{"id":8078,"date":"2026-07-19T15:41:51","date_gmt":"2026-07-19T13:41:51","guid":{"rendered":"https:\/\/blueportance.com\/knowledge-base\/expert-guides\/understanding-pain\/restoring-adaptability-chronic-pain\/"},"modified":"2026-10-25T22:43:29","modified_gmt":"2026-10-25T21:43:29","slug":"restoring-adaptability-chronic-pain","status":"publish","type":"page","link":"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/restoring-adaptability-chronic-pain\/","title":{"rendered":"KB 3_Expert Guide_01_Understanding Pain_11_Restoring Adaptability"},"content":{"rendered":"\n\n  <style>\n    body{font-family:Arial,sans-serif;line-height:1.65;padding:20px;color:#333}\n    .bp-q-breadcrumb{font-size:.85rem;color:#6b7280;margin:0 0 20px}\n    .bp-q-breadcrumb a{color:#2a7fba;text-decoration:none}\n    h1{color:#0e2a47;font-size:1.8rem;line-height:1.25;margin:0 0 22px}\n    h2{color:#1a4d72;margin-top:42px;line-height:1.3}\n    h3{color:#0e2a47;margin-top:28px}\n    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href=\"\/en\/\">Blue Portance<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">Knowledge Base<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/\">Understanding Pain<\/a> \u2192 Getting Out of Chronic Pain\n<\/nav>\n\n<div class=\"bp-bdc-header-card\">\n  <div class=\"bp-bdc-kicker\">Blue Portance Expert Guides<\/div>\n  <div class=\"bp-bdc-rule\"><\/div>\n  <div class=\"bp-bdc-dossier-title\">Understanding Pain<\/div>\n  <div class=\"bp-bdc-dossier-subtitle\">The biological, mechanical, and neurophysiological mechanisms of pain.<\/div>\n<\/div>\n\n<p class=\"bp-bdc-dossier-link\">\n  This article is part of the Expert Guide\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/\">\u201cUnderstanding Pain\u201d<\/a>.\n<\/p>\n\n<span class=\"bp-pillar-badge\">Synthesis article \u2014 Blue Portance Knowledge Base<\/span>\n\n<h1>Getting Out of Chronic Pain: Restoring the Adaptive Capacities of the Living Organism<\/h1>\n\n<div class=\"bp-origin\">\n  <nav class=\"bp-bdc-toc\" aria-label=\"Table of contents\">\n  <h2>Table of Contents<\/h2>\n  <ul>\n      <li><a href=\"#note-de-l-auteur-aux-origines-de-cette-reflexion\">Author\u2019s note \u2013 The origins of this line of thinking<\/a><\/li>\n      <li><a href=\"#pourquoi-cet-article-est-il-important\">Why does this article matter?<\/a><\/li>\n      <li><a href=\"#1-pourquoi-n-existe-t-il-pas-de-traitement-universel\">1. Why is there no universal treatment?<\/a><\/li>\n      <li><a href=\"#2-une-meme-douleur-peut-necessiter-plusieurs-leviers\">2. The same pain may require several levers<\/a><\/li>\n      <li><a href=\"#3-les-grandes-familles-d-intervention\">3. The main families of intervention<\/a><\/li>\n      <li><a href=\"#4-la-pause-dans-la-douleur-un-premier-pas-hors-de-la-boucle\">4. A pause in pain: a first step out of the loop<\/a><\/li>\n      <li><a href=\"#5-un-tableau-pas-un-catalogue-quel-niveau-de-preuve\">5. A table, not a catalog: what level of evidence?<\/a><\/li>\n      <li><a href=\"#6-les-approches-ne-s-opposent-pas-elles-peuvent-etre-complementaires\">6. The approaches are not in opposition: they can be complementary<\/a><\/li>\n      <li><a href=\"#vers-une-medecine-de-l-adaptation\">Toward a medicine of adaptation<\/a><\/li>\n      <li><a href=\"#7-un-dernier-facteur-le-contexte-du-soin\">7. One last factor: the care context<\/a><\/li>\n      <li><a href=\"#a-retenir\">Key takeaways<\/a><\/li>\n      <li><a href=\"#questions-frequentes\">Frequently asked questions<\/a><\/li>\n      <li><a href=\"#vous-souhaitez-comprendre-votre-propre-situation\">Would you like to understand your own situation?<\/a><\/li>\n      <li><a href=\"#references-scientifiques\">Scientific references<\/a><\/li>\n  <\/ul>\n<\/nav>\n\n<h2 id=\"note-de-l-auteur-aux-origines-de-cette-reflexion\">Author\u2019s note \u2013 The origins of this line of thinking<\/h2>\n  <p>\n    Throughout our many conversations with Pierre Ivaldi about functional rehabilitation and the use of Aporia\u00ae\n    seating, one word kept coming back: adaptability. It was the principle that guided his thinking.\n  <\/p>\n  <p>\n    For Pierre Ivaldi, the true goal of a treatment was not only to correct a lesion or eliminate a symptom, but to\n    preserve \u2014 and, whenever possible, to restore \u2014 the adaptive capacities of the living organism. In his view,\n    functional recovery depended on these capacities.\n  <\/p>\n  <p>\n    This vision also guided his work as managing director of a post-acute care and functional rehabilitation center.\n    Receiving patients referred after surgery every day, he regularly discussed with surgeons the functional\n    consequences of their procedures. He sought to make them aware of the fact\n    that an operation, however technically successful, could reduce the adaptive potential of the tissues and\n    compromise the possibilities for functional rehabilitation if this dimension was not sufficiently taken into\n    account.