8 Common Initial Treatments for Pain
Treatment should always be individualized to your needs as a patient. Treatments should be strategically implemented to help your symptoms of pain feel better and help you manage them moving forward. These treatments apply many of the principles already discussed on other pages within the “Got Pain?” series. It is important to understand that not all treatments will be focused on desensitization of the pain. Our goal as physiotherapists is to gradually increase the body’s tolerance to this excessive stimulation while gradually reducing this brain’s pain map alarm system. The focus is not always on pain-free but on freeing the patient from their chronic pain cycle through alternative means.
Initial treatment may be focused on reducing the pain with manual therapy treatments in order to relax the nervous system. The treatment will then focus on teasing that body pain alarm system to stimulate it into reducing the hyperresponsiveness to pain.
1. Manual therapy
Type of manual therapy:
- massage, joint mobilization, palpation, stretching
Benefits and Disadvantages:
- Create space
- Activation of the endogenous mechanisms
- increased blood flow
- Altered sympathetic
2. Neurodynamic
Benefits and Disadvantages:
- Creates space for the nerve
- Creates movement for the nerve
- Enhances circulation for the nerve
- Tease the system’s alarm to decrease the response
3. Thermotherapy
Benefits and Disadvantages:
- Enhances circulations
- Cold can be used to reduce inflammation/swelling
- Low cost and easy to use
- Decrease pain through desensitization
4. Electrostimulation therapy (TENS)
Benefits and Disadvantages:
- It has been shown to have an impact on patients and increase endogenous opioid release.
- It can be used both to desensitize pain or tease the pain alarm system depending on TENS unit setting and purpose.
- Does require some education on usage from a therapist
- Relatively inexpensive
5. Aquatic therapy
Benefits and Disadvantages:
- Great for offloading joints for individuals in special populations conditions like osteoporosis, rheumatoid arthritis, stroke patients, elderly, etc.
- Can have an added thermotherapy component to the treatment
- Requires supervision (lifeguard, therapist)
- Easy to participate due to water buoyancy. Has the added benefit of having a lower energy cost for those deconditioned.
6. Graded Motor Imagery
Is a treatment benefit for patients’ chronic pain as they present with an altered somatosensory cortex map. This map becomes altered, increasing pain, causing neglect, decreased use, and causing disability, which leads to abnormal body image and abnormal pain patterns. Treatment for pain is based on the principles of neuroplasticity. By training the body and mind with a specific stimulus, the brain can create a healthier somatosensory cortex body map.
The goal of the therapist is to “Sharpen the map”.
•It has been proposed that there is a certain order to follow with treatment
- Education
- Laterality: disguising left from right
- Motor Imagery: ( static, dynamic)
- Sensory Discrimination( two-point, graphiesia , localization, directional, textures, sounds, tastes) say look feel, close eyes discriminate
- Mirror Therapy
7. Physical Education
8. Physical Exercise
This includes(non-exclusive list) :
- Stretching: Yoga, Tia Chi, pilates
- Strength training: weightlifting, resistance band training, Machine training, free weights
- Aerobic exercise: walking, swimming, boxing (non-contact), playing a non-contact sport
- Restorative: Sleep, self-massage, meditation, relaxation breathing techniques, counseling, a spa day
Benefits and Disadvantages:
- Increase circiulation
- Increase body’s natural opioids and serotonin (improve mood)
- Able to both desensitize pain and train the body alarm system to reduce
- ***Risk of doing too much. Can cause pain if someone does too much too soon.
- Strengthening the body
- Improve biofeedback
- Improve balance
- Improves participation
This is a great way to manage pain over a lifetime. The most important takeaway is that physical exercise may be uncomfortable, sore, and achy, but it should not cause you more pain. It is important to understand that your body may not be able to distinguish sore pain from exercise and chronic pain. So following the therapist’s guidance and keeping everyone informed about the level of pain and any changes in the feeling.
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