Abstract
Persistent musculoskeletal pain interferes with one’s overall quality of life and is implicated as the global leader in disability and socio-economic burden. One of the most frequent complaints among people with musculoskeletal pain is pain during physical activity, commonly referred to as movement-evoked pain. Though physical activity is an important factor in the treatment of painconditions, different responses to physical activity can be observed in patients with persistent pain. To date, the underlying mechanisms of movement-evoked pain are not yet fully figured out, which complicates making appropriate treatment choices. In addition, sensory and psychological factors are suggested to play an essential role in how people with (persistent) musculoskeletal
pain experience and cope with movement-evoked pain. Gaining a better understanding of how these aspects influence movement-evoked pain will improve its management in both research and clinical practice.
First, this thesis focused on the underlying mechanisms and the (conservative) management of movement-evoked pain. The literature was reviewed for non-pharmacological, conservative treatment methods to tackle movement-evoked pain and evidence on the relation between movement-evoked pain and psychological factors. As a next step, two randomized trials were
conducted to investigate the effectiveness of transcutaneous electrical nerve stimulation on movement-evoked pain in people with chronic low back pain. The two final chapters examined the involvement of psychological factors and measures of central sensitization in movement-evoked
pain in patients with musculoskeletal pain and chronic low back pain, respectively.
• Chapter one: It hurts to move! A systematic review and meta-analysis of interventional effects and assessment methods for movement-evoked pain in patients with musculoskeletal pain.
• Chapter two: Transcutaneous electrical nerve stimulation and heat to reduce pain in a chronic low back pain population: a randomized controlled trial.
• Chapter three: Transcutaneous electrical nerve stimulation reduces movement-evoked pain in people with chronic low back pain: a randomized crossover study.
• Chapter four: Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis
• Chapter five: Do measures of central sensitization relate to movement-evoked pain in people with chronic low back pain? A longitudinal and prospective study.
Based on the results of the systematic review and meta-analysis, exercise therapy was found to be effective in reducing movement-evoked pain in patients with musculoskeletal pain and should therefore be considered the first-choice treatment modality. Further, this review revealed that, to date, movement-evoked pain had been assessed and referred to in multiple and various
ways. It can be concluded that movement-evoked pain scores are related to pain-related fear, pain catastrophizing, and depressive symptoms in patients with musculoskeletal pain, as well as to certain measures of central sensitization in patients suffering from chronic low back pain. These findings suggest an important role of the central nervous system in contributing to sensitized responses to physical activity.
Although the results of this thesis offer new insights, they also raise some questions and opportunities for further research. A clear definition and measurement protocol for movementevoked pain should be designed, validated, and further applied in interventional studies. These interventional studies should consider the relationship between movement-evoked pain
and psychological factors, as well as measures of central sensitization, and examine how influencing these factors affects movement-evoked pain.
| Date of Award | 23 Jun 2021 |
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| Original language | English |
| Awarding Institution |
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