Pain is a complex pathology as its origin and diagnosis both are difficult. With this, sometimes there is also a poor response to standard physical therapy modalities which can cause severe disability unrelated to its cause of origin.
The primary goal of an effective pain management is to investigate the underlying cause, to make the differential diagnosis, to eliminate risk factors, and to reduce pain. The physician should also be aware of functional and psychological conditions of the patient. Therefore, a multimodal management plan in pain is essential.
Causes of Pain
There can be infinite reasons for the development of pain in human body. It can be central as injuries, strokes, trauma, depression and HIV or peripheral as neuropathy, alcohol or substance abuse, inflammation, nutrition deficiency, phantom pain and others.
Physical Therapy Modalities
Physical therapy modalities include pain modulators like hot and cold packs, ultrasound, short wave diathermy, low frequency currents (TENS, diadynamic currents, interferential currents), high voltage galvanic stimulation, laser and neurostimulation techniques like deep brain stimulation. Hot and cold applications can be used together as in contrast baths. Sometimes fluidotherapy or whirlpool can also be chosen for this purpose. In all these superficial heat agents should not be applied in high degrees, due to possible risk of increase in pain.
- Laser is another physical therapy agent that can be used in the treatment of pain.
Very low level of laser has been shown effective in patients primarily with neuropathic pain. When very low laser therapy is applied, it decreases pain and inflammation, in addition to improving functional ability.
- Transcutaneous Electric Nerve Stimulation (TENS) is one of the best modalities that have been shown to be effective in the treatment of pain.
It is suggested that TENS activates central mechanisms to provide analgesia. Low frequency TENS activates μ-opioid receptors in spinal cord and brain stem while high frequency TENS produces its effect via δ-opioid receptors. Studies suggest that TENS is very effective in the cases of acute, chronic and postoperative pain.
- Neurostimulation techniques including Transcranial Magnetic Stimulation (TMS), Spinal Cord Stimulation (SCS) and Deep Brain Stimulation (DBS) have been found effective in the treatment of acute and neuropathic pain.
Patients have reported a decrease in pain depending on the localization and cause of pain.
- Rehabilitation is also an essential part of treatment in pain.
The main aims of rehabilitation are to decrease pain and amount of medication, improve dysfunction, increase quality of life and physical activity and bring the patient’s self-esteem back. Many kinds of therapeutic exercises have already been used in the rehabilitation program such as conditioning, strengthening and stretching exercises.
- Psychotherapy has the purpose to treat emotional, behavioral or mental dysfunction.
Remove negative symptoms such as anxiety or depression, modify or reverse problem behaviors, help the individual cope with situational crises such as bereavement, pain, or prolonged medical illnesses, improve the individual’s relationships, manage conflict or enhance positive personality growth and development.
- Psychosocial treatment approaches, cognitive behavioral methods and the prevalence of emotional stress have been investigated and the effectiveness of psychological treatment has been evaluated.
It showed that psychosocial support increases the efficacy of treatment.
Which one is for me?
There are many physical therapy modalities available along with rehabilitation and psychotherapy techniques. These must be emphasized and combined with pharmacotherapy in daily practice. Physical therapy modalities such as superficial and deep heat agents, analgesic currents and laser are sometimes not sufficient in the treatment of chronic pain when applied alone. With a combination of various techniques, pain treatment is bound to yield good results. Every modality can be customized according to the severity of pain. For more information, consult your pain physician.