For many people with spinal pain, especially persistent and disabling pain, there is a relationship between how they move and how much pain they have. However, the ways in which people move are also related to their cognitions about pain and their emotional response to pain. So, should we be treating movement or cognitions or both? Research using wearable wireless movement sensors is providing insights into this question.
Wearable wireless movement sensors can measure physical activity, joint movement and muscle activity in the clinic, laboratory or home. Some also allow the recording of events, such as pain events, and others also can provide real-time biofeedback in activities of daily living to enable context-specific rehabilitation in people’s daily lives. But are these types of sensors any good and what are they capable of telling us about the relationship between pain and movement?
Pain-related cognitions (such as ‘hurt equals harm’) and pain-related emotions (such as fear of movement) have a relationship to how spinal pain is perceived and its consequences in activities of daily living. These consequences include the effect of pain on activity limitations (such as an ability to lift an object from the floor) and the effect of pain on participation restrictions (such as absence from work). But if pain-related cognitions and emotions are related to movement, are they a consequence of painful movement and therefore movement should be a target of treatment, or are they a driver of painful movement and therefore these cognitions and emotions should be the target?
Research using movement sensors in multiple single case experimental designs and in placebo controlled clinical trials is providing an opportunity to explore the mechanisms that underpin the relationships between spinal pain, movement and pain-related cognitions and emotions. The findings of these studies will help us advance spinal therapeutics.