Title : Dysfunctional changes presented by individuals with chronic pain, which impact evidence-based practice for treating pain: Systematic review
Abstract:
Chronic pain is defined as persistent pain for more than three months, resulting in changes in the functional synaptic network of the brain and its gray matter dimensions, causing hypersensitivity to a nociceptive stimulus and increased excitability of the nodal stress mechanism, causing the individual to remain in a state of alert (hyperactivation of the sympathetic nervous system) in normal daily activities, increasing their level of stress, anxiety, and fear. It can be classified as primary with no known etiology or secondary pertinent to a specific pathological process and clinical diagnosis.
Despite the high relevance of studies that address the importance of exercising in these individuals, their understanding of the correct assessment and prescription during clinical practice still does not seem very clear. Scientific evidence is focused on establishing which exercise modality would be most suitable; however, we observed a lack of information on recurrent neurofunctional and biomechanical changes in this population, which we can classify as a pathological pattern that should not be neglected. In previous studies, we observed that it directly impacts cardiac rehabilitation and adherence to physical exercise, significantly increasing disability and mortality in the population.
We also observed that individuals with chronic pain present patterns of changes in motor control and kinesiophobia, with chronic low back pain and knee osteoarthritis being the most frequent causes of disability, directly impacting cardiac rehabilitation due to the difficulty in obtaining adequate adherence to physical exercise. Both pathologies mentioned are very relevant in literature and clinical practice. However, any type of chronic musculoskeletal pain can lead the individual to functional disability since musculoskeletal pain in the lower and upper limbs directly impacts gait, work activities, and physical activities in the practice of exercises and activities of daily living. In previous studies, it was possible to observe the pathophysiology of chronic pain being responsible for altering the neuromuscular reflex, causing changes in motor control due to several factors such as muscular inhibition, muscular rigidity, body perception deficit, and sensorimotor system changes.
