URL study guide

https://studiegids.vu.nl/en/courses/2024-2025/B_PBM

Course Objective

General course objectives In this course, the students will learn about the pathophysiology of pain and underlying mechanisms which can explain pain reduction due to musculoskeletal physiotherapy treatment. The students will also be able to measure and interpret different aspects of pain and pain processing. Intended learning outcomes (relation to end qualifications between brackets)The student is able to explain the pathophysiology of pain, (mal)adaptive pain processing, and underlying mechanisms of treatment (neurophysiological, neuro
- immune, psychological mechanism) and the relations between the different systems. (1,3)The student is able to argue which underlying mechanisms of treatment (the neuro-immune system, neurophysiological and psychological system) explain pain reduction after physiotherapy interventions. (1,3)The student is able to present in a poster pitch the underlying mechanisms of treatment that can explain pain reduction in research. (2,4,6)The student is able to apply common measurement tools for research related to pain, specifically: pressure pain thresholds, quantitative sensory testing measurements, questionnaires, and blood tests. (2,3,4)

Course Content

Pain is a worldwide public health problem. Chronic pain affects approximately 20% of the adult population and leads to high (in)direct costs. One could consider pain to be the most prevalent symptom of patients with musculoskeletal conditions who seek physiotherapy care. In the last years, the understanding of biological, psychological, and social factors involved in pain has increased enormously. Also, insight into the role of the neuro-immune system and brain activity/mechanisms in relation to pain and cognitive functioning has improved immensely. In patients with persistent pain, nociceptive input is not enough to explain the experienced pain severity. The altered processing in the central nervous system, with enhanced excitability, reduced inhibition and glial hyperactivity, play an important role. Activated macrophages and glial cells produce inflammatory mediators that can activate nociceptive neurons and might be an important contributor to pain persistence. Factors such as poor sleep and stress can also increase pro-inflammatory immune stages and enhance pain (and depression), or vice versa. Understanding the underlying mechanisms of pain and its relation with psychological factors improves the understanding of pain symptoms and comorbidities such as attention disorders or depression. Moreover, these mechanisms can also be considered a rationale for treatment selection as (functional and structural) brain changes or inflammatory stages do not seem to be perpetual. Modulation of underlying mechanisms of pain by different kinds of (physiotherapy) interventions can help clinicians to select appropriate treatment and explain (physiotherapy) treatment effects. In this course, you will learn more about the different aspects of pain, its relation with psychosocial factors, pain processing, underlying working mechanisms of pain, mechanism-based pain management, and pain assessment. The knowledge and skills learned in this course can be used to improve the assessment and management of pain in clinical practice and research. Moreover, graduates will better understand how various (physiotherapy) interventions may lead to pain reduction.

Teaching Methods

8 Lectures (2 hours each), 4 Practicals (2 hours each), 4 Working groups (2 hours each), an instructional video assignment and theoretical exam. Lectures: The lectures present the pathophysiology of pain, pain processing, the relationship of pain with the neuro-immune system, and psychosocial factors and potential action mechanisms of physiotherapy treatment are discussed. Hand-outs of the lecture slides are posted on Canvas. Students are strongly encouraged to prepare the study material pertaining to the lecture beforehand (see course schedule) as this facilitates the understanding of the lecture. Also, the lectures provide essential material to prepare the working group assignments. Understanding the lecture material is also essential in order to be able to successfully complete the practical sessions. Practicals: There are three practical sessions about pain assessment (Static and Dynamic Quantified Sensory Testing) and one practical session about immune responses in this course. In each practical, the student will perform and interpret different (pain) measurements or responses. No reports need to be handed in, but the knowledge and skills trained in these practicals will be tested in the theoretical exam and the instructional video. Although the practicals are not compulsory, attendance is highly recommended as the practicals are important for the preparation of the ‘instructional video’ examination. The lecturers are available for questions during the practicals. Working groups: In the working groups, students demonstrate their capability to critically reflect upon existing pain research, pain assessment, and the role of psychosocial factors in relation to pain specifically. Also, the posters and instructional videos will be presented and critically discussed within the group. The poster presentation assignment will be performed in small groups. The assignments are posted on Canvas. Please check Canvas for more detailed information about the poster and instruction video, and rubrics.

Method of Assessment

Theoretical exam (40%) Poster presentation (35%) Instructional video (25%) The video examination is scheduled in week 5, the poster presentation in week 7 and the theoretical examination at the end of the teaching period. All examinations require (≥5.5/10). Parts of the exam that are passed can be transferred to the next academic year for the period of one year.