\n  <\/p>\n  <p>\n    These conversations were one of the starting points of our own thinking. They thus led us to explore this notion of\n    adaptability in greater depth and to look for ways of connecting it with current knowledge in biomechanics,\n    neuroscience, and pain physiology. The concepts of the adaptive system (C7) and of adaptive loops developed in\n    this guide in fact grew out of this process.\n  <\/p>\n  <p>We extend our warmest thanks to him here.<\/p>\n<\/div>\n\n<div class=\"bp-bdc-epistemic\">\n  <strong>Epistemic note<\/strong> \u2014 This article offers neither a treatment protocol nor a catalog of solutions. It presents an interpretation of the main families of approaches according to the mechanism they target, distinguishing the levels of evidence available in the literature. No drug, device, or technique is individually recommended: the choice of care is a matter for evaluation by a healthcare professional.\n<\/div>\n\n<h3>What this article offers<\/h3>\n\n<section class=\"bp-summary\">\n  <p>\n    <strong>Summary<\/strong> \u2014 Having seen how pain can become chronic through the establishment of\n    <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/adaptive-pain-loops\/\">adaptive loops<\/a>\n    that sustain one another, the natural question is: can one get out of it? The answer is yes, but rarely\n    through a single solution. Chronic pain generally results from several interactions between tissues, the\n    nervous system, emotions, behaviors, sleep, and the environment; its care follows the same\n    logic: identifying the loops that have become dominant in a given person, and the levers capable of\n    gradually modifying them.\n  <\/p>\n<\/section>\n\n<h2 id=\"pourquoi-cet-article-est-il-important\">Why does this article matter?<\/h2>\n\n<p>\n  For a long time, pain was viewed as the direct consequence of a lesion: removing the cause was supposed to be\n  enough to remove the pain. This view remains accurate for many acute situations. It does a poor job, however, of\n  explaining why chronic pain sometimes persists long after its initial trigger has disappeared, or\n  why two people with comparable lesions can follow very different courses.\n<\/p>\n\n<p>\n  The aim of this article is therefore not to draw up a catalog of available treatments. Instead, it proposes a\n  different reading: understanding which mechanism each family of approaches acts on, in order to identify the levers\n  that can realistically be used in a given situation.\n<\/p>\n\n<h2 id=\"1-pourquoi-n-existe-t-il-pas-de-traitement-universel\">1. Why is there no universal treatment?<\/h2>\n\n<p>\n  Some pain, for example, remains dominated by an identifiable mechanical stress. Other pain is sustained by\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/nervous-system-hypersensitization\/\">nervous system hypersensitization<\/a>.\n  Still other pain results from several interacting adaptive loops: mechanical stresses,\n  nervous system function, behaviors, sleep, and the psychological dimension evolving together, as shown in\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/adaptive-pain-loops\/\">the previous article<\/a>.\n<\/p>\n\n<p>\n  It is therefore logical that no single approach can address every situation. The choice of care\n  depends above all on the mechanisms that appear dominant in a given person: it is this evaluation, and not\n  a universal hierarchy of treatments, that should guide the decision.\n<\/p>\n\n<h2 id=\"2-une-meme-douleur-peut-necessiter-plusieurs-leviers\">2. The same pain may require several levers<\/h2>\n\n<p>\n  Take the example of pudendal neuralgia, already covered on several pages of this Knowledge Base. In the\n  same person, the following may gradually combine: persistent mechanical compression at the pudendal nerve\u2019s\n  areas of vulnerability <span class=\"bp-inline-ref\">(see \u201c<a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/compressed-nerve-pain\/\">when does a compressed nerve become painful<\/a>\u201d)<\/span>,\n  progressive hypersensitization of the nervous system, a fear of sitting that sustains prolonged immobility\n  <span class=\"bp-inline-ref\">(see \u201c<a href=\"https:\/\/blueportance.com\/en\/2026\/01\/11\/pudendal-neuralgia-sitting-pain\/\">why a simple sitting position can become an ordeal<\/a>\u201d)<\/span>,\n  sleep disturbances, and psychological suffering linked to diagnostic uncertainty\n  <span class=\"bp-inline-ref\">(see \u201c<a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/psychological-pain\/\">psychological pain<\/a>\u201d)<\/span>.