pain neuroscience, has expanded dramatically over the past two decades and has led to shifts in how chronic pain is approached. In contrast to the old model of resting and decreasing activity to avoid pain, the trend is shifting towards promoting activity and exercise as a more effective way to treat chronic pain and maintain function. Exercise programs have been shown to be effective in ameliorating pain and improving function. As experts in exercise and movement, physical therapists are in an optimal position to provide individualized exercise programs in a safe and supportive environment. A systematic review of exercise for chronic pain suggests that exercise can contribute to improvements in pain symptoms and functioning, though more research is needed (Geneen et al., 2017). A large scale study that followed a population over 11 years showed that those who exercised at baseline were less likely to have musculoskeletal complaints than inactive people, and those who exercised three times or more per week were 28% less likely than inactive people to report chronic, widespread pain (Holth et al., 2008). The general consensus in research is that any movement and exercise, no matter how minimal, is desired, and no adverse effects of exercising have been found in randomized controlled trials (RCTs). Physical therapists can help patients avoid side effects such as soreness by providing patient education and safe progression (Ambrose & Golightly, 2015). Physical therapists are the optimal healthcare providers to help individuals with chronic pain engage in physical activity. Individuals with chronic pain often have many barriers to engaging in physical activity, Additional strategies A number of additional strategies that have been helpful in managing pain have been described. These include: ● Cognitive behavioral approaches : Cognitive-behavioral approaches include guided imagery, biofeedback, and meditation. The goal of these approaches is to decrease sympathetic nervous system activity and decrease the fear surrounding pain. For example, guided imagery involves having the patients use all of their senses to imagine being in a place that is comfortable, pleasant, and safe. Patients imagine seeing, hearing, and smelling the components of a summer garden, for instance. Biofeedback involves using a physiologic monitor (such as heart rate) to evaluate relaxation. As the patient focuses on relaxing, the heart rate should decrease. Using these types of approaches when experiencing pain helps to control the pain and diminish unpleasant effects (Copstead & Banasik, 2013). ● Mindfulness training : Is another behavioral technique that has been shown to decrease chronic pain levels and improve function. Mindfulness training involves increasing awareness of thoughts, feelings, and sensations without judging them. Rather than trying to control these feelings or react to them, a person learns to accept them. This helps to decrease the fear of their pain, which helps to decrease sympathetic nervous system activity. These techniques have been found to decrease symptom severity in women with fibromyalgia (Cash et al., 2015). A study comparing cognitive behavioral techniques and mindfulness training in patients with back pain also showed significant improvements in pain with both approaches (Cherkin et al, 2016). Research on these topics highly suggests the benefit of utilizing these types of behavioral approaches in treating chronic pain. Cognitive behavioral therapy treatment must be provided by a trained Conclusion Physical therapists play important roles in the assessment of and treatment options for the millions of people experiencing pain in the United States. This course has presented a brief overview of pain that included a definition, a discussion of acute and chronic pain, and a description of the types of pain. The physiology of
such as fear-avoidance behavior and poor self-efficacy. Through supervised, individualized exercise programs and education, physical therapists can help individuals overcome these barriers (Ambrose & Golightly, 2015). Pain neuroscience education (PNE) is another promising approach that has shown to be effective in reducing symptoms in individuals with chronic pain. The goal of PNE is to explain the biopsychosocial nature of chronic pain and the role the nervous system has in perpetuating pain, even in the absence of tissue damage. This knowledge then can decrease the patient’s fear of pain as they begin to understand the mechanism behind it. A systematic review of RCTs that studied the efficacy of PNE in treatment of chronic musculoskeletal pain showed that PNE is effective in lowering pain and disability and improving function, as well as decreasing maladaptive pain behaviors (Louw, et al, 2016). In one study, a brief psychosocial education program about low back pain reduced the incidence of back pain in a military population more than a preventative program of core stabilization (George et al, 2011). While PNE may seem at odds with physical therapy interventions such as manual therapy, Louw and colleagues argue that using PNE together with manual techniques is possible and even optimal, as PNE may decrease pain sensitivity that allow manual techniques to be used. Employing manual techniques may then allow the patient to engage in more active interventions like exercise (Louw et al., 2017). More research is needed to examine this relationship, but the research suggests that incorporating PNE into physical therapy treatment is beneficial to the patient’s outcomes. behavioral health practitioner. However, there are techniques and strategies that can be incorporated into physical therapy practice. The reader is encouraged to seek additional reading on this topic. ● Nutritional considerations : Nutrition, vitamins, and herbs. Foods that increase heart rate and agitation, such as caffeine, may increase pain levels in some patients. Patients should work with their healthcare team, particularly the dietician, to identify foods that have positive and negative influences on pain control. Some herbal preparations, such as ginkgo, cloves, and cinnamon, have been used in pain relief, as have some vitamin supplements. It is imperative that patients consult with their physicians before adding any nutritional, herbal, or vitamin supplements to their pain management regimen. These substances can cause harmful interactions with each other or with other drugs, and can also produce side effects (American Cancer Society, 2016). Finally, effective pain management programs depend on an interdisciplinary approach. Even though specific disciplines have specific areas of expertise, everyone must work together. It is also important to remember that patients and their families or caretakers are the most important members of the team. If they do not agree with and support the plan of care, their compliance will be poor. If they do not have all of the relevant information about a treatment, they may not adhere to their treatment plan. The therapeutic alliance, or the working relationship between physical therapists and patients, is drawing increased attention in research for the impact it has on patients’ pain perceptions (Fuentes et al, 2014). Involving the patient in goal setting, treatment planning, and education are essential parts of forming this therapeutic alliance. pain and its impact on economic and personal statuses was also discussed. Finally, an overview of pain assessment and treatment was presented, followed by a list of educational resources related to pain and pain management.
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Book Code: PTNC1023
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