Can a specific biobehavioral-based therapeutic education program lead to changes in pain perception and brain plasticity biomarkers in chronic pain patients? A study protocol for a randomized clinical trial.

BACKGROUND: Chronic pain conditions are complex multifactorial disorders with physical, psychological, and environmental factors contributing to their onset and persistence. Among these conditions, the role of brain-derived neurotrophic factor (BDNF) and the impact of a specific therapeutic education (TE) on pain management have emerged as important areas of research. OBJECTIVE: This study aims to investigate the effects of a specific type of therapeutic education on pain levels and BDNF concentrations. METHODS: In this single-blind, randomized clinical trial, patients will be randomly assigned to one of two groups: one will receive exercise with TE and the other without TE. Assessments will be made at baseline, mid-treatment, post-intervention, and at one and eight months. OUTCOMES: This study will shed light on the effectiveness of a therapeutic education (TE) program in pain management. Additionally, it will provide information on its effects on BDNF levels, a biomarker of brain plasticity, as well as on various psychosocial variables that can influence pain experience. CONCLUSION: By comprehensively addressing the need to quantify brain changes more precisely in individuals with chronic pain during interventions like TE and recognizing the importance of establishing a more structured and comprehensive protocol, this study lays a solid and replicable foundation for future evidence-based treatment developments.

Motor Imagery and Pain Processing in Patients With Entrapment Neuropathies: A Cross-sectional Study.

OBJECTIVES: (1) To assess the ability to generate both kinesthetic and visual motor imagery in participants with carpal tunnel syndrome (CTS), compared with asymptomatic participants. (2) To assess the influence of psychophysiological and functional variables in the motor imagery process. METHODS: Twenty patients with unilateral CTS and 18 pain-free individuals were recruited. An observational case-control study with a nonprobability sample was conducted to assess visual and kinesthetic movement imagery ability and psychophysiological variables in patients with CTS compared with asymptomatic participants in a control group. The trial was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. RESULTS: CTS patients have more difficulties in generating visual motor images compared with asymptomatic individuals ( t =-2.099; P <0.05; d=0.70). They need more time to complete the mental tasks (visual t =-2.424; P <0.05 and kinesthetic t =-2.200; P <0.05). A negative correlation was found between the ability to imagine and functional deficits ( r =-0.569; P =0.021) for the kinesthetic subscale and temporal summation ( r =-0.515; P <0.5). A positive correlation was found between pain pressure threshold homolateral (homolateral) and time to generate the visual mental images ( r =0.537; P <0.05). DISCUSSION: CTS patients have greater difficulty generating motor images than asymptomatic individuals. Patients also spend more time during mental tasks. CTS patients present a relationship between temporal summation and the capacity to generate kinesthetic images. In addition, the CST patients presented a correlation between chronometry mental tasking and mechanical hyperalgesia.

Effect of Different Physical Therapy Interventions on Brain-Derived Neurotrophic Factor Levels in Chronic Musculoskeletal Pain Patients: A Systematic Review.

OBJECTIVE: The main objectives of this review were, firstly, to study the effect of different physiotherapy interventions on BDNF levels, and, secondly, to analyze the influence of physiotherapy on pain levels to subsequently draw conclusions about its possible relationship with BDNF. BACKGROUND: Based on the theory that neurotrophic factors such as BDNF play a fundamental role in the initiation and/or maintenance of hyperexcitability of central neurons in pain, it was hypothesized that the levels of this neurotrophic factor may be modified by the application of therapeutic interventions, favoring a reduction in pain intensity. METHODS: A literature search of multiple electronic databases (Pubmed, PsycINFO, Medline (Ebsco), Scopus, WOS, Embase) was conducted to identify randomized control trials (RCTs) published without language restrictions up to and including March 2022. The search strategy was based on the combination of medical terms (Mesh) and keywords relating to the following concepts: "pain", "chronic pain", "brain derived neurotrophic factor", "BDNF", "physiotherapy", and "physical therapy". A total of seven papers were included. RESULTS: There were two studies that showed statistically significant differences in pain intensity reduction and an increase in the BDNF levels that used therapies such as rTMS and EIMS in patients with chronic myofascial pain. However, the same conclusions cannot be drawn for the other physical therapies applied. CONCLUSIONS: rTMS and EIMS interventions achieved greater short-term reductions in pain intensity and increased BDNF over other types of interventions in chronic myofascial pain patients, as demonstrated by a moderate amount of evidence. In contrast, other types of physical therapy (PT) interventions did not appear to be more effective in decreasing pain intensity and increasing BDNF levels than placebo PT or minimal intervention, as a low amount of evidence was found.