\n<\/p>\n\n<p>\n  Indeed, each element sustains the others. When these factors are actually present, addressing only one of them may leave other maintaining factors unchanged. The challenge then becomes less about searching for a single treatment than about identifying the\n  main levers capable of gradually modifying how the system functions.\n<\/p>\n\n<div class=\"bp-figure\">\n  <img decoding=\"async\" src=\"https:\/\/blueportance.com\/wp-content\/uploads\/XI.1.Self-sustaining-chronic-pain.png\" alt=\"Diagram showing several mechanical, neural, behavioral and psychological loops that can sustain the same chronic pain.\" loading=\"lazy\">\n<\/div>\n<p class=\"bp-figure-caption\">\n  <strong>Figure 1 \u2014 The same pain, several adaptive loops.<\/strong> In the same person, several\n  mechanisms can combine and sustain one another: acting on only one of them often leaves the others\n  active.\n<\/p>\n\n<h2 id=\"3-les-grandes-familles-d-intervention\">3. The main families of intervention<\/h2>\n\n<p>\n  This diversity of mechanisms thus explains the diversity of treatments. Chronic pain is most often\n  sustained by several adaptive loops at once; each family of treatment acts preferentially\n  on one of these loops. The various approaches are therefore not competing but complementary, each\n  targeting a different link in the same system.\n<\/p>\n\n<p>\n  Rather than classifying approaches by profession or by technique, it is therefore possible to group them according to the\n  mechanism on which they mainly act. This reading helps explain why very\n  different methods can sometimes produce comparable effects: they act on the same link in the loop.\n<\/p>\n\n<table aria-label=\"Map of therapeutic targets\">\n  <thead>\n    <tr>\n      <th>Main target<\/th>\n      <th>Examples of approaches<\/th>\n    <\/tr>\n  <\/thead>\n  <tbody>\n    <tr><td>Mechanical stresses<\/td><td>Ergonomics, postural aids (including the Aporia\u00ae range by Blue Portance), orthoses, decompression surgery<\/td><\/tr>\n    <tr><td>Tissue repair<\/td><td>Anti-inflammatory drugs, injections, platelet-rich plasma (PRP), reconstructive surgery<\/td><\/tr>\n    <tr><td>Nociceptive transmission<\/td><td>Analgesics, treatments for neuropathic pain<\/td><\/tr>\n    <tr><td>Neuromodulation<\/td><td>TENS, rTMS, tDCS (noninvasive); spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation (invasive)<\/td><\/tr>\n    <tr><td>Physical capacities<\/td><td>Physical therapy, adapted physical activity, graded exposure<\/td><\/tr>\n    <tr><td>Self-regulation<\/td><td>Sleep, hypnosis, meditation, relaxation, biofeedback<\/td><\/tr>\n    <tr><td>Cognitive and social dimensions<\/td><td>Cognitive behavioral therapies, therapeutic patient education, psychological support, multidisciplinary programs<\/td><\/tr>\n  <\/tbody>\n<\/table>\n\n<p class=\"bp-note\">\n  Blue Portance\u2019s Aporia&nbsp;\u00ae range is cited here as one example of a postural aid aimed at reducing\n  mechanical stresses, in the same way as other ergonomic solutions: it does not claim to be\n  a universal therapeutic answer, nor to replace the other targets listed in this table.\n<\/p>\n\n<h3>Reducing mechanical stresses<\/h3>\n\n<p>\n  When pain is sustained by tissue overload or persistent compression, reducing this\n  stress is often a first step: ergonomic adaptation, changes in support points, an orthosis, an assistive\n  device, workstation adjustment, or a surgical procedure when the cause is clearly identified.\n  The goal is therefore to reduce the mechanical stimulus that feeds the pain loop.\n<\/p>\n\n<h3>Repairing tissues<\/h3>\n\n<p>\n  Other approaches aim directly at tissue repair or regeneration: anti-inflammatory drugs,\n  injections, reconstructive surgery, or platelet-rich plasma (PRP) injections. This last technique\n  clearly illustrates the heterogeneity of the available data: it is being studied in several musculoskeletal\n  conditions, with results that vary considerably depending on the indication, the preparation protocol, and\n  the area treated <span class=\"bp-inline-ref\">(Thu, 2022)<\/span>.\n<\/p>\n\n<h3>Acting on nociceptive transmission<\/h3>\n\n<p>\n  Other approaches act on the transmission of pain signals: analgesics and pharmacological\n  treatments for neuropathic pain. They do not always correct the initial cause, but they can\n  help the system regain conditions more favorable to adaptation. The choice, type, and duration of\n  this kind of treatment are exclusively a matter for individualized medical prescription.