Physiotherapy in the Management of Pain
Physiotherapy has traditionally had a role based on maximising an individual’s functional movement and participation towards maintaining and improving health, well-being and quality of life Skills employed in wide variety of fields and many settings Many different patient groups and types of condition Involved at all stages of dysfunction Recognised part of MDT management Well placed to have a role in the management of pain
Pain is often accompanied by significant emotional distress, disruption in physical and social functioning, and reduction in quality of life The causes and consequences of pain are complex and multifactorial. Pain is often difficult to assess, investigate, treat and manage Specific role of physiotherapy dependant on the context, environment, and specific expertise of individual therapists
Injury / pain Rest and gentle movement Improvement Movement restored / no pain What generally happens
Injury /pain Attempted movement / Tried to rest More pain Fatigue, sleep disturbance, mood changes etc. Sometimes this happens
Widespread pain and tenderness Fatigue Less movement Sleep disturbance Mood changes Decreased appetite Reduced quality of life Can lead to this
Manual therapy Electrotherapy Exercise therapy Rehabilitation programmes All these have been shown to have some level of benefit but are sometimes not completely effective Going back to our traditional approach
RCP Guidelines CRPS 2012
Altered chemical profile Altered sensory maps Altered response to sensory stimuli Altered motor maps Altered brain activation with movement In individuals with chronic pain
Desensitisation Behaviour change techniques Exercise and movement with particular focus on application and progression Facilitation of normal movement Be part of an MDT approach May need to broaden our approach
Part of Overall Management
Flexibility – stretches, active, active assisted Exercise Strength – working all groups Cardiovascular fitness Posture and alignment
General / mixed Programme Include specifics – core stability Functional Based around goals
Overactivity Increased Pain Rest (with frustration) Pain Eased Beware of overdoing it
Boom or Bust Cycle Flare-up occurs Pain Onset Incapacitated Time Activity
What does individual want to achieve ? Progression Steps to success Establish baseline Start at 80 % Increase activity level by 5-10% per week
Daily gentle active stretches For example Relaxation / supported positioning Daily walk – given distance and time Small number strengthening / stabilisation exercises
Maintain activity level Aiming to Don’t stop Spread it out If pain remains increased for 48 hours, reduce to 50%, explore options but don’t stop
Advise Role of Physiotherapist Feedback Reassure / support Liaise Supervise
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