Clinical trials

Low back pain (LBP) is frequently managed in physical therapy using the McKenzie method, in which a patient's directional preference-most commonly extension-is used to guide treatment. Extension-based interventions are associated with symptom improvement and centralization in many individuals with LBP. At the same time, research in pain neuroscience has shown that people with LBP may have altered cortical representations of the low back, which may contribute to pain and disability. For patients who experience high pain levels or significant fear of movement, active directional preference exercises may be difficult to perform. Motor imagery, the mental simulation of movement without physical execution, has been shown to activate brain regions involved in movement and may help modify altered cortical representations. Preliminary research has suggested that virtual or imagery-based McKenzie extension exercises may improve pain and movement-related outcomes. This exploratory study aims to evaluate the immediate effects of a brief motor imagery-based extension protocol in adults with LBP who demonstrate a directional preference for extension. The study will assess changes in pain intensity, disability, fear-avoidance, pain catastrophization, lumbar flexion, straight leg raise, pain distribution, and symptom centralization following a single motor imagery session.

Brief Summary: The goal of this observational study (case series) is to determine whether Pain Neuroscience Education (PNE) can influence memory function and sensory awareness in adults (18 years and older) experiencing chronic pain lasting more than one year. The main questions it aims to answer are: Does a single PNE session improve memory performance, as measured by the Montreal Cognitive Assessment (MoCA)? Does PNE change sensory awareness, as represented by alterations in body pain drawings using a grid overlay method? Participants will: Complete pre-intervention assessments, including: Numeric Pain Rating Scale (NPRS) Body chart drawing to map pain area Montreal Cognitive Assessment (MoCA) Pain Catastrophization Scale (PCS) Receive a 10-15 minute standardized PNE session delivered by a licensed clinician trained in pain science Complete the same assessments immediately after the intervention to identify any changes in memory, sensory awareness, and pain perception This study aims to explore whether PNE can positively impact cognitive and sensory functions affected by chronic pain, beyond its already-established effects on movement and pain intensity.

Cervical radiculopathy (CR) is a common form of peripheral neuropathic pain characterized by neck and upper extremity symptoms in a dermatomal distribution. Neural tissue mobilization (NTM) is an intervention shown to provide benefit for neuropathic pain presentations; however, some patients are unable to tolerate direct treatment of the symptomatic limb due to allodynia, hyperalgesia, or fear of movement. Early evidence from lower-extremity research suggests that contralateral NTM may produce therapeutic effects similar to ipsilateral treatment, but this approach has not been investigated in individuals with upper-extremity symptoms. This exploratory case series aims to examine the immediate effects of contralateral NTM in adults presenting to outpatient physical therapy with CR. Participants will undergo pre- and post-treatment assessments of pain intensity, disability, fear-avoidance beliefs, pain distribution, and neurodynamic mechanosensitivity. Findings will provide preliminary evidence regarding whether contralateral NTM may serve as a viable treatment option when direct symptomatic limb treatment is not tolerated.