\n<\/p>\n\n<h3>Modulating nervous system activity: noninvasive neuromodulation<\/h3>\n\n<p>\n  In fact, the nervous system has its own mechanisms for modulating pain. Certain noninvasive techniques\n  seek to influence them directly: transcutaneous electrical nerve stimulation (TENS), repetitive transcranial\n  magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). These approaches do not act on\n  tissues but on how the nervous system processes pain information. The available data\n  remain heterogeneous: a Cochrane review of noninvasive brain stimulation reports small,\n  short-lived effects for single-dose rTMS, without clearly exceeding the threshold of clinical significance\n  used <span class=\"bp-inline-ref\">(O&#8217;Connell et&nbsp;al., 2018)<\/span>; for TENS, an overview of several Cochrane\n  reviews concludes that the overall quality of evidence is low despite good methodological quality of the available\n  studies <span class=\"bp-inline-ref\">(Gibson et&nbsp;al., 2019)<\/span>.\n<\/p>\n\n<h3>Invasive neuromodulation<\/h3>\n\n<p>\n  When neuropathic pain remains severe despite the previous approaches, certain invasive\n  neuromodulation techniques may be offered after specialist evaluation: spinal cord stimulation\n  (electrodes placed against the spinal cord, connected to an implanted generator), dorsal root ganglion\n  stimulation, which is more targeted at certain localized neuropathic pain, and peripheral nerve\n  stimulation for very localized pain. The principle remains the same as for noninvasive techniques\n  \u2014 modifying the activity of the nerve circuits involved in pain \u2014 but the level of intervention differs. These\n  techniques generally require a trial period before implantation, followed by gradual adjustment of the\n  stimulation parameters, sometimes over several months. The available data support their use in certain\n  chronic refractory neuropathic pain conditions \u2014 notably after failed spine surgery or in complex regional pain\n  syndrome \u2014 after specialist evaluation, and not as a general answer to all chronic\n  pain <span class=\"bp-inline-ref\">(Taylor, 2006)<\/span>.\n<\/p>\n\n<h3>Restoring the adaptive capacities of movement<\/h3>\n\n<p>\n  Pain often leads to a gradual reduction in movement. Indeed, in the short term, this strategy is protective. In the long\n  term, it can reduce physical capacities and sustain certain adaptive loops, as discussed regarding\n  fear of movement in the article on\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/nervous-system-hypersensitization\/\">nervous system hypersensitization<\/a>.\n  Rehabilitation, adapted physical activity, and graded exposure seek to restore these capacities without\n  needlessly worsening symptoms.\n<\/p>\n\n<h3>Restoring self-regulation capacities<\/h3>\n\n<p>\n  Chronic stress, sleep disturbances, hypervigilance, and certain emotional responses can lastingly alter\n  how the nervous system functions, as detailed in the article on\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/psychological-pain\/\">psychological pain<\/a>.\n  Several approaches aim to strengthen self-regulation capacities: hypnosis, for which controlled trials\n  show significant reductions in pain associated with several chronic conditions\n  <span class=\"bp-inline-ref\">(Jensen &amp; Patterson, 2014)<\/span>; mindfulness meditation, for which a\n  review of the literature reports benefits for pain and quality of life in people with chronic\n  pain <span class=\"bp-inline-ref\">(Hilton et&nbsp;al., 2017)<\/span>; relaxation, controlled breathing, and\n  biofeedback. Their goal is not to deny the pain, but to act on certain mechanisms that contribute to\n  sustaining it.\n<\/p>\n\n<h3>Psychological approaches and non-drug therapies<\/h3>\n\n<p>\n  Cognitive behavioral therapies have a relatively solid body of literature for chronic pain,\n  particularly for reducing catastrophizing beliefs and improving day-to-day functioning\n  <span class=\"bp-inline-ref\">(Williams et&nbsp;al., 2020)<\/span>. Acupuncture shows a small but statistically significant specific effect beyond sham acupuncture on several types of chronic pain, with larger overall effects versus no-acupuncture controls\n  <span class=\"bp-inline-ref\">(Vickers et&nbsp;al., 2018)<\/span>. Yoga shows evidence of benefit for chronic low back pain, especially in the short to intermediate term; certainty varies across outcomes and follow-up periods\n  <span class=\"bp-inline-ref\">(Cramer et&nbsp;al., 2013)<\/span>. Other approaches such as qigong or tai chi are\n  frequently mentioned in the literature, with a level of evidence that varies considerably depending on the conditions and\n  protocols studied: they remain avenues to consider rather than established recommendations.\n<\/p>\n\n<div class=\"bp-figure\">\n  <img decoding=\"async\" src=\"https:\/\/blueportance.com\/wp-content\/uploads\/XI.2.Major-therapeutic-approaches-act-at-different-levels-of-an-integrated-system.png\" alt=\"Levels involved in chronic pain and the corresponding families of therapeutic approaches.