© 2020 Brandon Drinan
Background and Purpose: Chronic low back pain (LBP), defined as pain that persists for three or more months, is widely considered the leading cause of physical activity limitation and work-related disability in the world. The purpose of this case report was to describe the rehabilitation for a middle-aged male with chronic LBP, emphasizing pain neuroscience education (PNE) and cortical remapping of the brain through Graded Motor Imagery (GMI), with movement being a secondary consideration.
Case Description: The patient was a 51-year-old Caucasian male who suffered a low back injury at work. This was a work-related injury covered under Worker’s Compensation. The patient’s goals were to reduce LBP, regain the ability to perform activities of daily living (ADLs) and work-related duties, and learn better pain management. The plan of care (POC) included aerobic exercise, strengthening exercises, PNE, and cortical remapping through GMI, localization, and graphesthesia training.
Outcomes: The patient’s discrimination between left and right sided movements improved from a baseline of 3.1 seconds and 2.7 seconds respectively, with 88% accuracy to 1.5 seconds for both sides with 100% accuracy. His Oswestry Disability Index (ODI) improved, 42/100 to 38/100, and his Fear Avoidance Behavior Questionnaire (FABQ) increased from initial Physical:19 and Work:41 to Physical:23 and Work:43 as did pain values with baseline of 3-4/10 to end of care 4-5/10.
Discussion: The POC produced inconsistent outcomes as the patient’s cortical abilities, strength, and perception of function improved with no meaningful improvement in pain, ODI, or FABQ values. Further research is needed to determine if this POC can be successful in a healthcare continuum that utilizes a biopsychosocial approach to chronic pain treatment.
Drinan, Brandon, "Graded Motor Imagery And Pain Neuroscience Education For A Middle-Aged Patient With Chronic Low Back Pain: A Case Report" (2020). Case Report Papers. 116.