasticity to restore the function of the nervous system. Research supports that the chemistry of neuroplasticity is enhanced by movement, especially movements that are novel, fun and demand our attention. These are the types of movement strategies, along with an “Explain Pain” education program, that I employ as a physical therapist for patients with persistent pain.
The programs that I offer are based on the latest research about the neurophysiology of pain as described by some amazing colleagues in the physical therapy profession such as Lorimer Moseley, David Butler, Neil Pearson and others. Their work has demonstrated the importance of understanding the changes that occur throughout the nervous system in those in persistent pain. When treating patients with persistent pain, an understanding that their nervous systems should be the primary target for treatment is certainly a new paradigm that a majority of therapists are not aware of.
At my clinic, I offer informational seminars based on the principles of Lorimer Moseley and David Butler’s work in their book “Explain Pain.” I cover the latest research that pertains to pain neurophysiology. I go over:
- the processes that occur in the nervous system that makes it more sensitive to movement and touch
- the changes that occur in the virtual body map of the brain
- how thoughts, attitudes and beliefs about pain and its meaning influence our experience of pain
- the ways in which persistent pain affects a host of body systems, including the immune, endocrine, and neuromusculoskeletal system
Once patients learns how persistent pain can affect their mind and body, I then educate them about strategies to help them take control of their pain. As their therapist, I feel it’s my role to help the patient reconnect with their own mind and body, and to facilitate an environment for their nervous system to adapt in a positive direction. I find that teaching them ways to down-regulate their nervous system is very helpful.
To begin, I teach relaxed breathing techniques that help calm the nervous system. Then I move into teaching body self-awareness. I want to teach them how to feel their body again, how to reconnect the body and mind with various movement strategies. These techniques, along with manual therapy, helps to facilitate a connection with the nervous system and promote neuroplasticity.
Thank you for allowing me to share my philosophy of treating persistent pain conditions.
Thanks very much to Chad for his perspective. Readers, you can write your thoughts in the comments section below. If you’d like to contact Chad directly, or for information about his educational classes, his email is: firstname.lastname@example.org.