As of 2004, at least a fifth of adults worldwide experienced chronic musculoskeletal pain [1]. A 2019 estimate indicated low back pain affects ~52 million people in the United States alone and ~568 million people across the globe [2]. This pain significantly impacts most, if not all, areas of daily functioning through physical, emotional, mental, or social impairment [3]. Although it is not perfectly understood why some individuals develop this pain and others do not, various studies have delineated differences in brain activity for specific regions between patients and healthy controls [4,5]. Changes to the somatosensory cortex, which processes sensory information from the body, have gained significant attention; altered activity in this brain region has been suggested to contribute to the development/maintenance of musculoskeletal pain [6,7]. Sensorimotor retraining is an umbrella term for treatment methods aimed at correcting these changes in nervous system activity and reducing musculoskeletal pain through behaviorally relevant stimulation [8,9]. Graded sensorimotor retraining is a cognitive and perceptual technique designed to change the way patients think about their bodies when they experience musculoskeletal pain and how they process that pain [8]. A clinical trial done in Sydney, Australia randomly allocated patients to receive either graded sensorimotor retraining or attention control with sham procedures. While the retraining sessions mostly relied on introspection and psychoeducation, the sham procedures were designed to mimic neuroimaging tools (for example, sham laser therapy and sham transcranial direct current stimulation). Analysis found a 30% decrease in pain intensity scores within the groups 18 weeks following the start of the intervention; this persisted up to 52 weeks post-randomization. Also analyzed were scores on psychological assessments measuring disability (through the Roland-Morris Disability Questionnaire), quality of life (using the EuroQol-5 dimensions questionnaire), depressive symptoms (measured on the Depression Anxiety Stress Scale), sleep quality (through the Insomnia Severity Index), beliefs about patient pain (using the Back Beliefs Questionnaire), kinesiophobia (measured with the Tampa Scale of Kinesiophobia), catastrophizing (through use of the Pain Catastrophizing Scale and the Pain Self-Efficacy Questionnaire), and treatment rationale credibility (measured through the Credibility and Expectancy Questionnaire). Secondary outcomes that had the greatest change were kinesiophobia (reduction by 6 points), pain catastrophizing (reduction by 7 points), and pain self-efficacy (improvement by 6 points). The authors concluded sensorimotor retraining is effective and advantageous because of its minimal adverse effect rate, compared to other interventions for musculoskeletal back pain such as medications, surgery, or spinal cord stimulation [8,10].
A review of sensorimotor retraining for patients with chronic wrist pain describes 17 studies involving intervention and assessment of sensorimotor performance [11]. Several studies included in the review found that patients with focal hand dystonia who completed supervised sensorimotor retraining were more likely to exhibit improved somatosensory hand function, fine motor skills, and sensorimotor discrimination [11]. Performance was defined through sensory tasks such as identifying sensory stimulation of varying textures and temperatures, reading Braille, matching coins or beads, among others [12]. Additionally, two included studies evaluated the use of a local anesthetic cream (applied to the forearm during sensorimotor retraining) and found patients applying the cream during retraining improved on performance measures compared to patients using a placebo [13]. After reviewing this literature, the authors concluded there is significant value in sensorimotor retraining interventions when treating chronic pain affecting the hand and wrist.
Research seems to support sensorimotor retraining interventions for musculoskeletal pain; the evidence suggests this training improves results on both psychological and physiological assessments. However, given the great variability between sensorimotor tasks and definitions of “improvement”, further research is needed to understand the generalizability of these findings.
References
- Right to Pain Relief. International Association for the Study of Pain (IASP). https://www.iasp-pain.org/GlobalYear/RighttoPainRelief
- Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Abreu, L. G., Abrigo, M. R. M., Abu-Raddad, L. J., Abushouk, A. I., … Murray, C. J. L. (2020). Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
- Baker, K. S., Gibson, S., Georgiou-Karistianis, N., Roth, R. M., & Giummarra, M. J. (2016). Everyday Executive Functioning in Chronic Pain: Specific Deficits in Working Memory and Emotion Control, Predicted by Mood, Medications, and Pain Interference. The Clinical Journal of Pain, 32(8), 673–680. https://doi.org/10.1097/AJP.0000000000000313
- Kikkert, S., Mezue, M., O’Shea, J., Henderson Slater, D., Johansen-Berg, H., Tracey, I., & Makin, T. R. (2019). Neural Basis of Induced Phantom Limb Pain Relief: Neural Basis of PLP Relief. Annals of Neurology, 85(1), 59–73. https://doi.org/10.1002/ana.25371
- Makin, T. R., Filippini, N., Duff, E. P., Henderson Slater, D., Tracey, I., & Johansen-Berg, H. (2015). Network-level Reorganisation of Functional Connectivity Following Arm Amputation. NeuroImage, 114, 217–225. https://doi.org/10.1016/j.neuroimage.2015.02.067
- Mancini, F., Wang, A. P., Schira, M. M., Isherwood, Z. J., McAuley, J. H., Iannetti, G. D., Sereno, M. I., Moseley, G. L., & Rae, C. D. (2019). Fine-grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome. The Journal of Neuroscience, 39(46), 9185–9196. https://doi.org/10.1523/JNEUROSCI.2005-18.2019
- Kikkert, S., Johansen-Berg, H., Tracey, I., & Makin, T. R. (2018). Reaffirming the Link Between Chronic Phantom Limb Pain and Maintained Missing Hand Representation. Cortex, 106, 174–184. https://doi.org/10.1016/j.cortex.2018.05.013
- Bagg, M. K., Wand, B. M., Cashin, A. G., Lee, H., Hübscher, M., Stanton, T. R., O’Connell, N. E., O’Hagan, E. T., Rizzo, R. R. N., Wewege, M. A., Rabey, M., Goodall, S., Saing, S., Lo, S. N., Luomajoki, H., Herbert, R. D., Maher, C. G., Moseley, G. L., & McAuley, J. H. (2022). Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients with Chronic Low Back Pain: A Randomized Clinical Trial. JAMA, 328(5), 430–439. https://doi.org/10.1001/jama.2022.9930
- Graham, A., Ryan, C. G., MacSween, A., Alexanders, J., Livadas, N., Oatway, S., Atkinson, G., & Martin, D. J. (2022). Sensory Discrimination Training for Adults with Chronic Musculoskeletal Pain: A Systematic Review. Physiotherapy Theory and Practice, 38(9), 1107–1125. https://doi.org/10.1080/09593985.2020.1830455
- Abdel Shaheed, C., Maher, C. G., Williams, K. A., Day, R., & McLachlan, A. J. (2016). Efficacy, Tolerability, and Dose-dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 176(7), 958. https://doi.org/10.1001/jamainternmed.2016.1251
- Valdes, K., Naughton, N., & Algar, L. (2014). Sensorimotor Interventions and Assessments for the Hand and Wrist: A Scoping Review. Journal of Hand Therapy, 27(4), 272–286. https://doi.org/10.1016/j.jht.2014.07.002
- Byl, N. N., & McKenzie, A. (2000). Treatment Effectiveness for Patients with a History of Repetitive Hand Use and Focal Hand Dystonia: A Planned, Prospective Follow-up Study. Journal of Hand Therapy, 13(4), 289–301. https://doi.org/10.1016/S0894-1130(00)80021-6
- Rosén, B., Björkman, A., & Lundborg, G. (2006). Improved Sensory Relearning After Nerve Repair Induced by Selective Temporary Anaesthesia – A New Concept in Hand Rehabilitation. Journal of Hand Surgery, 31(2), 126–132. https://doi.org/10.1016/J.JHSB.2005.10.017