Nociception affects motor output: a review on sensory-motor interaction with focus on clinical implications.
Chronic nociception alters autonomic and motor output, making proper central movement control impossible. In general clinicians working with a variety of patients with subacute and chronic musculoskeletal pain should consider nociception- motor interaction. This article reviews current concepts of nociception-motor interaction and their implications:
- In the presence of chronic nociception (as in non specific low back pain), the strategies used by the central nervous system to control trunk muscles (ie, motor control) may be altered.
- Nociception-motor interaction may modulate the transition from acute to chronic pain. In fact, acute nociception is characterized by a high motor variability, resulting in a protective adaptation with decreased muscle activity during functional tasks. In chronic pain states, the magnitude of motor variability decreases and the muscle activity increases.
- Disruption of the body image can be recognized clinically by a variety of movement anomalies; this becomes relevant in those with subacute (6 to 12 weeks) to chronic pain (> 12 weeks).
Despite these observations, rehabilitation strategies around the globe continue using motor control (re)training strategies for those with chronic nociception. Clinicians should consider stop trying to restore normal motor control in case of chronic nociception in patients with musculoskeletal disorders. Using strategies to decrease nociceptive input before motor control training might be an option. This could be accomplished by using TENS, centrally acting drugs or manual joint mobilization. > From: Nijs et al., Clin J Pain 28 (2012) 175-181. All rights reserved to Lippincott Williams & Wilkins.
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