start at: 21st february 2025
about
About the course
Chronic pain is defined as pain that lasts for more than three months2 or that lasts longer than the expected healing period3. Chronic pain causes neuroplastic changes in the nervous system (peripheral or central), which are important not only for classifying the pain mechanism (nociceptive, neuropathic, nociplastic), but also for a better treatment plan, including osteopathic treatment (4-8).
These mechanisms can be assessed by quantitative sensory testing (QST)9 , namely pressure pain threshold (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM). PPT, assessed in a painful and non-painful area, can quantifiably differentiate localized muscle hyperalgesia (peripheral sensitization) from generalized hyperalgesia (central sensitization) (8,10). TSP assesses the wind-up process that reflects dorsal horn excitability 7,11 and CPM tests the inhibitory mechanism of pain (7,12).
Furthermore, nociplastic pain does not exclude the importance of nociceptive pain in determining whether there is a peripheral, central or both pain mechanisms, and in determining whether the treatment method will be top-down, bottom-up or a combination of both (13). In addition, other changes in sensory perception should be assessed and included in therapeutic programs. One such change is altered selfperception of the back and tactile acuity in chronic low back pain (14-17).
Recognition of nociplastic pain remains challenging in clinical practice. In chronic pain, assessment of pain mechanisms is an important step in the decision-making process for individual care, rather than a diagnosis5,8. Currently, QST can assess and identify pain mechanisms using reference values, cut-off points and bedside clinical instruments that are easily transferable to clinical practice. This course is organized into an online theoretical component and two “face-to-face” days with an exhaustive practical component where participants will develop skills in administering QST in clinical practice in various chronic musculoskeletal diseases.
Course objectives
To increase knowledge of the neurophysiology of pain and to utilize contemporary principles in the assessment and management of patients with chronic pain. To recognize the utility and promise of QST in clinical practice to assess and differentiate pain mechanism.
Discussion of clinical cases to include clinical decision making in the treatment management plan based on QST results.
Learning objectives
By the end of this course, participants will:
• Apply the research that supports quantitative sensory testing in assessment and treatment.
• Learn how to perform quantitative sensory testing in clinical settings for variouschronic musculoskeletal diseases.
• Recognize nociplinary presentations of pain and likely plastic areas within the central nervous system for more effective treatment planning.
• Recognize and understand the risk variables that contribute to pain sensitivity and incorporate them into patient treatment.
Recearch Supporting the Course
Pesquisa que apoia o curso
- Nunes A, Arendt-Nielsen L, Espanha M, Teles J, Moita J, Petersen KK. Bedside clinical tests to assess sensitization in office workers with chronic neck pain. Somatosensory Motor. Research. 2021, ;38(4):357–65. http://www.ncbi.nlm.nih.gov/
pubmed/34635001
- Smith, B., Fors, E., Korwisi, B., Barke, A., Cameron, P., Colvin, L., Richardson, C., Rief, W., & Treede, R-D. (2019). The IASP classification of chronic pain for ICD-11: applicability in primary care. Pain, 160, 83-87. http://dx.doi.org/10.1097/
j.pain.0000000000001360
- Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. V, & Santilli, V. (2019). Chronic low back pain and postural rehabilitation exercise: a literature review.Journal of Pain Research, 12, 95–107. https://doi.org/10.2147/JPR.S171729
- Boudreau, S., Farina, D., & Falla, D. (2010). The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Manual Therapy,15, 410-414. http://doi.org/10.1016/j.math.2010.05.008
- Chimenti, R. L., Frey-Law, L. A., & Sluka, K. A. (2018). A mechanism-based approach to physical therapist management to pain. Physical Therapy, 95, 302-314. http://doi.org/10.1093/ptj/pzy030
- Pavlakovic, G., & Petzke, F. (2010). The role of quantitative sensory testing in the evaluation of musculoskeletal pain conditions. Current Rheumatology Reports, 12, 455-461. http://doi.org/10.1007/s11926-010-0131-0
- Pelletier, R., Higgins, J., & Bourbonnais, D. (2015). Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskeletal Disorders, 16:25. http://doi.org/10.1186/
s12891-015-0480-y
- Arendt-Nielsen, L., Morlion, B., Perrot, S., Dahan, A., Dickenson, A., Kress, H. G., Wells, C., Bouhassira, D., & Drewes, A. M. (2018). Assessment and manifestation of central sensitisation across different chronic pain conditions. European Journal of
Pain, 22, 216–241. http://doi.org/10.1002/ejp.1140
- Kosek, E., Cohen, M., Baron, R., Gebhart, G F., Mico, J-A., Rice, A. S. C., Rief, W., & Sluka, A. K. (2016). Do we need a third mechanistic descriptor for chronic pain states. Pain,157, 1382-1386. http://doi.org/10.1097/j.pain.0000000000000507
- Arendt-Nielsen, L., Fernández-de-las-Peñas, C., & Graven-Nielsen, T. (2011). Basic aspects of musculoskeletal pain: from acute to chronic pain. The Journal of Manual & Manipulative Therapy, 19(4), 186–193. http://doi.org/
10.1179/106698111X13129729551903
- Latremoliere, A., & Woolf, C. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10, 895-926. http://doi.org/10.1016/j.jpain.2009.06.012
- Heinricher, M., Tavares, I., Leith, J., & Lumb, B. (2009). Descending control of nociception: specificity, recruitment and plasticity. Brain Research Reviews, 60, 214-225. http://doi.org/10.1016/j.brainresrev.2008.12.009
- Fryer, G., (2017). Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical Approach. International Journal of Osteopathic Medicine, 26, 3643.
- Moseley, G. L., (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140(1), 167–171
- Luomajoki, H., & Moseley, G. L. (2011). Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. British Journal of Sports Medicine, 45(5), 37–440. https://doi.org/10.1136/bjsm.2009.060731
- Senkowski, D., Heinz, A., (2016) Chronic pain and distorted body image: Implications for multisensory feedback interventions. Neuroscience and Biobehavioral Reviews, 69:232- 239
- Catley, M. J., O’Connell, N. E., Berryman, C., Ayhan, F. F., & Moseley, G. L. (2014). Is tactile acuity altered in people with chronic pain? a systematic review and metaanalysis. The Journal of Pain, 15(10), 985–1000. https://doi.org/10.1016/
j.jpain.2014.06.009
Conditions/Dates
Dates
- 21nd and 22nd February. 2025
Duration:
2 Days
Location>
• Online Training
Price
• 239 €