Author: Sérgio Miguel Pereira Santos


Pain is an unpleasant multidimensional phenomenon with a neuronal or physiological component and it is a consequence of diseases or regional structures disorders due to a dysfunction of the nervous system. It results from the activation of harmful receptors and it is called neuropathic pain, when it results from a Central Nervous System (CNS) or Peripheral Nervous System (PNS) dysfunction, or central pain, when it results from a CNS injury.

While acute pain is a physiological symptom that must be understood as a warning sign to protect the body, chronic pain (longer than 3 months) should be considered a disease or dysfunction.

Noxious stimuli activate several cortical levels, particularly the primary somatosensory area, as it is the center of pain perception. Another region that may be activated by the noxious stimulus is the cingulate cortex region, which can lead to chronic pain when there is an injury.

Neuroplasticity is the capacity that the Nervous System (NS) has to reorganize itself when confronted to continuous stimuli. Chronic pain results from non-adaptive neuroplasticity of the NS as a consequence of an injury or dysfunction. The pathological imbalance caused by neuroplastic changes contributes to the development of neuropathic pain, inducing the synaptic potentiation and the activation of pain-facilitating paths.

Cortical reorganization is the basis for the recovery potential of the neurological functions, due to the fact that motor integration may promote neurogenesis, synaptogenesis, angiogenesis, pre and post synaptic modulation, and all these mechanisms may contribute to positive recovery outcomes.

Littlejohn considered as constitutional diseases all those that affect the body’s systems, namely the coordination of the functional activity of the different organs, tissues and structures of the organism, such as structural disorder and degenerative dysfunctions of NS.

Since osteopathic adjustment is a process of integration and mechano-physiological integrity that aims to maintain or establish the balance between the CNS and the PNS, maintaining the balance between nutrition and elimination. It allows the removal of the obstruction and the coordination of life forces allowing to restore normality, and it is done based on the expression of the NS of each organism, and therefore expect similar results in a biodiversity that the human species represents.

Keywords: Chronic pain; Neuroplasticity; Classical Osteopathy

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Neuroplasticity in chronic pain. The osteopathic view of chronic pain as a constitutional disease.

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