Nijs Jo, Paul van Wilgen C, Van Oosterwijck Jessica, van Ittersum Miriam, Meeus Mira
Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
Man Ther. 2011 Oct;16(5):413-8. doi: 10.1016/j.math.2011.04.005. Epub 2011 May 31.
Central sensitization provides an evidence-based explanation for many cases of 'unexplained' chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session 1). Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.
中枢敏化现象为许多“不明原因”的慢性肌肉骨骼疼痛病例提供了基于证据的解释。在此类病例开始康复治疗之前，改变适应不良的疾病认知、改变适应不良的疼痛认知以及重新认识疼痛至关重要。这可以通过向患者进行关于中枢敏化及其在慢性疼痛中作用的教育来实现，这一策略被称为疼痛生理学教育。当出现以下情况时，建议进行疼痛生理学教育：1）临床表现以中枢敏化现象为特征且占主导地位；2）存在适应不良的疾病认知。这两点都是开始疼痛生理学教育的先决条件。面对面的疼痛生理学教育课程，结合书面教育材料，对于改变各种慢性肌肉骨骼疼痛疾病患者的疼痛认知和改善健康状况是有效的。这些疾病包括慢性腰痛、慢性挥鞭样损伤、纤维肌痛和慢性疲劳综合征。在进行生物心理社会评估后，疼痛生理学教育包括第一次面对面课程，解释基本的疼痛生理学，并对比急性伤害性感受与慢性疼痛（第1节）。关于疼痛生理学的书面信息应在第1节和第2节之间作为家庭作业提供。第二次课程可用于纠正误解，并促进在日常生活中从知识向适应性疼痛应对的转变。疼痛生理学教育是一个持续的过程，始于教育课程期间，并在积极治疗和长期康复计划中持续进行。
