The Role of Physical Therapy in Pain Management

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The Role of Physical Therapy in Pain Management

There are currently a variety of physical modalities with specific reference

to effectiveness in reducing arthritis-related pain. As the physician

considers selection of a specific modality, two facts must be remembered:

the physiologic component of pain may be of musculoskeletal origin and from

the disease itself and physical relief of musculoskeletal pain is short

lived at best, unless paired with some form of exercise that alters the

source of pain. Therefore the proper treatment and therapy should be well

planned.

The goals of physical therapy in the care of the patient with arthritis are:

Relieve pain

Decrease impairment

Improve or maintain function

Prevent or minimize disability, both primary and secondary

Educate the patient to be effective in self-management

Therapeutic effect is sought through a variety of physical interventions in

the clinical and self-management settings. Pain management becomes a primary

objective when the person wants to engage in a therapeutic exercise program,

sleep more comfortably, function more successfully, or maintain adequate

levels of physical activity during the day. Arthritis pain management may be

the primary goal of treatment, or it may occur as the consequence of other

therapeutic interventions.

Heat

Heat can provide pain relief, promote relaxation, reduce muscle spasms, and

enhance muscle flexibility. Heat can be delivered by radiation (light) or

conduction (hot pack, water). In physical therapy, heat is used in

conjunction with other interventions, such as exercise.

Cold

Cooling has a local pain relief effect and reduces inflammatory responses

and muscle spasms. Cold is applied using ice packs, ice massage, immersion,

or coolant sprays. There is no evidence that a particular type of coolant

produces superior results.

In the treatment of arthritis, pain relief, reduction of muscle spasms and

the management of overuse injuries are the principle uses for cold therapy.

Cold tends to be effective and well tolerated by arthritis patients. Cold

packs are generally applied three times a day for a month.

Exercise

Persons with arthritis demonstrate limited range of motion, decreased muscle

strength and endurance, abnormalities in walking, and an overall general

de-conditioning. Appropriate regular exercise can improve deficits in these

areas and reduce pain, fatigue, and depression. The evidence supporting

improvement of pain through exercise in arthritis is ever climbing.

Although arthritis is a chronic, often progressive disease, care providers

must be conscious of the potential trajectory of the disease and long-range

outcomes. Most individuals seek care when pain interferes with function and

social roles. Then, clinical care is shifted on resolution of the immediate

crisis, and pain reduction is a major goal.

No one health care provider can be a knowledgeable expert about all areas of

comprehensive care, but providers can decide when and where to refer

patients when additional services are needed. This will enable the patient

to find his or her way to the appropriate resource at the appropriate time.