Literature

Mandatory scientific peer-review papers as recommended in the course preparations: Al-Khazali HM, Krøll LS, Ashina H, Melo-Carrillo A, Burstein R, Amin FM, Ashina S. Neck pain and headache: Pathophysiology, treatments and future directions. Musculoskelet Sci Pract. 2023 Aug;66:102804. doi: 10.1016/j.msksp.2023.102804. Epub 2023 Jun 16. PMID: 37394323.Ashina S, Mitsikostas DD, Lee MJ, Yamani N, Wang SJ, Messina R, Ashina H, Buse DC, Pozo-Rosich P, Jensen RH, Diener HC, Lipton RB. Tension-type headache. Nat Rev Dis Primers. 2021 Mar 25;7(1):24.Bülow K, Lindberg K, Vaegter HB, Juhl CB. Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Pain Med. 2021 Apr 20;22(4):891-904.Bijker L, Sleijser-Koehorst MLS, Coppieters MW, Cuijpers P, Scholten-Peeters GGM. Preferred Self-Administered Questionnaires to Assess Depression, Anxiety and Somatization in People With Musculoskeletal Pain
- A Modified Delphi Study. J Pain. 2019 Sep 2. pii: S1526-5900(19)30048-3.Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10(March):1–7.Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther. 2018 May 1;98(5):302-314.Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097.van Dijk H, Köke AJA, Elbers S, Mollema J, Smeets RJEM, Wittink H. Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators-A Scoping Review. Int J Environ Res Public Health. 2023 Jan 16;20(2):1634. doi: 10.3390/ijerph20021634. PMID: 36674387; PMCID: PMC9861865.Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature reviews Immunology. 2011;11(9):607-15.Hermans L, Calders P, Van Oosterwijck J, Verschelde E, Bertel E, Meeus M. An overview of offset analgesia and the comparison with conditioned pain modulation: a systematic literature review. Pain Physician. 2016 Jul;19(6):307-26.Hoegh M, Bannister K. Pain Science in Practice (Part 7): How Is Descending Modulation of Pain Measured? J Orthop Sports Phys Ther. 2024 Mar;54(3):1-6. doi: 10.2519/jospt.2024.12113. PMID: 38305757.Hooten WM. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc. 2016 Jul;91(7):955-70. doi: 10.1016/j.mayocp.2016.04.029. Epub 2016 Jun 22. PMID: 27344405.Klyne D, Barbe M, Van Den Hoorn W, Hodges P. Longitudinal analysis of inflammatory, psychological, and sleep-related factors following an acute low back pain episode: A potential factor in tissue effects in low back pain. Journal of Bodywork and Movement Therapies. 2018;22 (4):866.Koop MA, Lutke Schipholt IJ, Scholten-Peeters GGM, Coppieters MW. Identifying the Most Important Confounders When Assessing the Association Between Low-Grade Systemic Inflammation and Musculoskeletal Pain: A Modified Delphi Study. Pain Med. 2021 Nov 26;22(11):2661-2669.Lesnak JB, Sluka KA. Mechanism of exercise-induced analgesia: what we can learn from physically active animals. Pain Rep. 2020 Sep 23;5(5):e850. doi: 10.1097/PR9.0000000000000850. PMID: 33490844; PMCID: PMC7808683.Lutke Schipholt IJ, Coppieters MW, Meijer OG, Tompra N, de Vries RBM, Scholten-Peeters GGM. Effects of joint and nerve mobilisation on neuroimmune responses in animals and humans with neuromusculoskeletal conditions: a systematic review and meta-analysis. Pain Rep. 2021 Jun 3;6(2):e927. doi: 10.1097/PR9.0000000000000927. PMID: 34104836; PMCID: PMC8177878.Lutke Schipholt IJ, Scholten-Peeters GGM, Koop MA, Bonnet P, Bontkes HJ, Coppieters MW. Systemic neuroimmune responses in people with non-specific neck pain and cervical radiculopathy, and associations with clinical, psychological, and lifestyle factors. Front Mol Neurosci. 2022 Oct 13;15:1003821. doi: 10.3389/fnmol.2022.1003821. PMID: 36311017; PMCID: PMC9608367.Lutke Schipholt IJ, Coppieters MW, Diepens M, et al. Systemic Inflammation, Sleep, and Psychological Factors Determine Recovery Trajectories for People With Neck Pain: An Exploratory Study. J Pain. Published online February 9, 2024. doi:10.1016/j.jpain.2024.02.010Moriarty O, Finn DP. Cognition and pain. Curr Opin Support Palliat Care. 2014 Jun;8(2):130-6.Moseley LG, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. J Pain. 2024 May;25(5):104425. doi: 10.1016/j.jpain.2023.11.008. Epub 2023 Nov 19. PMID: 37984510.Nicholson L. B. (2016). The immune system. Essays in biochemistry, 60(3), 275–301. https://doi.org/10.1042/EBC20160017Nijs J, George SZ, Clauw DJ et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021 May;3(5):e383-e392. doi: 10.1016/S2665-9913(21)00032-1. Epub 2021 Mar 30. PMID: 38279393.Ramaswamy S, Wodehouse T. Conditioned pain modulation-A comprehensive review. Neurophysiol Clin. 2020 Dec 14:S0987-7053(20)30146-5.Rolke R, Baron R, Maier C, Tölle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihöfner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain 2006;123:231–243.Scholten-Peeters GGM, Coppieters MW, Durge TSC, Castien RF. Fluctuations in local and widespread mechanical sensitivity throughout the migraine cycle: a prospective longitudinal study. J Headache Pain. 2020 Feb 14;21(1):16.Siddall B, Ram A, Jones MD, Booth J, Perriman D, Summers SJ. The short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis. Pain. 2021 Apr 9. doi: 10.1097/j.pain.0000000000002308.Sleijser-Koehorst MLS, Bijker L, Cuijpers P, Scholten-Peeters GGM, Coppieters MW. Preferred self-administered questionnaires to assess fear of movement, coping, self-efficacy, and catastrophizing in patients with musculoskeletal pain-A modified Delphi study. Pain. 2019 Mar;160(3):600-606. doi: 10.1097/j.pain.0000000000001441. PMID: 30422871; PMCID: PMC6407805.Vaegter HB, Petersen KK, Mørch CD, Imai Y, Arendt-Nielsen L. Assessment of CPM reliability: quantification of the within-subject reliability of 10 different protocols. Scand J Pain. 2018 Oct 25;18(4):729-737.Wiech K, Ploner M, Tracey I. Neurocognitive aspects of pain perception. Trends Cogn Sci. 2008 Aug;12(8):306-13.Woo AKM. Depression and anxiety in pain. Reviews in Pain. 2010; 4 (1); 8-12.Yarnitsky D, Bouhassira D, Drewes AM, Fillingim RB, Granot M, Hansson P, Landau R, Marchand S, Matre D, Nilsen KB, Stubhaug A, Treede RD, Wilder-Smith OHG. Recommendations on practice conditioned pain modulation (CPM) testing. Eur. J. Pain (United Kingdom) 2015;19:805–806.

