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Vol. 21. Issue 5.
Pages 378-387 (01 September 2017)
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Vol. 21. Issue 5.
Pages 378-387 (01 September 2017)
Clinical Trial Protocol
DOI: 10.1016/j.bjpt.2017.06.019
Applying contemporary neuroscience in exercise interventions for chronic spinal pain: treatment protocol
Anneleen Malflieta,b,f,
Corresponding author

Corresponding author at: Vrije Universiteit Brussel, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
, Jeroen Kregelb,c, Mira Meeusb,c,d, Barbara Cagniec, Nathalie Rousselb,d, Mieke Dolphensc, Lieven Danneelsc, Jo Nijsa,b,e
a Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
b Pain in Motion International Research Group1
c Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
d Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium
e Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
f Research Foundation – Flanders (FWO), Brussels, Belgium

  • Treating the central nervous system and psychosocial factors in chronic spinal pain.

  • This protocol combines pain neuroscience education and cognition targeted exercises.

  • This paper can be used as guidelines for implementation in clinical practice.

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Table 1. Example of an ‘activity form’ completed by a chronic low back pain patient.
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Nonspecific chronic spinal pain is a common problem within the chronic pain population and is characterized by high social, economic and personal impact. To date, therapists are still struggling in adequately treating these types of patients, as seen in the small and short-term benefits of frequently applied primary care treatments. It is remarkable that despite the well-documented presence of abnormalities in central nociceptive processing in nonspecific chronic spinal pain patients, the implementation of this knowledge in clinical practice is still nearly non-existent.


This paper provides the treatment protocol used in a large randomized controlled trial that aimed to assess the effectiveness of a modern neuroscience approach compared to usual care evidence-based physiotherapy. This comprehensive pain neuroscience treatment program combines pain neuroscience education and cognition-targeted exercise therapy.


Based on previous small-scaled studies, this treatment protocol is expected to normalize central alterations by addressing central nervous system dysfunctions, psychological factors, as well as peripheral dysfunctions in a broader biopsychosocially-driven framework.

Chronic spinal pain
Pain neuroscience education
Exercise therapy
Patient communication
Treatment protocol


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