\" loading=\"lazy\">\n<\/div>\n<p class=\"bp-figure-caption\">\n  <strong>Figure 2 \u2014 The main families of therapeutic levers.<\/strong> The approaches are organized according to the\n  level of the system on which they act \u2014 mechanical stresses, tissues, peripheral nerve, spinal cord,\n  brain, emotional regulation, behaviors, and social life \u2014 rather than according to the profession that delivers them.\n<\/p>\n\n<div class=\"bp-figure\">\n  <img decoding=\"async\" src=\"https:\/\/blueportance.com\/wp-content\/uploads\/XI.3.Therapeutic-approaches-target-adaptive-loops.png\" alt=\"Correspondence between chronic-pain maintenance loops and the main families of therapeutic approaches.\" loading=\"lazy\">\n<\/div>\n<p class=\"bp-figure-caption\">\n  <strong>Figure 3 \u2014 Therapeutic approaches target adaptive loops.<\/strong> Each family of approaches\n  acts preferentially on certain sustaining mechanisms; combining them in a personalized way makes it possible to intervene\n  at several levels of the system.\n<\/p>\n\n<h2 id=\"4-la-pause-dans-la-douleur-un-premier-pas-hors-de-la-boucle\">4. A pause in pain: a first step out of the loop<\/h2>\n\n<p>\n  People often talk about making pain go away. In practice, however, many people describe a different\n  goal instead, more modest and often more achievable: finally getting a few hours of relief.\n<\/p>\n\n<p>\n  Chronic pain often locks the person into a continuous experience of threat. A period of relief, even a\n  limited one, can be the first opportunity to experience once again a body that is no longer associated solely with\n  pain.\n<\/p>\n\n<p>\n  In fact, this notion of a pain pause deserves to be taken seriously. A period of relief, even a partial and\n  temporary one, may help reduce hypervigilance toward bodily sensations, allow new\n  positive experiences associated with movement or activity, rebuild confidence in the body\u2019s capacities, and\n  gradually reintroduce movement without experiencing it as a threat. In other words: the pause does not end\n  the adaptive loop on its own, but it can be its starting point.\n<\/p>\n\n<div class=\"bp-figure\">\n  <img decoding=\"async\" src=\"https:\/\/blueportance.com\/wp-content\/uploads\/XI.4.A-pause-in-pain-a-window-of-reversibility.png\" alt=\"Diagram showing how a temporary period of pain relief can create a window for positive movement and recovery experiences.\" loading=\"lazy\">\n<\/div>\n<p class=\"bp-figure-caption\">\n  <strong>Figure 4 \u2014 A pause in pain, a first step out of the loop.<\/strong> A period of relief, even a\n  brief one, may reintroduce positive experiences that could help initiate the way out of an established adaptive loop.\n<\/p>\n\n<h2 id=\"5-un-tableau-pas-un-catalogue-quel-niveau-de-preuve\">5. A table, not a catalog: what level of evidence?<\/h2>\n\n<div class=\"bp-definition\">\n  <strong class=\"bp-def-source\">Why this table?<\/strong>\n  <p>\n    Indeed, not all of the approaches mentioned have the same level of evidence. Some are widely validated, others\n    remain promising but still debated. This table does not seek to rank treatments,\n    but to help readers gauge how solid current knowledge is; it is not a formal evidence-grading system.\n  <\/p>\n<\/div>\n\n<table aria-label=\"How well documented are the main families of approaches?\">\n  <thead>\n    <tr>\n      <th>Family<\/th>\n      <th>What the literature shows<\/th>\n      <th>How well documented?<\/th>\n    <\/tr>\n  <\/thead>\n  <tbody>\n    <tr>\n      <td>Cognitive behavioral therapies<\/td>\n      <td>Significant effects on pain, mood, and day-to-day functioning <span class=\"bp-inline-ref\">(Williams et&nbsp;al., 2020)<\/span><\/td>\n      <td><span class=\"bp-evidence-etabli\">Well documented for selected chronic pain conditions<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Multidisciplinary programs<\/td>\n      <td>Superior to single-discipline care for pain, mood, and return to activity <span class=\"bp-inline-ref\">(Flor et&nbsp;al., 1992)<\/span><\/td>\n      <td><span class=\"bp-evidence-etabli\">Well documented for selected chronic pain conditions<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Acupuncture<\/td>\n      <td>Small but statistically significant specific effect beyond sham acupuncture, with larger overall effects versus no-acupuncture controls <span class=\"bp-inline-ref\">(Vickers et&nbsp;al., 2018)<\/span><\/td>\n      <td><span class=\"bp-evidence-modere\">Evidence varies by indication<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Yoga<\/td>\n      <td>Evidence of benefit for chronic low back pain, especially