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Put the brain and body back together in pain research

Advances in pain research are yielding new insights into mysteries lurking inside the brain and how brain mechanisms influence chronic pain. 

April 8, 2019  By American Pain Society

However, a senior official at the National Institutes of Health says let’s not forget how muscles and other tissues in the body can be successfully treated to help alleviate low-back pain and other chronic pain conditions.

Helene Langevin, M.D. serves as director, National Center for Complementary and Integrative Health. She has devoted her career to studying the benefits of various physical therapies, such as acupuncture, massage, yoga and stretching, to promote overall wellness and help improve quality of life for people coping with chronic pain.

“Pain research in the past few decades has strengthened our view of chronic pain as a disease of the brain,” Langevin said. “As a result, some of the newer treatment approaches focus on ways to target neural pain pathways to help achieve relief. While this is important research, the brain isn’t the whole story in pain management.”

Langevin noted that more studies are needed to explore the benefits of mind and body therapies to reduce inflammation and prevent long-term muscle and tissue damage that can lead to chronic pain. “When pain after an injury lasts more than three months, patients are often told the tissues have healed and the brain is responsible for the ongoing pain,” said Langevin. “But have the tissues really healed, and what tissues are we talking about?”


Langevin is concerned about research gaps in the interface of growing neuroscience knowledge with understanding of the rest of the body. “Studies of mind and body therapies can give valuable insights into chronic musculoskeletal and low-back pain, for example, as a dynamic interplay between the nervous system and musculoskeletal tissues,” she said.

Langevin also said one of the reasons low-back pain is so difficult to manage may be that we are not paying enough attention to structural restrictions of connective tissue that can impair muscle function over time.

Ultrasound studies in Langevin’s lab revealed connective tissues surrounding back muscles are thicker in people with chronic low back pain.

“Connective tissues surrounding muscles in the back normally have alternating layers of fibers that handle substantial loads and glide easily. People with longstanding low-back pain have decreased gliding motion between connective tissue layers, which could contribute to functional impairment,” Langevin explained.  “Interventions that restore connective tissue mobility and muscle function may be important to prevent long-term damage to vulnerable structures such as joints and intervertebral discs.”

According to Langevin, complementary medicine clinicians have long emphasized the importance of connective tissues in health and disease. “Connective tissue is the scaffold that holds our body together,” she said.  “Stretching and other manual-and movement-based therapies are grounded on the assumption that connective-tissue pathology contributes to musculoskeletal pain, and that mind and body approaches can help both reduce pain and improve function. We need to understand better how muscles, connective tissue, and the nervous system all contribute to musculoskeletal pain and how to address this in an integrative way”.

Langevin also believes more studies are needed in combination with conventional medicine. “Integrative health care combines complementary and conventional approaches, and future musculoskeletal research will benefit from this integration. It’s time to put the brain and body back together in pain research.”

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