| Summary: | The non-specific chronic lower back pain (CLBP) has been for the last few years one of the mankind "scourges", with high prevalence and incidence rates, reflected in high rates of absenteeism, high social costs and overburden of the healthcare systems. This disease is yet to find an effective therapeutic response, either in the pharmacological or non-pharmacological treatments. It is a systemic condition, not just a local one, considering all the multiple dysfunctions it entails. One of these is reflected on the central nervous system and the peripheral nervous system, negatively influencing the neuronal connections, the cortical thickness and the volume of the gray matter in certain areas of the brain. The chronic pain has therefore repercussions on brain organization and its performance on the ability to modulate and inhibit pain. As a result, changes in discriminatory sensitivity located in the painful lumbar region are described, however, it is not yet known whether the remaining region of the dorsum is also affected. Given the clinical importance of this information for postural correction and muscle strengthening, the purpose of the first work of this thesis was to investigate the ability for superficial and painful tactile sensory discrimination throughout the dorsum of CLBP patients and compare it with healthy individuals. The results led to the conclusion that CLBP patients have less capacity for sensitive discrimination throughout the dorsum, with marked differences between various regions. It is known that physical exercise programs have been the most successful instruments to decrease CLBP symptoms by raising the threshold of pain perception and physical capacity of these patients. Given that physical exercise, specially of high-intensity seems to have favourable physiological responses, either peripheral and central, the second work of this thesis tested the raised hypothesis that high-intensity physical training improves the discriminative ability of these patients' superficial and painful tactile sensitivity and decreases the intensity of their pain. The results supported the hypothesis, leading to the conclusion that high-intensity physical training improves sensitive discrimination in the dorsum, reduces the intensity of referred pain as well as the extent of the painful area. It is known that, depending on the intensity of physical exercise, there is production of a vast set of neurotrophins, crucial for the creation of a new network of brain connections with the activation of the modulation system of descending inhibition and with the growth of new brain connections. The creation of new brain connections is also associated with the training of motor imaging, whose therapeutic efficacy has been tested, in isolation, in CLBP. Considering this, as well as the results of the second study, it was hypothesized that motor imaging training combined with high-intensity physical training would have better results compared to physical training when applied on its one. This hypothesis was tested in the third and fourth works of this thesis, and the results confirmed the working hypothesis, with improvement in the intensity and pain area of the patients. The results of the four studies carried out allow us to conclude that CLBP has a central affection component, with peripheral repercussions on the intensity and extent of the pain area, on the discrimination of the sensitivity of the dorsum and on the functional ability. High-intensity physical training, especially when associated with motor imaging training, minimizes these consequences.
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