Course ObjectiveGeneral course objective
In this course, the students will become familiar with the
pathophysiology of pain and underlying mechanisms which can explain pain
reduction due to musculoskeletal physiotherapy treatment. The students
will also learn how to measure and interpret different aspects of pain
and pain processing.
Intended learning outcomes (relation to end qualifications between
- 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. (1,2,8)
- The student is able to argue which underlying mechanisms of treatment
(the neuro-immune system, neurophysiological and psychological system)
explain pain reduction after physiotherapeutic interventions. (6, 7)
- The student is able to present in a poster pitch the underlying
mechanisms of treatment that can explain pain reduction in research.
(12, 13, 15)
- The student is able to apply common measurement tools for research
related to pain, specifically: pressure pain thresholds, quantitative
sensory testing measurements, questionnaires, blood tests. (3)
Course ContentPain 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 complaint of
patients with musculoskeletal disorders who seek physiotherapy care. The
last years the understanding of biological, psychological and social
factors involved in pain has increased enormously. Also the insight into
the role of the neuro-endocrine-immune system and brain
activity/mechanisms in relation to pain and cognitive functioning
improved immensely. In patients with persistent pain, nociceptive input,
is often not enough to explain the experienced pain severity. The
altered processing in the central nervous system, with enhanced
excitability, reduced inhibition and glial hyperactivity, seems to 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 the relation with psychological
factors improves the understanding of pain symptoms, and comorbidities
such as attention disorders and depression. But these underlying
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 (physiotherapeutic) treatment can help clinicians to
select appropriate treatments and explain (physiotherapeutic) treatment
effects. In this course you will gain more insight into the different
aspects of pain, its relation with psychosocial factors, pain
processing, underlying working mechanisms of pain, mechanism-based pain
management and pain assessment.
Teaching Methods8 Lectures (2 hours each)
4 Practicals (4 hours each)
3 Working groups (2 hours each)
Instruction video assignment
The practicals are mandatory
The lectures present the pathophysiology of pain, pain processing, the
relationship of pain with the neuro-endocrine-immune system and
psychosocial factors and potential action mechanisms of
physiotherapeutic treatment are discussed.
Hand-outs of the lecture slides will be posted on CANVAS. Students are
strongly encouraged to prepare the study material pertaining to the
lecture beforehand (see course schedule) as this will facilitate the
understanding of the lecture. Also, the lectures provide essential
material to prepare the working group assignments. Understanding of the
lecture material is also essential in order to be able to successfully
complete the practical sessions.
There will be 3 practical sessions about pain assessment (Quantified
Sensory Testing, Pain Pressure Thresholds, questionnaires) and 1
practical session about immune responses in this course. In each
practical the student will perform and interpret different (pain)
measurements or responses. Although the practicals are not compulsory,
attendance is highly recommended as the practicals are an important
preparation for the ‘instruction video’ examination. The lecturers are
available for questions during the practicals.
In the working groups, students demonstrate their capability to
critically reflect upon existing pain research, pain assessment and the
role of psychosocial factors in pain specifically. Also the posters and
instruction videos will be presented and critically discussed within the
group. The poster presentations assignment will be performed in couples
and the instruction video in a group of 3 persons. The assignments will
be posted on CANVAS. Please check CANVAS for more detailed information
about the poster and instruction video, score sheets and rubrics.
Method of AssessmentTheoretical exam (40%)
Poster presentation (35%)
Development of an instruction 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).
LiteratureCastien R, De Hertogh W. A Neuroscience Perspective of Physical
Treatment of Headache and Neck Pain. Front Neurol [Internet].
Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to
Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain.
Chen Y. Advances in the pathophysiology of tension-type headache: From
stress to central sensitization. Curr. Pain Headache Rep.
Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to
Physical Therapist Management of Pain. Phys Ther. 2018 May
Driver C, Kean B, Oprescu F, Lovell GP. Knowledge, behaviors, attitudes
and beliefs of physiotherapists towards the use of psychological
interventions in physiotherapy practice: a systematic review. Disability
& Rehabilitation 2016. 39 (22); 2237-2249.
Gallo J, Raska M, Kriegova E, Goodman SB. Inflammation and its
resolution and the musculoskeletal system. Journal of orthopaedic
Gan SD, Patel KR. Enzyme immunoassay and enzyme-linked immunosorbent
assay. J Invest Dermatol. 2013 Sep;133(9):e12.
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.
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
Kami K, Tajima F, Senba E. Exercise-induced hypoalgesia: potential
mechanisms in animal models of neuropathic pain. Anatomical science
Kovanur-Sampath K, Mani R, Cotter J, Gisselman AS, Tumilty S. Changes in
biochemical markers following spinal manipulation-a systematic review
and meta-analysis. Musculoskeletal science & practice. 2017;29:120-31.
Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain
neuroscience education on musculoskeletal pain: A systematic review of
the literature. Physiotherapy Theory and Practice. 2016; 32:5, 332-355.
Moriarty O, Finn DP. Cognition and pain. Curr Opin Support Palliat Care.
Moseley L. Butler D. Fifteen years of explaining Pain: The past, the
present and the future: A Critical review. The Journal of Pain. 2015;,
Vol 16, No 9 (September): pp 807-813
Nijs J, Meeus M, Cagnie B, Roussel NA, Dolphens M, Van Oosterwijck J,
Danneels L. A modern neuroscience approach to chronic spinal pain:
combining pain neuroscience education with cognition-targeted motor
control training. Phys Ther. 2014 May;94(5):730-8.
Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den Bandt H,
Goubert D, Kregel J, Coppieters I, Dankaerts W. In the spine or in the
brain? Recent advances in pain neuroscience applied in the intervention
for low back pain. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl
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.
Sleijser-Koehorst MLS, Bijker L, Cuijpers P, Scholten 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. 160 (3);
Teodorczyk-Injeyan JA, McGregor M, Triano JJ, Injeyan HS. Elevated
Production of Nociceptive CC-chemokines and sE-selectin in Patients with
Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized
Clinical Trial. Clin J Pain.2017 Apr 19.
Testa M, Rossetini G. Enhance placebo, avoid nocebo: How contextual
factors affect physiotherapy outcomes. Manual therapy. 2016; 24; 65-74
Tseli E, Boersma K, Stalnacke B, Enthoven P, Gerdle B, Ang BJ, Grooten
WJA. Prognostic factors for physical functioning after multidisciplinary
rehabilitation in patients with chronic musculoskeletal pain. A
systematic review and meta-analysis. The Clinical Journal of Pain.
35(2); 148-173, 2019.
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 Jul 14.
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);
- Moseley L, Butler D. Explain Pain Supercharged. The Clinician’s
Handbook. Noigroup Publications: 2017.
- Parham, P. The Immune System. fourth ed. London: Garland Science: 2015
- Sluka KA (2016). Mechanisms and management of pain for the Physical
therapist. Philadelphia: Wolter Kluwer Health: second edition: chapter
Target AudienceThis course is only open for students of the progamme Musculoskeletal
|Language of Tuition||English|
|Faculty||Fac. of Behavioural and Movement Science|
|Course Coordinator||dr. G.G.M. Scholten-Peeters|
|Examiner||dr. G.G.M. Scholten-Peeters|
dr. G.G.M. Scholten-Peeters
drs. L. Bijker
dr. R.F. Castien
dr. N.C. de Knegt
You need to register for this course yourself
|Teaching Methods||Study Group, Lecture, Practical|