Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice

Wand, Benedict Martin; Parkitny, Luke; O’Connell, Neil Edward; Luomajoki, Hannu; McAuley, James Henry; Thacker, Michael; Moseley, G. Lorimer

doi:10.1016/j.math.2010.06.008

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Volume 16, Issue 1 , Pages 15-20, February 2011

Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice

Benedict Martin Wand
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
Luke Parkitny
- Neuroscience Research Australia & The University of New South Wales, Barker Street, Randwick, Sydney, NSW 2031, Australia
Neil Edward O’Connell
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Uxbridge, UK
Hannu Luomajoki
- Zürich University of Applied Sciences, Institute of Physiotherapy, Department of Health, Winterthur, Switzerland
James Henry McAuley
- Neuroscience Research Australia & The University of New South Wales, Barker Street, Randwick, Sydney, NSW 2031, Australia
Michael Thacker
- CHAPS & Centre for Neuroimaging Sciences, IoP King’s College London, London, UK
G. Lorimer Moseley
- Neuroscience Research Australia & The University of New South Wales, Barker Street, Randwick, Sydney, NSW 2031, Australia
- Corresponding author. Tel.: +61 2 93991266; fax: +61 2 93991081.

Received 6 May 2010; accepted 22 June 2010. published online 26 July 2010.

Abstract

There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.

Keywords: Low back pain, Cortical reorganisation, Physical therapy