Neurobiology of pain & strategies to modulate at various levels from MDT perspective

  • Andreas Kopf

    Chair, Department of Pain Medicine, Benjamin Franklin campus, Charité University of Medicine, Berlin, Germany
  • Thomas Graven-Nielsen

    Director, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Denmark
  • Anneleen Malfliet

    Assistant Professor, Vrije Universiteit Brussels, Postdoctoral Researcher, Research Foundation Flanders, Brussels

Chair: Andreas Kopf, Germany
Basic science perspective
Thomas Graven-Nielsen, Denmark
The clinical importance of chronic pain is obvious and a mechanistic understanding of how transduction, transmission, and modulation is affected in patients may help directing appropriate management. A multi-disciplinary approach from basic to clinical science is crucial for improving the management of pain conditions. This includes an understanding of the involved basic pain mechanisms, how they can be assessed in patients, and treatment procedures based on the underlying mechanisms. In this refresher session information will be provided on basic mechanisms in musculoskeletal pain, definitions and methodologies for assessing musculoskeletal pain in humans, and how different pain anti-nociceptive and pro-nociceptive mechanisms (e.g. sensitization, temporal summation of pain, conditioning pain modulation, referred pain) can be evaluated quantitatively in healthy volunteers and in pain patients. The focus will in particular be on the processing of nociceptive information from musculoskeletal tissue under normal conditions and conditions with peripheral sensitization and facilitated central mechanisms.

Physio perspective 
Anneleen Malfliet, Belgium
(Chronic) pain is a multifactorial and complex problem that asks for a biopsychosocial and lifestyle
approach in clinical practice. As a physiotherapist, one of the main treatment modalities we have to
target (chronic) pain is exercise therapy since it comes with low costs, and evidence shows (small to
moderate) positive effects on pain (neurobiology). Exercise therapy does not only have the ability to
target (chronic) pain on a structural level (i.e. the nervous system etc.), but also has an important
role within the energy balance. More specifically, exercise can be crucial in maintaining a healthy weight (BMI), which is important since an unhealthy BMI is linked to higher pain intensity.
While the importance of exercise therapy in (chronic) pain management is well-established, many patients experience barriers to engage in physical activity and/or exercise therapy. These barriers are personal and individually variable, but often include fear of movement or re-injury and/or maladaptive thoughts or beliefs related to pain. Many of these barriers can partly be explained by a lack of knowledge on the underlying neurobiological pain mechanisms. Therefore, pain education is
an important first step within (chronic) pain management. With this this talk, participants will learn about the importance of pain education and exercise therapy within a biopsychosocial/lifestyle approach to target (chronic) pain.


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