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Pain Unstuck Presentation Notes
Pain Unstuck Presentation Notes
Power of words
VAEGTER, HENRIK BJARKE1,2; THINGGAARD, PETER3; MADSEN, CASPER HØJ3; HASENBRING, MONIKA4; THORLUND, JONAS BLOCH3,5. Power of Words: Influence of Preexercise Information on Hypoalgesia after Exercise—
Randomized Controlled Trial. Medicine & Science in Sports & Exercise: November 2020 - Volume 52 - Issue 11 - p 2373-2379 doi: 10.1249/MSS.0000000000002396
Outcome: LBP, leg pain, fear avoidance, pain catastrophizing scale, active Lx flex, SLR
Patients with LBP that have a directional preference for extension // reduced +/- proximized Sxs
Intervention: Patients put in prone, pre-push up position. Asked to visualize extension movement 10 times (5
mins guided visualization)
Result: stat sig improvement in all outcomes, but only SLR reached MCID
Biopsychosocial elements
o Can potentially fit within PP
o Placebo: induce an expectation of safety = estimation of lower overall threat to the body > decreased
pain intensity // vice versa for nocebo
o Social factors: having social support may give support behind hypothesis that body is safe, thereby
reducing the precision of the threat indicating the uncertainty about the continued integrity of the
body
o Continued social adversity: NEI learns to predict being in a stressful and threatening situation more
often than not
Pain education
Therefore, given PP, it makes sense that it’s hard to change chronic pain with just verbal reassurance, education
o Stuck priors + no precise prediction error has occurred to sway the system
Best way = to find a way where they can do the provocative movement with a pain level that is less than
expected
o And to make it as precise as possible, with plenty of non-noxious sensory info
Mirror
Tactile cues
o Objective tests can be a good opportunity to show them that their priors are incorrect