WHAT IS PAIN?

Pain is an unpleasant feeling that is the biggest reason behind your visit to healthcare professionals especially physical therapists because, in the management of pain, the role of physical therapists is extremely important. To better understand this, you need to have some sound knowledge of why pain occurs and what is the mechanism behind this. In this way, you can better understand why one feels pain and how to manage it more effectively.

PAIN ACCORDING TO LATEST STUDIES

Pain was once regarded as an indicator of injury but now the latest studies reveal that pain can also occur as a warning signal to alert us about any potential damage to body tissues so, we can take action to protect ourselves. In short, feeling pain does not necessarily mean a physical injury has occurred. Pain can also result from the potential for injury, such as with an ankle sprain, where special nerves send signals to the brain to warn of damage. The body responds to minimize damage and begin the healing process.Interestingly, when a tissue is injured, pain signals can increase or decrease based on specific situations. For example, while trying to escape a burning building, you may not be aware of your injury until you are safe because the warning signals are overridden for a more important reason: survival. Science has shown that this ability to rank the importance of warning signals occurs in the brain, leading to the conclusion that the sensation of pain is triggered by and occurs in the brain. Science has also shown that no two human experiences of pain are alike. Therefore, each person’s pain experience will be different from others and is affected by a range of factors such as life experiences, psychological histories, living environments, and social structures. These past experiences can help in designing treatment regimens to alleviate pain and understand the other causes behind persistent pain conditions.

BRAIN & BODY APPROACH TO TREAT PAIN

The current concept of pain leads to several major changes in the treatment strategies. For example, it changes the way a physical therapist approaches the condition. Back in the day, many treatments were mainly focused on healing injury or damaged tissue that actually helped people to reduce pain. But now, based on the new evidence regarding pain, physical therapists are using treatment plans to manage pain that also focus on other factors such as environment, stress, psychology, and social considerations. This new concept, called as “Brain and Body” approach, is known to positively influence the amount of pain experienced, and is therefore, regarded as an important shift in pain treatment that opens new doors to a better understanding of the purpose and nature of pain.

MISUSE OF OPIOIDS

The misuse of opioids has evolved into a pressing public health crisis in the United States and beyond. Its origins trace back to the late 1990s when the medical community lacked awareness of the addictive nature of opioid-based pain relief medications. As healthcare providers increased their opioid prescriptions, alarming evidence of addiction began to emerge. To overcome this crisis, a series of measures have been put into action. These include enhanced efforts in addiction prevention, treatment, and recovery services, improved data collection, more effective pain management strategies, targeted distribution of overdose-reversing medications, and increased investment in research. Ultimately, the resolution to this crisis is likely to be found in innovative approaches to pain treatment and management. Physical therapy, in particular, is emerging as one of the safest methods for addressing and managing pain.

TYPES OF PAIN ACCORDING TO SENSATION

Usually, various terms are used to characterize pain, such as sharp, burning, stabbing, or aching. However, it’s challenging to ascertain whether your perception of pain aligns with others. Your experience of pain is distinctly your own, and it has the capacity to fluctuate from day to day and situation to situation. Recent studies have yielded several key findings such as:

• Pain is adaptable and subject to change.
• The intensity or magnitude of pain you endure does not necessarily reflect the extent or seriousness of an underlying injury. In fact, there might be no injury present at all.
• The sensation of pain is dynamic; the pain you experience today is not necessarily indicative of the pain you might experience tomorrow.

SIGNS AND SYMPTOMS

Pain exhibits distinct signs and symptoms based on its duration, leading to the classification of pain into two primary types:

1. Acute Pain:

• Persists for a duration of less than 3 months.
• Typically localizes to the area of injury.
• Accompanied by noticeable signs such as swelling, warmth, and redness in the affected region.
• Usually linked to a specific injury or an identifiable event.
• Tends to intensify when the injured tissue is agitated or when the source of pain is removed (for example, if you have a swollen tendon, the pain often diminishes or resolves when you move the affected area).

2. Chronic Pain:

• Pain that persists for longer than 3 months.
• Not necessarily attributable to recent injury or damage.
• Can manifest throughout the body, lacking a specific localized source.
• Often exhibits unpredictability and isn’t consistently associated with a particular motion or activity.
• May entail heightened sensitivity to even minor pain stimuli.
• Can be influenced by psychological factors like depression, fear, or anxiety

DIAGNOSIS AND ASSESSMENT

There is no one particular method to diagnose pain. Instead, your healthcare provider or physical therapist may use a questionnaire to pinpoint how the pain may be affecting your daily life. Besides, they will ask a series of questions to understand what is causing your pain. These questions may include:

• Can you point out the location of your pain?
• On a scale of 0 to 10, how would you rate the intensity of your pain, with 0 being no pain and 10 being the worst pain imaginable?
• When did the pain first start, and have you experienced it before?
• Can you identify any specific activities or movements that worsen or alleviate your pain?
• Is your pain feels constant, or does it come in waves?
• Are there any other symptoms associated with your pain, such as numbness, tingling, or weakness?
• Have you had any recent injuries or accidents that could be related to your pain?
• Does your pain limit your range of motion or your ability to perform daily activities?
• Are there any factors, such as posture or ergonomics, that you suspect might contribute to your pain?
• Have you tried any home remedies or treatments to alleviate your pain, and if so, did they provide any relief?

Along with this, a physical therapist will conduct some other physical examination tests and functional assessments to further identify specific issues, and can also refer you to imaging tests including X-rays, CT scans, or MRIs to exclude the risk of other underlying disorders.  

