A review of the proposal that innocuous proprioceptive input may maintain movement-evoked joint pain

Abstract

The proposal that movement-produced innocuous mechanoreceptive (proprioceptive) input may help maintain clinical symptoms and signs long after the original sensitizing nociceptive input has subsided, is reviewed. It is proposed that this normally innocuous input continues to drive neurones in an area of the brain such as the amygdala with which it has formed an excitatory association. A hypothetical clinical example is given illustrating how learning and memory for such chronic (back) pain are considered to be due to an ‘error of prediction’ on the part of the nervous system. The review then draws on up-to-date evidence to propose how informed delivery of movement-based treatments has the potential to extinguish the aversely acquired pain memory along with its behavioural consequences. This is achieved by altering ‘bottom-up’ and ‘top-down’ sources of synaptic sensory reinforcement.

Keywords:

• Pain
• Associative memory
• Proprioceptive input
• Pavlovian conditioning
• Extinction
• Movement-based treatment