High quality evidence suggests that current approaches to the management of CLBP show only limited effectiveness; one explanation of this finding is that current models of management are misdirected or incomplete. This talk proposes a model of CLBP underpinned by data on the psychological contributors to the LBP experience and recent evidence of neuroplastic changes in the brains of people with CLBP (see below). The model suggests that maladaptive cognitive perception about the nature of the back problem and future consequences drive behaviours that might bring about maladaptive neuroplastic changes. These central nervous system changes may enhance sensitivity, influence normal attentional processing and potentially create a state of maladaptive self perception of the back, in terms of how the back feels to the individual, the control they feel they have over their back and the meaning of sensory information from the back. Maladaptive cognitive perception and maladaptive self perception are potentially mutually reinforcing and contribute to the maintenance of the CLBP experience. Identification of these issues in the clinical setting and the implications of this model to the rehabilitation of people with CLBP will also be discussed.
Wand, B. M. (2012). Chronic lower back pain: A maladaptive perceptions model. Paper presented at the NOI 2012 Neurodynamics and the Neuromatrix Conference, Adelaide, SA, 26-28 April, 2012.