Everybody experiences pain, which is a healthy response in the body. However, when pain fails to go away then chronic pain can develop. Chronic pain is estimated to affect 1.65 million people in Ireland alone. Topping that list of chronic pain is chronic back pain. To celebrate World Physiotherapy Day 2019, we will discuss the role of physiotherapy in the management of chronic pain.
Chronic pain has been defined as, “pain that persists for 3 months or longer, it is considered chronic and, while not necessarily mal-adaptive, often leads to physical decline, limited functional ability and emotional distress.”
So, this means that chronic pain can be pain that exists beyond the normal tissue healing process or where there is no evidence of tissue damage or biological reason for the pain symptoms. Chronic pain becomes a disease of the central nervous system.
There are a couple of difference kinds of chronic pain, which can present with hyperalgesia, a heightened sensitivity to pain, allodynia, sensitivity to pain response of non-painful stimuli, or dysaesthesia, a response to irregular abnormal sensations.
For many, chronic pain can have a detrimental effect on daily life. It will impact sleep, work, home life, leisure activities, and the ability to interact with children, family and friends. In cases where the pain is severe, chronic pain can stop sufferers from participating in social events, or even affect ability to work or play.
There are closely associated psychological factors, such as anxiety, depression and stress, to chronic pain. It’s estimated that between 30-45% of people who suffer from chronic pain also suffer from depression. Negative emotional events can create a sensation of pain in the absence of tissue damage, which can worsen the symptoms of pain.
Physiotherapists can play an important role in the management of chronic pain, though, as our profession allows us to understand the limitations and dysfunction that comes from it.
By working with a physiotherapist who understands the pain, they will be able to treat symptoms in a holistic manner with the aim to improve quality of life. The physiotherapist will set specific achievable goals with the patient that suits their lifestyle. Physiotherapy needs to also consider the patient’s particular condition and wellbeing in order to progress them on the road to recovery.
From a physiotherapy point of view, treating chronic pain requires a multi-dimensional approach, combined with efforts from GPs, pain management consultants, psychologists, orthopaedic specialists and rheumatologists to give greater benefits from treatment.
How Physiotherapy Can Treat Chronic Pain
Patient Education: Education and increasing the patient’s understanding of chronic pain is an important step in the management of the condition.
Exercise Therapy: Often, due to the severity of chronic pain, participation in exercise declines due to fear of worsening symptoms. Patients are often advised not to move through pain due to fear of increased pain. Physiotherapists will be able to advise and prescribe exercises that are pain-free or pain-reducing in order to get patients mobile again. The physiotherapist can create a programme of graded approach to exercise based on the individual’s needs, as well as aiming to improve strength and flexibility.
Manual Therapy: With reduced movements or limited exercise due to the chronic pain, joints can become stiff and irritable. Your physiotherapist can help by manipulating or mobilising joints, which will restore movement.
Soft Tissue Treatments: Your physiotherapist may decide to perform massage, trigger point therapy, myofascial release and stretching to improve movement and reduce pain. Soft tissue treatments can desensitise the area of pain.
Pilates Or Postural Exercises: Physiotherapy-lead Pilates can be an excellent treatment option, especially for chronic neck or back pain as it is low intensity and helps to build strength and control. Physiotherapists can also give patients a home exercise program of postural exercises.
Cognitive Behaviour Therapy: Specialist Physiotherapists can be trained in the management of chronic pain by using cognitive therapy and pain management approaches. This can be done on one to one basis or in group settings.
Acupuncture: This ancient Chinese medicine can be a useful alternative treatment option for chronic pain. The National Institute Of Health found studies which suggest that acupuncture is effective in chronic pain associated with the neck and back, headaches and osteoarthritis of the knee. Physiotherapists may have completed additional training in acupuncture and can offer this as a treatment option.
Electrotherapy: Treatment options can be effective in decreasing the sensation of pain. You can read more about electrotherapy in a previous blog post.
Heat & Cold Therapy Treatment: This can be effective in the desensitising of pain. Heat helps the muscles to relax, encourages circulation and increases blood flow to the area, which can reduce pain. Cold therapy reduces the blood flow to the area, numbing the area and slowing down the pain messages sent from your nerves to your brain.
By using a combination of treatment options, patients suffering with chronic pain can begin to control their pain and resume participation in daily activities. The goal of physiotherapy is to enable and empower the individual to gain back control of their life, and reduce the fear and avoidance associated with chronic pain.