Shifting pain phenotypes with physical therapy treatment: an exploration study
Adriaan Louw1,2,3, Merrill R Landers3, Kevin Farrell1,2
1Pain Science Division, Evidence in Motion, Story City, IA, USA.
The Journal of Manual & Manipulative Therapy
|May 8, 2026
Summary
Pain phenotypes can change during physical therapy. This study found that patients
Area of Science:
- Pain management
- Clinical assessment
- Musculoskeletal disorders
Background:
- Pain phenotyping classifies pain as nociceptive, neuropathic, or nociplastic, guiding treatment.
- Empirical evidence for pain phenotype shifts during treatment is lacking.
Purpose of the Study:
- To investigate if pain phenotypes change during physical therapy for musculoskeletal pain.
Main Methods:
- Clinicians assessed pain phenotypes at initial, 3rd, and 6th visits for 92 patients.
- Patients received standard physical therapy care between assessments.
Main Results:
- A significant shift in pain phenotypes was observed over the course of physical therapy.
- Phenotypes changed from more complex (nociplastic) to less complex (nociceptive) types by the 6th visit.
Conclusions:
- Pain phenotypes may evolve during physical therapy interventions.
- Further research is needed to identify factors influencing these phenotype shifts.