in the short to intermediate term; certainty varies across outcomes and follow-up periods <span class=\"bp-inline-ref\">(Cramer et&nbsp;al., 2013)<\/span><\/td>\n      <td><span class=\"bp-evidence-modere\">Moderately documented<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Hypnosis<\/td>\n      <td>Significant reductions in pain in several controlled trials <span class=\"bp-inline-ref\">(Jensen &amp; Patterson, 2014)<\/span><\/td>\n      <td><span class=\"bp-evidence-modere\">Moderately documented<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Mindfulness meditation<\/td>\n      <td>Benefits for pain and quality of life <span class=\"bp-inline-ref\">(Hilton et&nbsp;al., 2017)<\/span><\/td>\n      <td><span class=\"bp-evidence-modere\">Moderately documented<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>TENS<\/td>\n      <td>Overall low quality of evidence despite good methodological quality of the reviews <span class=\"bp-inline-ref\">(Gibson et&nbsp;al., 2019)<\/span><\/td>\n      <td><span class=\"bp-evidence-variable\">Limited \/ heterogeneous evidence<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Noninvasive neuromodulation (rTMS, tDCS)<\/td>\n      <td>Small, short-lived effects, below the threshold of clinical significance used <span class=\"bp-inline-ref\">(O&#8217;Connell et&nbsp;al., 2018)<\/span><\/td>\n      <td><span class=\"bp-evidence-variable\">Limited \/ heterogeneous evidence<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Invasive neuromodulation (spinal cord stimulation)<\/td>\n      <td>Good-quality evidence for refractory neuropathic pain after failed spine surgery or complex regional pain syndrome, subject to specialist evaluation <span class=\"bp-inline-ref\">(Taylor, 2006)<\/span><\/td>\n      <td><span class=\"bp-evidence-modere\">Evidence varies by indication<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Platelet-rich plasma (PRP)<\/td>\n      <td>Results varying widely depending on the musculoskeletal condition treated and the protocol used <span class=\"bp-inline-ref\">(Thu, 2022)<\/span><\/td>\n      <td><span class=\"bp-evidence-variable\">Evidence varies by indication<\/span><\/td>\n    <\/tr>\n    <tr>\n      <td>Qigong, tai chi<\/td>\n      <td>Mentioned in the literature; heterogeneous protocols and study populations<\/td>\n      <td><span class=\"bp-evidence-variable\">Limited \/ heterogeneous evidence<\/span><\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n\n<h2 id=\"6-les-approches-ne-s-opposent-pas-elles-peuvent-etre-complementaires\">6. The approaches are not in opposition: they can be complementary<\/h2>\n\n<p>\n  It would be reductive to set drug treatments, physical techniques, rehabilitation, psychological approaches,\n  and non-drug therapies against one another. In many situations, these approaches act on different\n  dimensions of the same system: combining them can help interrupt several adaptive loops\n  simultaneously. This is the logic followed by multidisciplinary pain management programs,\n  whose effectiveness, superior to that of isolated approaches, has long been documented\n  <span class=\"bp-inline-ref\">(Flor et&nbsp;al., 1992)<\/span> and has been confirmed by more recent reviews of the\n  biopsychosocial approach to chronic pain <span class=\"bp-inline-ref\">(Gatchel et&nbsp;al., 2007)<\/span>.\n<\/p>\n\n<div class=\"bp-model\">\n  <h2 id=\"vers-une-medecine-de-l-adaptation\">Toward a medicine of adaptation<\/h2>\n  <p>\n    The question is therefore no longer only \u201cwhich treatment should be chosen?\u201d It becomes: which adaptive\n    loops are sustaining this pain, and which levers will most effectively modify them?\n  <\/p>\n  <p>\n    This change of perspective thus no longer consists solely of treating pain. It consists of gradually\n    restoring the adaptive capacities of the living organism \u2014 the most integrative expression of the adaptive system (C7)\n    described in the Blue Portance model.\n  <\/p>\n  <h3>Concrete levers for restoring movement<\/h3>\n\n  <p>\n    In concrete terms, this restoration often relies on simple levers already at the heart of the Blue Portance\n    biomechanical model: relearning movement where immobility has set in \u2014 because after a prolonged period of\n    pain or avoidance, it is not just a matter of resuming an activity, but of rebuilding\n    motor patterns that have become cautious or altered \u2014, regaining the micro-movements and continuous postural\n    micro-adjustments that define dynamic balance (C6), and seeking variability in support points rather than fixed\n    support: living organisms tolerate a varying stress better than a monotonous one (C1).