HOW DOES PHYSICAL THERAPY MANAGE PAIN?

After the extensive assessment and accurate diagnosis, your physical therapist will develop a specialized treatment plan that is tailored to your pain management.

Treatment of Acute Pain

For the management of acute pain, your physical therapist will focus on reducing the stress on the affected part e.g., bones, muscles, tendons, and ligaments, and design a plan that will promote effective healing. Moreover, returning to normal activities is an important aspect of pain management. Research indicates that people who return to their normal daily activities have lower long-term problems than those who do not. Your physical therapist may help you identify positions and movements that don’t hurt and prescribe exercises to help the injured tissue move more efficiently.

Treatment of Chronic Pain

To treat chronic pain, a physical therapist will focus on several factors that might be contributing to the prolonged pain. These factors may include mobility problems, irregular movement patterns, muscle weakness or stiffness preventing regular movement, recent injuries or previous events leading to painful conditions, mental or emotional conditions such as fear, negativity, and other behaviors, or social factors that can lead to long-term pain. After thoroughly examining the condition, your physical therapist will then plan a treatment strategy tailored to your specific needs that includes manual therapy, exercises, and addressing psychological factors. Besides, your treatment plan will also include ‘education on pain’ because research has shown that positive changes occur in patients who are educated about the purpose and causes of pain.

TREATMENT TECHNIQUES

Treatment techniques are customized according to the patient’s requirements. Moreover, treatments always include one or a combination of the following, depending on your unique needs:

• Manual Therapy: Manual therapy encompasses hands-on techniques employed by skilled physical therapists to manipulate joints and soft tissues. Through precise movements, therapists aim to reduce pain, improve joint mobility, and accelerate tissue healing. Techniques like joint mobilization and soft tissue manipulation are used to address acute pain by releasing muscle tension, restoring normal joint mechanics, and promoting blood flow to injured areas.
• Movement and Exercise: Customized exercise programs are essential in acute pain management. These regimens are designed to strengthen the nervous system, reduce pain, and enhance overall function. Controlled movements, tailored to the patient’s condition, help build a tolerance to previously painful activities while promoting healing and preventing further injury.
• Modalities: Modalities include therapeutic methods like applying heat, cold, or electrical stimulation to specific areas of the body to reduce pain, inflammation, and muscle tension. Heat increases blood flow, relaxing muscles, while cold therapy can numb the area and minimize swelling. Electrical stimulation aids in pain relief and muscle rehabilitation.
• Graded Exposure: Graded exposure involves a gradual reintroduction of activities that may have caused pain. This approach helps reduce pain by desensitizing the nervous system and building confidence in movements, ultimately restoring the ability to perform everyday activities without discomfort.
• Psychologically Informed Physical Therapy: This approach acknowledges the psychological factors influencing pain perception. Therapists address emotional and psychological aspects that contribute to pain, providing patients with coping strategies and education to enhance pain management. By addressing anxiety, fear, or negative thought patterns, patients can experience reduced pain and improved overall well-being.
• Home Program: Physical therapists create personalized home exercise programs that empower patients to manage their condition independently. These programs are tailored to maintain the progress achieved during therapy sessions and prevent pain recurrence. Patients are equipped with the knowledge and tools necessary to continue their rehabilitation efforts at home, promoting sustained pain relief and improved quality of life.

PRECAUTIONS TO PREVENT FUTURE INJURIES OR PAIN

Pain is an inherent and indispensable aspect of life, serving as a vital protective mechanism. It plays a crucial role in our ability to respond to threats or injuries. Pain, by its nature, cannot be entirely prevented, nor should it be. The key to effectively managing pain lies in preventing its transition from the normal acute sensation that warns us of potential harm and aids in protecting and healing damaged tissues, into a chronic state that hinders our enjoyment of life. For this, your physical therapist will collaborate with you to develop strategies that enhance your comprehension and management of pain.

HOW TO DEAL WITH PAIN?

Here are some important points to bear in mind when dealing with pain:

• Stay Informed: Understanding the nature of pain equips us to utilize it as a guide for our movements and activities.
• Bed Rest Isn’t Always Beneficial: Contrary to previous beliefs, extended periods of bed rest (lasting more than a day or two) may exacerbate your pain and lead to additional medical complications. Your physical therapist can assist you in establishing safe activity levels to address your condition.
• Exercise Regularly: Consistent exercise offers numerous advantages, including the improvement of nervous system conditioning, responsible for transmitting pain signals.
• Relaxation and Imagery Exercises: Various factors in our daily lives can trigger pain, such as stress, loud noises, or uncomfortable situations. Your physical therapist will teach you relaxation techniques and imagery exercises to calm your body and soothe the nervous system.

WHAT KIND OF PHYSICAL THERAPIST DO I NEED?

Physical therapists receive extensive education in pain management, making them one of the most knowledgeable healthcare providers in this field. They are also at the forefront of pain research, investigating its origins and optimal treatment approaches. Physical therapists are experts uniquely prepared through education and experience to assist you in managing your pain. When seeking the services of a physical therapist, consider the following:

• Opt for a physical therapist who is board-certified as a pain management specialist or has completed a residency or fellowship in physical therapy. These therapists possess advanced knowledge, experience, and skills that can be applied to your specific condition.
• Choose a physical therapist who recognizes that pain can be influenced by a multitude of variables and has undergone advanced training in the science and management of pain.

In short, selecting the right physical therapist can significantly impact your pain management journey, leading to better outcomes and an improved quality of life.