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Physiotherapy 2012: Physios need to adopt a new pain paradigm

18 October 2012 - 9:49am

Physiotherapists should let go of outdated paradigms and stop dwelling on biomechanical tissue-based models.


Speaking at Physiotherapy UK, Dr Mick Thacker recommends a move away from purely mechanical therapies for back pain. Photo: Gabriel Szabo/Guzelian

This was the message from CSP fellow Dr Mick Thacker, director of the 'Pain: Science and Society' MSc course at King’s College London.
Giving a keynote lecture, Dr Thacker advised delegates to move away from purely mechanical-based therapies for back pain patients, and become more aware of the role of neuro-immnunology in relation to pain.
‘Traditional physiotherapy has based its management of back pain on anatomical, tissue-based principles and biomechanics,’ said Dr Thacker.
‘But if we have a disc problem, a facet joint problem or a nerve problem in our spinal patients then we’ve got to raise the suspicion that a significant component of their pain may be due to some neuro-immune interactions.’
During the presentation, delegates heard about the relationship between the immune and nervous systems and the role of cytokines, small soluble proteins that act as communication molecules between cells, tissues and organs.
Dr Thacker explained that as well as being involved in immune responses, cytokines are also produced by neurons in the peripheral and central nervous system, and are associated with the release of pro-inflammatory chemicals which can activate the nocicepter system and result in pain.
‘Pain that persists in people, particularly in back pain, may have a significant immune component,’ said Dr Thacker.
‘So when we see people with mechanical disorders we should always suspect that they have an inflammatory component to their spinal pain – which precedes the mechanical aspects of their condition.’

Brain changes

Delegates were also told that research has revealed that back injuries not only produce changes in the nerves and discs of the spine, but also in the brain.
Dr Thacker explained that the cortex becomes reorganised in people with low back pain, resulting in sensory distortions, motor function impairments and a loss of ability to activate muscles. Patients' brains begin to ‘waste’ because they lose representation in the thalamus - which may explain why people with back pain often report losing their clarity of thought.
Exercise therapies or psychological support can help people regain their neurological representation, but other therapies such as creative writing have also been shown to have an effect.
‘We need to see pain in its fullest context and question the effects of purely mechanical-based therapies on these conditions,’ said Dr Thacker.
‘We still have about a 40 per cent drop out rate in our profession in the first five years and the single biggest reason for that is that people feel inadequate – and that’s because we’re still providing inadequate explanations and inadequate paradigms. We need to update our knowledge to a 21st century paradigm that helps us better understand the pathologies we see; keep the person and their problem at the focus of what we are doing and incorporate mechanical therapies into a bigger schema.’
Dr Thacker was made a CSP fellow in 2011 in recognition of his outstanding contribution to the understanding and education of pain science.


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