\n  <\/p>\n  <p>\n    There is, however, no single path: each person presents a different combination of adaptive\n    loops, stresses, and resources. Restoring adaptability therefore requires the practitioner to\n    build an individualized adaptability strategy \u2014 in which the gradual relearning of movement\n    is often the common thread \u2014 rather than applying a standard protocol.\n  <\/p>\n  <img decoding=\"async\" src=\"https:\/\/blueportance.com\/wp-content\/uploads\/XI.5.Toward-adaptation-medicine.png\" alt=\"Diagram showing restoration of adaptive capacities through movement, micro-movements, support variability and individualized care.\" loading=\"lazy\">\n<\/div>\n<p class=\"bp-figure-caption\">\n  <strong>Figure 5 \u2014 Toward a medicine of adaptation.<\/strong> Lastingly restoring the adaptive capacities of the\n  living organism does not consist solely of eliminating pain. It involves gradually reintroducing\n  movement, micro-movements, variability in support points, and functional activity, along a\n  personalized path specific to each individual.\n<\/p>\n\n<h2 id=\"7-un-dernier-facteur-le-contexte-du-soin\">7. One last factor: the care context<\/h2>\n\n<p>\n  Chronic pain appears when the adaptive capacities of the living organism become insufficient in the face of the\n  stresses imposed on it. This interpretation does not replace existing approaches: it proposes a\n  framework for connecting them, in which each treatment becomes a means of restoring these adaptive\n  capacities at its own level. Another element, however, plays a part in the effectiveness of care: how\n  the brain interprets the care context itself \u2014 which is what we will address in the next article of this\n  guide, devoted to the placebo effect.\n<\/p>\n\n<div class=\"bp-takeaway\">\n  <h2 id=\"a-retenir\">Key takeaways<\/h2>\n  <ul>\n    <li>There is no universal treatment for chronic pain: the choice of care depends on the mechanisms that are dominant in a given person.<\/li>\n    <li>The same pain can simultaneously involve several adaptive loops \u2014 mechanical, neural, behavioral, psychological \u2014, which explains why acting on a single lever is rarely enough.<\/li>\n    <li>The approaches fall into seven main families according to the target they modify: mechanical stresses, tissue repair, nociceptive transmission, neuromodulation (noninvasive and invasive), physical capacities, self-regulation, and cognitive and social dimensions.<\/li>\n    <li>A pause in pain, even a partial one, can be a starting point for gradually getting out of an established adaptive loop.<\/li>\n    <li>The level of evidence varies widely from one approach to another: some are well documented for selected chronic pain conditions (cognitive behavioral therapies, multidisciplinary programs), while others are moderately documented, or their evidence varies by indication or remains limited.<\/li>\n    <li>These approaches are thus not in opposition: combining them often makes it possible to act on several adaptive loops at once.<\/li>\n  <\/ul>\n<\/div>\n\n<section class=\"bp-faq\">\n  <h2 id=\"questions-frequentes\">Frequently asked questions<\/h2>\n\n  <details>\n    <summary>Is there a treatment that works for all chronic pain?<\/summary>\n    <div class=\"faq-content\">\n      No. Chronic pain generally results from several interacting mechanisms that are specific to each\n      person. The choice of care depends on the adaptive loops that appear dominant in a given\n      situation, not on a universal hierarchy of treatments.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary>Do you have to choose between medication, rehabilitation, and psychological approaches?<\/summary>\n    <div class=\"faq-content\">\n      Not necessarily. These approaches often act on different dimensions of the same system, and\n      combining them can help interrupt several adaptive loops simultaneously \u2014 this is the principle behind\n      multidisciplinary pain management programs.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary>Does a pause in pain mean recovery?<\/summary>\n    <div class=\"faq-content\">\n      No, but it can play an important role. A period of relief, even a partial one, can reduce\n      hypervigilance, allow new positive experiences, and make a gradual return to\n      movement easier \u2014 without, on its own, guaranteeing that the pain will disappear for good.\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary>Do all non-drug therapies have the same level of evidence?<\/summary>\n    <div class=\"faq-content\">\n      No. Some, such as cognitive behavioral therapies or acupuncture for several indications,\n      have a relatively solid body of literature. Others, such as qigong or tai chi, remain interesting\n      avenues but with a level of evidence that varies more from study to study.