Specialising in musculoskeletal, orthopaedic, spinal and sports rehabilitation

The neuromatrix paradigm was first proposed in 1996 by Ronald Melzack as a new way to look at pain pathways (Melzack, 1999) . The neuromatrix is a multiple series of inputs from various biological and pathobiological sources which collates together to create an output mechanism which can lead to pain. The multiple inputs may be nociceptive, peripheral neurogenic, central pathways, motor, immune or various cognitive inputs which can lead to an output system that creates a pain experience which is diverse and variable for all individuals (Gifford & Butler, 1997). Recent imaging studies have demonstrated diverse neuroanatomical regions which are activated in a pain experience, however various areas upon the cortex are reliably activated within pain experiences including the Anterior Cingulate Cortex (ACC), thalamus and prefrontal and parietal cortexes (G. L. Moseley, 2003). The output of pain can be activated through any or none of the inputs above (list is not exhaustive) to create the pain experience and not just as previously thought from a simple nociceptive input. This is why the pain experience from one gentleman who has put a nail though his foot is very different to the footballer who puts a nail through his foot (Butler & Moseley, 2003). The basis for pain has only just been given physiological emphasis within chronic pain states and for this reason it is critical that we begin to embrace the benefits of using this system with chronic pain.

Pain is thought to be a survival mechanism where the brain recognises that the body is in danger, and produces pain as a response (Butler & Moseley, 2003). Various inputs which can trigger a pain response, may be peripheral, centrally driven or even stress related. Recent research has indicated that thoughts, experiences and moods can trigger the pain experience and helping to explain the neurophysiology for chronic pain patients can give them a greater understanding of how the system operates (G. L. Moseley, 2004; G. L. Moseley, Nicholas, & Hodges, 2004; L. Moseley, 2002). This can allow the dampening down of the pain inhibition system and to switch off the danger signalling. Retraining people’s altered pain belief’s and educating patients about neurophysiology and associated changes that occur within a chronic pain state has been shown to be beneficial in reducing one’s pain level (G. L. Moseley, 2004, 2005). Due to the multifaceted approach necessary to account for the various input and output systems that create a pain experience it seems appropriate that retraining peoples beliefs and altered thought patterns in relation to their pain will affect a positive change on their pain state. Explaining the adaptions that occur within the spinal system ( dorsal horn), the changes within receptor sites and the brains ability to increase or decrease the pain state (L. Moseley, 2005). Empirical evidence suggests that explaining and teaching the neurophysiology can be more effective than traditional back school and needs to be implemented appropriately so we can assist chronic pain patients better (G. L. Moseley, 2004, 2005; G. L. Moseley et al., 2004).

Neurophysiology education for chronic pain patients has been demonstrated to be effective and should form an integral part of their management. Identifying patient’s beliefs and targeting the education appropriately can have a positive effect on this population that is so difficult to treat. Pain management schools need to embrace the neurophysiology and ‘explain pain’ education systems. These should be used in combination with a mechanisms based clinical diagnosis to specifically target the systems that involved with pain. Generating a clinical hypothesis of the pain mechanisms involved with patients will assist in treating the specific target site effectively (Smart & Doody, 2006). It will allow treatment to be specific in identifying the factors involved with a particular patient’s pain rather than treating the pain itself. A multifaceted approach to chronic pain is necessary to be effective in this recalcitrant population but teaching the awareness of the pain neuromatrix can provide lasting clinical effects with patients.