Pain is complex. It is no longer acceptable to consider pain solely as a peripheral phenomenon involving activation of nociceptive neurons. The contemporary understanding of pain involves consideration of different underlying pain mechanisms and an increasing awareness of plasticity in all of the biological systems. Of note, recent advances in technology and understanding have highlighted the critical importance of neuroimmune interactions, both in the peripheral and central nervous systems, and the interaction between the nervous system and body tissues in the development and maintenance of pain, including low back pain (LBP). Further, the biology of many tissues changes when challenged by pain and injury, as reported in a growing body of literature on the biology of muscle, fat, and connective tissue. These advances in understanding of the complexity of LBP have implications for our understanding of pain and its interaction with the motor system, and may change how we consider motor control in the rehabilitation of LBP. This commentary provides a state-of-the-art overview of plasticity of biology in LBP. The paper is divided into 4 parts that address (1) biology of pain mechanisms, (2) neuroimmune interaction in the central nervous system, (3) neuroimmune interaction in the periphery, and (4) brain and peripheral tissue interaction. Each section considers the implications for clinical management of LBP.
|Original language||English (US)|
|Number of pages||13|
|Journal||Journal of Orthopaedic and Sports Physical Therapy|
|State||Published - Jun 2019|
Bibliographical noteFunding Information:
body of research was based, “State-of-the-Art in Motor Control and Low Back Pain: International Clinical and Research Expert Forum,” was supported by the National Health and Medical Research Council of Australia, in collaboration with the North American Spine Society. The forum was chaired by Dr Paul Hodges.
1Clinical Centre for Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. 2Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. 3Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA. 4Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. 5Department of Pharmacology and Therapeutics and Department of Anesthesiology, McGill University, Montreal, Canada. 6Alan Edwards Centre for Research on Pain, Faculty of Dentistry and Faculty of Medicine, McGill University, Montreal, Canada. Dr Hodges receives book royalties from Elsevier. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain, motor control, and exercise therapy at scientific conferences/symposia. He has received fees for teaching practical courses on motor control training. He is also supported by a Senior Principal Research Fellowship from the National Health and Medical Research Council of Australia (APP1102905). Drs Barbe, Loggia, Nijs, and Stone have been reimbursed by professional and scientific bodies for travel costs related to presentation of research on pain at scientific conferences/symposia. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Paul W. Hodges, School of Health and Rehabilitation Sciences, The University of Queensland, Level 3, Therapies Annex (84A), St Lucia, QLD 4072 Australia. E-mail: email@example.com U Copyright ©2019 Journal of Orthopaedic & Sports Physical Therapy®
- Low back pain
- Lumbar spine
- Motor control
- Neuroimmune system