\n    <\/div>\n  <\/details>\n<\/section>\n\n<div class=\"bp-cta\">\n  <h2 id=\"vous-souhaitez-comprendre-votre-propre-situation\">Would you like to understand your own situation?<\/h2>\n  <p>\n    The mechanisms presented in this guide help explain why pain persists, but they do not\n    replace an individual evaluation.\n  <\/p>\n  <a href=\"https:\/\/blueportance.com\/en\/personalized-pain-analysis\/\">Analyze my situation \u2192<\/a>\n<\/div>\n\n<p class=\"bp-note\">\n  <strong>Note:<\/strong> this content presents general knowledge and does not constitute a diagnosis or a\n  prescription. The choice of care, including non-drug care, should be discussed with a healthcare\n  professional, particularly if you are currently taking medication or have a coexisting medical condition.\n<\/p>\n\n<section class=\"bp-references\">\n  <h2 id=\"references-scientifiques\">Scientific references<\/h2>\n\n  <h3>Psychological approaches and multidisciplinary care<\/h3>\n  <ol>\n    <li>Williams ACC, Fisher E, Hearn L, Eccleston C. <em>Psychological therapies for the management of chronic pain (excluding headache) in adults.<\/em> Cochrane Database Syst Rev. 2020;8(8):CD007407.<\/li>\n    <li>Flor H, Fydrich T, Turk DC. <em>Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.<\/em> Pain. 1992;49(2):221\u2013230.<\/li>\n    <li>Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. <em>The biopsychosocial approach to chronic pain: scientific advances and future directions.<\/em> Psychol Bull. 2007;133(4):581\u2013624.<\/li>\n  <\/ol>\n\n  <h3>Tissue repair<\/h3>\n  <ol start=\"4\">\n    <li>Thu AC. <em>The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review.<\/em> J Yeungnam Med Sci. 2022;39(3):206\u2013215.<\/li>\n  <\/ol>\n\n  <h3>Neuromodulation and stimulation<\/h3>\n  <ol start=\"5\">\n    <li>Gibson W, Wand BM, Meads C, Catley MJ, O&#8217;Connell NE. <em>Transcutaneous electrical nerve stimulation (TENS) for chronic pain \u2014 an overview of Cochrane Reviews.<\/em> Cochrane Database Syst Rev. 2019;CD011890.<\/li>\n    <li>O&#8217;Connell NE, Marston L, Spencer S, DeSouza LH, Wand BM. <em>Non-invasive brain stimulation techniques for chronic pain.<\/em> Cochrane Database Syst Rev. 2018;CD008208.<\/li>\n    <li>Taylor RS. <em>Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain\/failed back surgery syndrome: results of a systematic review and meta-analysis.<\/em> J Pain Symptom Manage. 2006;31(4 Suppl):S13\u2013S19.<\/li>\n  <\/ol>\n\n  <h3>Non-drug therapies<\/h3>\n  <ol start=\"8\">\n    <li>Vickers AJ, Vertosick EA, Lewith G, et al. <em>Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.<\/em> J Pain. 2018;19(5):455\u2013474.<\/li>\n    <li>Cramer H, Lauche R, Haller H, Dobos G. <em>A systematic review and meta-analysis of yoga for low back pain.<\/em> Clin J Pain. 2013;29(5):450\u2013460.<\/li>\n    <li>Jensen MP, Patterson DR. <em>Hypnotic approaches for chronic pain management: clinical implications of recent research findings.<\/em> Am Psychol. 2014;69(2):167\u2013177.<\/li>\n    <li>Hilton L, Hempel S, Ewing BA, et al. <em>Mindfulness meditation for chronic pain: systematic review and meta-analysis.<\/em> Ann Behav Med. 2017;51(2):199\u2013213.<\/li>\n  <\/ol>\n<\/section>\n\n<p class=\"bp-copyright\">\n  \u00a9 Gil Ayache. The concepts, diagrams, terminology, and principles presented on this page constitute a work protected by copyright. They are made available to Blue Portance under an intellectual property license agreement, without transfer of economic rights or of authorship.\n<\/p>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Blue Portance \u2192 Knowledge Base \u2192 Understanding Pain \u2192 Getting Out of Chronic Pain Blue Portance Expert Guides Understanding Pain The biological, mechanical, and neurophysiological mechanisms of pain. This article is part of the Expert Guide \u201cUnderstanding Pain\u201d. Synthesis article \u2014 Blue Portance Knowledge Base Getting Out of Chronic Pain: Restoring the Adaptive Capacities of [&#8230;]\n","protected":false},"author":6,"featured_media":0,"parent":8012,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_yoast_wpseo_title":"Restoring Adaptability in Chronic Pain | Blue Portance","_yoast_wpseo_metadesc":"Getting out of chronic pain by restoring adaptability: therapeutic levels, evidence, and a window of reversibility.","footnotes":""},"pathologie_secondaire":[],"effet_positif":[],"class_list":["post-8078","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.7 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Restoring Adaptability in Chronic Pain | Blue Portance<\/title>\n<meta name=\"description\" content=\"Getting out of chronic pain by restoring adaptability: 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