A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain

Abstract

Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.

Association between central sensitization, pain sensitivity and balance control in patients with migraine

“…These results are in line with studies on musculoskeletal pain conditions such as knee, low back and neck pain, which attribute balance alterations mainly to peripheral factors such as reduced muscular strength (Jadelis et al, 2001), trunk stiffness (Brumagne et al, 2008) and decreased proprioceptive acuity, measured through the joint position sense error (Pinsault et al, 2008;Viseux et al, 2022). These aspects are postulated to influence the body sway due to altered proprioceptive input and consequent accuracy reduction in the sensory integration process, which would lead to an imprecise estimation of the body centre of mass (Viseux et al, 2022). However, older adults with pain present greater balance deficits in contrast to individuals without pain, even after controlling for confounders such as lower limb strength, physical activity levels and the presence of neurological and degenerative diseases (Lihavainen et al, 2010).…”

“…Studies on experimental acute pain using saline injection, electrical stimulation or heat pain demonstrated increased balance sway, suggesting that sensorimotor mechanisms are predominantly related to balance control rather than cognitive and central processes of pain (Corbeil et al., 2004; Hirata et al., 2011). These results are in line with studies on musculoskeletal pain conditions such as knee, low back and neck pain, which attribute balance alterations mainly to peripheral factors such as reduced muscular strength (Jadelis et al., 2001), trunk stiffness (Brumagne et al., 2008) and decreased proprioceptive acuity, measured through the joint position sense error (Pinsault et al., 2008; Viseux et al., 2022). These aspects are postulated to influence the body sway due to altered proprioceptive input and consequent accuracy reduction in the sensory integration process, which would lead to an imprecise estimation of the body centre of mass (Viseux et al., 2022).…”

“…Balance alterations are observed in several neurological/musculoskeletal conditions (Berenshteyn et al., 2019; Hirase et al., 2020; Mingorance et al., 2021; Nunez‐Fuentes et al., 2021; Peinado‐Rubia et al., 2020) and measuring balance displacement is one of the sensorimotor markers evidenced in chronic pain patients (Viseux et al., 2022). Its control is fundamental to the performance of daily activities, while its decline is associated with a loss of independence and increased fall risk (Carvalho, Luedtke, et al., 2022; Horak, 2006).…”

Pain and Parkinson's disease: Current mechanism and management updates

“…Some studies have highlighted the importance of peripheral sensory feedback applied to the plantar sole (Viseux et al, 2018(Viseux et al, , 2019Viseux, Martins, et al, 2020) and have improved clinical symptoms in Parkinsonian patients, including reduction in postural instability, through plantar sole stimulation (Brognara & Cauli, 2020;Viseux, Delval, et al, 2020). Given the linear relationship between the intensity of perceived pain and postural instability characterized by the velocity and amplitude of the centre of pressure displacement (Lihavainen et al, 2010;Ruhe et al, 2011Ruhe et al, , 2013Viseux et al, 2022), these results provide new clinical perspectives in the development of intervention strategies to manage postural instability and pain in patients with PD. At last, several complementary approaches including massage therapy (Angelopoulou et al, 2020), acupuncture (Shulman et al, 2002 or yoga (Myers et al, 2019), have also been investigated to ease the pain in PD.…”

Balance Disorders and Pain: An Analysis Based on the 2003-2004 NHANES Survey After Propensity Score Matching.

“…Numerous studies have shown that the presence of pain has an impact on proprioception and interferes with sensorimotor control. In addition, pain affects body perception at the central nervous level 11,12 . Thus, in theory, we believe that balance disorders and pain are correlated through the interplay of the central nervous system and proprioception.…”