SP0150 Functional rehabilitation for the relief of complex persistent pain

Abstract

Persistent pain, by definition, is a long-term condition that cannot be resolved by available medical or other treatments. Historically, the focus for pain and rehabilitation specialities has been on management, to improve quality of life and function in the presence of pain. However, most patients seek pain relief. Research by the Bath Pain group, and other published literature indicates that people make hypotheses about bodily feelings based on prior performance and the current environment. This is an active process. Pain related adaptations to the sensory and motor systems ensure we act to minimise potential threats. These adaptations impact on bodily feelings and modify autonomic and limbic systems. The degree of adaptation can be minor and brief, or significant and persistent. Where adaptive mechanisms continue to engage beyond what is deemed as useful, this can be considered hyper-adaptive. I will present clinical evidence of pain related hyper-adaptations that people with persistent pain describe in clinic. For example, perceived changes in the painful limb, ownership, temperature, and size, as well as feelings of peculiarity, discomfort, pain, and altered movement trajectory when motor output does not match expected sensory feedback. People with Rheumatoid Arthritis, Fibromyalgia, Complex Regional Pain Syndrome, or after limb fracture all describe altered body perceptions. Individuals may, for example, perceive a painful hand (and an object held within it), as excessively heavy and enlarged (when in reality it is not), report clumsiness, and difficulty moving the hand due to a perceived inability to 'engage' with it. We have described visual neglect and emotional changes about the painful limb, and consequent impacts on motor and autonomic function. The sensory system encodes the characteristics and location of stimuli and determines if these are harmful or innocuous. This process is impaired in a painful body part. The ability to determine the texture or temperature of materials applied to the painful skin is commonly lost; or non-painful stimuli, such as light touch, are perceived as painful (allodynia). This session will describe work that has focused on aiming to increase our understanding of the pain-related adaptations in sensorimotor processing and associated behaviours, in order to design interventions that help to redefine this hyperadaptive response, essentially broadening sensorimotor function, and relieving persistent pain.