Target Audience

This course is only open for students of the progamme MusculoskeletalPhysiotherapy Sciences.

Additional Information

Plagiarism Academic misconduct is defined as any act or omission by a student that partially or entirely obstructs an accurate assessment of their knowledge, understanding, and skills, or those of another student, as well as wrongful participation in an examination. Academic misconduct includes, but is not limited to, submitting work as one's own that is not one's own, plagiarism, unauthorized collaboration, and, during an examination, cheating, sharing information or using unauthorized aids. If the examiner suspects (complicity in) academic misconduct, their suspicion is immediately reported in writing to the Examination Board. The examiner also informs the student(s) about their report to the Examination Board. The Board investigates and summons the student(s) to respond in writing and/or to be heard orally. Based on the available information, the Examination Board reaches a decision. For sanctions, procedures and more information on academic misconduct, please see the Rules and Guidelines Examination Board FBMS. In all courses with writing assignments, students are required to write their own texts. Unfortunately, we regularly suspect cases of plagiarism. Please be aware that: · It is not allowed to copy sentences from other sources (literature, internet, other student's papers, own work for other courses, etc.) without proper reference to this source (text between quotes and mentioning of the source). · Using a sentence and putting the reference between brackets behind it, is not sufficient! · Reshuffling words in a sentence from another source is NOT the same as writing text in your own words! · Replacing a few words in a sentence from another source is NOT the same as writing text in your own words! · Using ChatGPT or comparable software is not writing your own text. We do not tolerate plagiarism of fraud. If plagiarism or fraud is suspected, the Examination Committee will be contacted. The recording of classes is only allowed after the permission of the lecturer. Publishing of audio recordings and PowerPoint presentations are never allowed. These fall under the copyright of the lecture.

Entry Requirements

N/A
Academic year1/09/2431/08/25
Course level6.00 EC

Language of Tuition

  • English

Study type

  • Master