Publication: Educación en neurofisiología del dolor. Aplicación en Fisioterapia
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2016
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Abstract
En el campo del tratamiento del dolor musculoesquelético (ME) crónico en fisioterapia, las limitaciones de un abordaje puramente biomédico hacen necesario aplicar un enfoque basado en los factores biopsicosociales del dolor (estado cognitivo y emocional del paciente, circunstancias culturales, familiares y de trabajo…), factores que pueden manifestarse en forma de barreras a la rehabilitación.
De este paradigma biopsicosocial surge, entre otros programas de educación en dolor, la educación en neurofisiología del dolor (END). La END consiste en una gama de intervenciones educativas, con el fin de cambiar cómo entendemos los procesos biológicos que dan pie al dolor. La END aumenta el conocimiento biológico acerca del dolor (con una especial atención a diferenciar entre nocicepción y dolor, y a entender el dolor como mecanismo de protección y no como indicador de daño tisular), y así disminuye la catastrofización. El fin último de la reconceptualización del dolor por parte del paciente consiste en que disminuya su percepción del dolor y mejore su función física.
Los objetivos de esta revisión narrativa son 1) explicar los objetivos y herramientas de la END, y aclarar posibles ideas equivocadas que tengan los fisioterapeutas acerca de esta terapia; y 2) revisar la evidencia científica existente en relación a la eficacia clínica de la END a la hora de mejorar los síntomas del paciente con dolor ME crónico.
In the field of chronic musculoskeletal pain in physical therapy, the limitations of a purely biomedical approach make necessary an approach based on the biopsychosocial factors of pain (patient’s cognitive and emotional status, cultural, family and work circumstances…) which can manifest as barriers to rehabilitation. Out of this biopsychosocial paradigm, from among other pain education programmes, comes out Pain Neurophysiology Education (PNE). PNE consists in a range of education interventions, with the end goal of changing the way we understand the biological processes at the origin of pain. PNE increases our biological knowledge of pain (with special attention to differentiating between nociception and pain, and understanding pain as a protection mechanism and not as an indication of tissue damage), therefore reducing pain catastrophizing. The ultimate end goal of pain reconceptualization by the patient consists in diminishing their perception of pain and improving their physical function. The objectives of this narrative review are 1) to explain the objectives and tools of PNE, and to clarify eventual misconceptions that physical therapists may have about this therapy; and 2) to look at the scientific evidence there is in relation to the clinical efficacy of PNE in improving the patient’s chronic musculoskeletal pain symptoms.
In the field of chronic musculoskeletal pain in physical therapy, the limitations of a purely biomedical approach make necessary an approach based on the biopsychosocial factors of pain (patient’s cognitive and emotional status, cultural, family and work circumstances…) which can manifest as barriers to rehabilitation. Out of this biopsychosocial paradigm, from among other pain education programmes, comes out Pain Neurophysiology Education (PNE). PNE consists in a range of education interventions, with the end goal of changing the way we understand the biological processes at the origin of pain. PNE increases our biological knowledge of pain (with special attention to differentiating between nociception and pain, and understanding pain as a protection mechanism and not as an indication of tissue damage), therefore reducing pain catastrophizing. The ultimate end goal of pain reconceptualization by the patient consists in diminishing their perception of pain and improving their physical function. The objectives of this narrative review are 1) to explain the objectives and tools of PNE, and to clarify eventual misconceptions that physical therapists may have about this therapy; and 2) to look at the scientific evidence there is in relation to the clinical efficacy of PNE in improving the patient’s chronic musculoskeletal pain symptoms.