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首页> 外文期刊>Physiotherapy theory and practice >Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature
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Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature

机译：人工疗法与疼痛神经科学教育相结合治疗慢性下腰痛：文献综述

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摘要

Teaching people with chronic low back pain (CLBP) about the neurobiology and neurophysiology of their pain is referred to as pain neuroscience education (PNE). There is growing evidence that when PNE is provided to patients with chronic musculoskeletal pain, it can result in decreased pain, pain catastrophization, disability, and improved physical performance. Because the aim of PNE is to shift the patient's focus from the tissues in the low back as the source of their pain to the brain's interpretation of inputs, many clinicians could mistakenly believe that PNE should be a hands-off, education-only approach. An argument can be made that by providing manual therapy or exercise to address local tissue pathology, the patient's focus could be brought back to the low back tissues as the source of their problem. In this narrative literature review, we present the case for a balanced approach that combines PNE with manual therapy and exercise by considering how manual therapy can also be incorporated for interventions with patients with CLBP. We propose that as well as producing local mechanical effects, providing manual therapy within a PNE context can be seen as meeting or perhaps enhancing patient expectations, and also refreshing or sharpening body schema maps within the brain. Ideally, all of this should lead to better outcomes in patients with CLBP.
机译：向患有慢性下腰痛（CLBP）的人讲授有关其疼痛的神经生物学和神经生理学的知识称为疼痛神经科学教育（PNE）。越来越多的证据表明，向患有慢性肌肉骨骼疼痛的患者提供PNE可以减轻疼痛，减轻疼痛的灾难性，致残和改善身体机能。由于PNE的目的是将患者的注意力从作为疼痛源的后腰组织转移到大脑对输入的解释上，因此许多临床医生可能会错误地认为PNE应该是一种无需干预，仅受教育的方法。可以说，通过提供手动疗法或锻炼来解决局部组织病理问题，可以将患者的注意力转移到腰部组织作为其问题的根源。在本篇叙事性文献综述中，我们通过考虑如何将手法也可以纳入CLBP患者的干预中，提出一种平衡方法，将PNE与手法治疗和运动相结合。我们建议，除了产生局部机械作用外，在PNE环境中提供手动治疗也可以被视为满足或可能增强了患者的期望，并且可以刷新或锐化大脑内的人体图谱。理想情况下，所有这些都应该使CLBP患者获得更好的预后。

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