Cortical change in chronic low back pain
Chronic low back pain is characterised by a range of structural, functional and neurochemical changes within the brain. Significant changes in the neurochemical profile (some markers increase, others decrease) and areas of reduced grey matter volume (or less neuron-matter) have been observed in individuals with chronic low back pain compared to healthy controls. In addition, functional changes in individuals with chronic low back pain are reflected in a cortical reorganisation, altered cortical activity and altered cortical responsiveness. These central changes are seen as a promising target for treatment as most existing approaches to the management of chronic low back pain have only limited success.
The clinical implications of this altered brain state in individuals with chronic low back pain are not completely known yet. However, the authors make three interesting observations for clinical practice. Firstly, a number of manual therapies focus on an analgesic effect via descending pathways that inhibit pain, while these pathways are disrupted in this population. Secondly, psychological and cognitive deficits are involved in the problem of chronic low back pain. Thirdly, the changed cortical representation will disrupt the body perception of the individuals, another possible target for treatment.
In other chronic painful disorders treatments that aim to normalise some of these brain changes have been tested and proven effective. For chronic low back pain, this process is in its infancy and more research is needed to investigate the effectiveness of this type of management.
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> From: Wand et al., Man Ther 16 (2011) 15-20 (Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.