Title : Rehabilitation of patients with chronic musculoskeletal pain
Abstract:
Chronic pain is defined as persistent pain lasting more than three months, resulting in alterations in the brain's functional synaptic network and its gray matter dimensions.
It causes hypersensitivity to nociceptive stimuli and increased excitability of the nodal stress mechanism, causing the individual to remain in a state of alert (hyperactivation of the nervous system) during normal daily activities, increasing their levels 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 great relevance of studies addressing the importance of physical exercise in these individuals, the understanding of 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 appropriate; however, we observe a lack of information on recurrent neurofunctional and biomechanical alterations in this population, which we can classify as a pathological pattern that should not be neglected.
In previous studies, we observed that chronic pain directly impacts cardiac rehabilitation and adherence to physical exercise, significantly increasing disability and mortality in this population.
We also observed that individuals with chronic pain exhibit patterns of altered motor control and kinesiophobia.
Since any type of chronic musculoskeletal pain can lead to functional disability, musculoskeletal pain in the lower and upper limbs directly impacts gait, work activities, and physical activities, including exercise and activities of daily living.
Previous studies have shown that the pathophysiology of chronic pain is responsible for alterations in neuromuscular reflexes, causing changes in motor control due to factors such as muscle inhibition, muscle strength deficits, altered body perception, and alterations in the sensorimotor system.
Multimodal physiotherapy is a clinical approach where the physiotherapist uses more than one technique or therapeutic resource in the same session. This approach will address the treatment and prevention of chronic musculoskeletal pain, considering neurofunctional improvement as well as the locomotor system, focusing on the assessment and functional improvement of these individuals.
It utilizes evidence-based practice, drawing from studies we have previously published highlighting the importance of manual therapy and the optimization of motor control through therapeutic exercise in pain management.
Keywords: Chronic Pain, Physiotherapy, Manual Therapy, Motor Control, Therapeutic Exercise.
