Therapeutic Neuroscience Education by Adriaan Louw

Book Notes

Therapeutic Neuroscience Education by Adriaan Louw is a great read on pain science. This book highlights much of the research that has been done on the use of therapeutic neuroscience education for treating chronic pain patients and greatly enhanced my understanding of how the brain interprets pain. I would recommend this book for anybody who works with clients that are suffering from pain.

 

Highlighted Quotes

  • Pain mechanisms due to processing issues, commonly referred to as ‘central sensitization,’ occur due to neuroplastic changes in the dorsal horn of the spinal cord, inappropriate synapsing, neuronal death, sprouting, receptor field expansion, activation of the neuromatrix, changes in neurotransmitters and ion channels in the CNS and brain, and loss of gray matter. In central sensitization, pain is due more to abnormal processing of the nociception by the spinal cord, brainstem and cerebral hemispheres. – page 103

Notes

  1. A recent European study reported more than 1 in 3 people in Ireland (35%) live with persistent pain, suggesting a worldwide epidemic of pain (Raftery, Sarma, Murphy, De la Harpe, Normand, & McGuire, 2011).
  2. It is widely known that pain is more prevalent in patients with lower educational levels
  3. it has been shown that healthcare providers who experience a similar injury to non-medically trained persons will report significantly less pain and disability
  4. Catastrophizing due to pain is often associated with chronic pain
  5. A neuroscience education session for patients with chronic LBP by itself produces a more favorable immediate effect on decreasing pain ratings (out of 100) (39.3 ± 26.2 to 8.4 ± 7.5) than a program combining neuroscience education and an exercise program (28.1 ± 20.4 to 23.9 ± 23.3) (p < 0.025), but loses its superior efficacy at three-month follow-up
  6. Neuroscience education sessions for chronic LBP patients delivered as single one-on-one sessions or as group sessions decreased pain significantly (p < 0.05), yet individual one-on-one education sessions were associated with a more favorable outcome compared to the group educational sessions
  7. Following a neuroscience education session, patients with chronic whiplash associated disorders (WAD) had a significant reduction in pain (VAS) during a neck extension test without fixation (p = 0.04) and with fixation… PPT was significantly increased (decreased sensitivity of the nervous system) in patients with chronic WAD (
  8. Neuroscience education compared to back education causes an immediate increase in SLR ROM… Neuroscience education compared to back education causes an immediate increase in trunk forward flexion in patients with chronic LBP
  9. Even slow healing tissues, such as intervertebral discs, have been shown to heal over time
  10. With persistent nociception via C-fibers from the knee, permanent neuroplastic changes are likely to occur. It is now well established that after constant barrage from the C-fibers, the interneuron may die, due to high levels of amino acids (Woolf and Doubell, 1994; Fukuoka, Tokunaga et al., 1998; Doubell, Mannion et al., 1999; Woolf, 2007). With a persistent toxic environment, it is unlikely the interneuron will regenerate. The end result is a decreased ability to modulate nociception and ultimately a pain experience.
  11. The changes in representation of body parts within the SSH have been described extensively in chronic conditions, such as Complex Regional Pain Syndrome (CRPS) and chronic LBP
  12. It is now well established that patients with chronic pain have distorted views of body parts, and these distorted views may be strongly correlated to pain (Moseley, 2004; Moseley, Zalucki et al., 2008). Furthermore, the brain also struggles when identifying left and right body parts (left-right discrimination), and this has now been shown to be present in persistent pain states such as CRPS (Moseley, 2004; Moseley, Sim et al., 2005).
  13. Endogenous chemicals, which are needed to modulate the incoming nociception and ultimately the pain experience, are reduced in chronic pain states (Figure 3.10) (Basbaum and Fields, 1978; Larsson, Cai et al., 1995; ter Riet, de Craen et al., 1998). In chronic pain, from an evolutionary survival perspective, the brain needs more information from the tissues (nociception). By reducing the normal endogenous chemicals, the brain allows more information to ascend for further interpretation
  14. if during a painful experience an area of the brain is activated that is typically designated to perform another task, e.g., motor control in transversus abdominus contraction in the therapeutic application of spinal stabilization exercises, the pain processing is likely to influence the motor control. Several studies have shown that cognitions such as fear and catastrophizing can impact motor control significantly
  15. Kids that play contact sports early in life are likely to have a lower chance of developing chronic pain
  16. Demolition derby drivers experience an average of 1500+ motor vehicle collisions during their career yet less than 10% develop chronic neck pain. Compare this to the general population involved in motor vehicle accidents where 33% will develop chronic pain
  17. Patients attending therapy carry expectation and beliefs in them, which can modulate their pain experiences
  18. it is argued that TNE is likely more effective when administered in the context of physical therapy, including exercise and manual therapy (Louw, Diener et al., 2011; Louw, Puentedura et al., 2011; Nijs, Paul van Wilgen et al., 2011).
  19. Specific indications for TNE include patients with central sensitization or chronic pain
  20. When faced with a threat, stabilizing muscles, such as transversus abdominis and lumbar multifidus, experience delays in contraction
  21. Numerous studies have shown that pain changes motor control related to spinal stabilization
  22. pain affects the deep cervical spine flexors, which are designed to provide stabilization and protection in the cervical spine (
  23. low dose anti-depressants and membrane stabilizing medication may help patients in chronic pain
  24. Skillful delivery of manual therapy techniques has a significant potential to alter nociception and, ultimately, a pain experience (
  25. One hundred and twenty six patients who attended the Emergency Department or Urgent Care within 48 hours post-motor vehicle accident were randomized to receive usual care or usual care plus an 11-minute video addressing the important issues patients with whiplash need to know. The results showed that patients viewing the video had dramatically lower pain ratings at a one-month follow-up (6.09 [10.6] vs. 21.23 [17.4], P < 0.001) and remained lower for the three- and six-month follow-up period. Similarly, for 17 of 21 items asked at follow-up, the video group showed superior outcomes (Chi-square ranged from 5 to 35, P < 0.05, all). For example, 4% of patients in the video group were using narcotics at six-month post ED visit, compared with 36% of the control group. The brief psycho-educational video had a profound effect on subsequent pain and medical utilization.
  26. in cardiac rehabilitation in patients who have had a heart attack, only one in seven follow through with their exercise program and make long lasting changes (

 

 

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