Neuroplasticity of sensorimotor control in low back pain

Low back pain (LBP) represents an important medical and socio-economic problem. Impaired sensorimotor control has been suggested to be a likely mechanism underlying development and/or maintenance of pain. Although early work focused on the structural and functional abnormalities within the musculoskeletal system, over the past twenty years there has been increasing realization that patients with LBP might also have structural and functional changes within the central nervous system. Moreover, clinical interventions increasingly aim to drive neuroplasticity with treatments to improve sensorimotor function and pain. This commentary provides a state-of-the-art overview of neuroplasticity of the sensorimotor system in LBP. The paper is divided into four parts that address: 1) defining neuroplasticity in relation to control of the spine and LBP; 2) implications of different research approaches applied to study neuroplasticity in LBP; 3) structural and functional brain changes as they relate to non-specific LBP and sensorimotor function; and 4) clinical implications. Research shows that individuals with recurrent and persistent LBP differ systematically from those without LBP, in several markers of the nervous system’s function and structure. Neuroplastic changes may be addressed by top-down cognitive-based interventions and bottom-up physical interventions. An integrated contemporary neuroscience and clinical approach may combine physical treatment with intensive pain neuroscience education and cognition-targeted sensorimotor control, and this may lead to better outcomes in patients with recurrent and persistent LBP.status: publishe