Reconnecting the Brain With the Rest of the Body in Musculoskeletal Pain Research

Abstract

A challenge in understanding chronic musculoskeletal pain is that research is often siloed between neuroscience, physical therapy/rehabilitation, orthopedics, and rheumatology which focus respectively on 1) neurally mediated effects on pain processes, 2) behavior and muscle activity, 3) tissue structure, and 4) inflammatory processes. Although these disciplines individually study important aspects of pain, there is a need for more cross-disciplinary research that can bridge between them. Identifying the gaps in knowledge is important to understand the whole body, especially at the interfaces between the silos-between brain function and behavior, between behavior and tissue structure, between musculoskeletal and immune systems, and between peripheral tissues and the nervous system. Research on "mind and body" practices can bridge across these silos and encourage a "whole person" approach to better understand musculoskeletal pain by bringing together the brain and the rest of the body. Perspective: Research on chronic musculoskeletal pain is limited by significant knowledge gaps. To be fully integrated, musculoskeletal pain research will need to bridge across tissues, anatomical areas, and body systems. Research on mind and body approaches encourages a "whole person" approach to better understand musculoskeletal pain.

Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults

“… 28 , 40 A prime example for this interplay is pain: people move differently in (the expectation of) pain, and conversely, dysfunctional or degraded movement can enhance pain. 11 , 23 , 32 This particularly applies to body parts thought to require superior protection such as the back. 12 , 13 , 22 Common beliefs are that the back is easily injured and that the healing process is long.…”

“… 12 Such beliefs can increase protective behaviors, including control of posture and avoidance of daily activities, potentially aggravating disability and pain in the long term. 13 , 32 , 64 , 68 …”

“… 10 , 18 , 21 In the long term, this can provoke pronociceptive mechanisms, potentially initiated by deterioration of (para)spinal tissues and decreased movement (variability). 5 , 21 , 32 , 34 , 64 Yet, many healthcare professionals still promote lifting with a neutral spine as the safer lifting technique, 44 , 55 , 67 potentially reinforcing erroneous fear-avoidance beliefs (ie, flexed back danger beliefs) underlying pain-related fear. In support of this notion, recent evidence indicates an implicit bias towards “lifting with a flexed spine is dangerous,” compared to lifting with a neutral spine, in patients with persistent LBP as well as in pain-free individuals.…”

Fascia Mobility, Proprioception, and Myofascial Pain

“…For example, in low-back pain, many asymptomatic patients have abnormal-looking discs, and a large number of patients with severe, disabling back pain have no demonstrable structural abnormalities in the spine [ 43 , 44 ]. Meanwhile, imaging and other objective measurements of soft tissues (including muscles, and especially connective tissue) lag far behind, but are gaining recognition as possible musculoskeletal pain biomarker candidates [ 45 , 46 ].…”

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

“…Living with chronic musculoskeletal pain is a great burden to an individual experiencing pain, along with large-scale implications for society including enormous medical annual costs worldwide, the occurrence of sick leave, and work disability ( 3 ). Despite these high individual and societal costs, efforts to effectively treat chronic pain have been met with moderate success and in many patients, chronic pain remains untreated or poorly treated ( 4 ). The prevention of the transition from acute to chronic pain is therefore an important goal.…”