Overview on new physical therapy approaches for the management of acute & chronic pain conditions

1. Physical Therapy Management
of
Pain
Dr. Shimaa A. Essa
MSc. PT, neurological disorders and its surgery

3. Tissue Healing &
What’s the Ultimate Goal of PT
Recovery of function
for pain control?

4. Tissue Healing &
Recovery of function

5. What is Pai ?
An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage.
One of the body’s defense mechanisms - warns
the brain that its tissues may be in jeopardy.
May be triggered without any physical damage
to tissues.

6. Types of pain
Acute Pain
o Physiologic response to tissue damage
o Warning signals damage/danger
o Acute pain is the primary reason people seek
medical attention and the major complaint that
they describe on initial evaluation

7. Types of pain
Chronic Pain
o Difficult to diagnose & harder to treat
o Subjective personal experience
o Cannot be measured except by behavior
o May originate from a physical source but
slowly it “out-shouts” and becomes the
disease
o It has no biologic value as a symptom
o Life permanently disrupted

8. Types of pain
Type Acute Pain Chronic Pain
Cause Generally known Often unknown
Duration of
pain
Short,
well-characterized
Persists after healing,
> 3 months
Treatment
approach
Resolution of
underlying cause,
usually self-limited
Underlying cause and
pain disorder; outcome is
often pain control, not
cure

9. Types of pain

10. Acute Pain

11. Acute Pain
RICE VS MEAT
Rest, Ice, Compression, Elevation Move, Exercise, Analgesia, Therapy

12. Acute Pain
Movement
Exercise
Analgesia
Therapy:
Benefits
Lymphatic drainage;
MS pump
Tissue strength; ligament
healing under minimal
stress
Further Tissue growth,
strength; Blood Circulation
Pain that inhibits
tissue healing
Gentle ROM Ex
Beyond gentle,
full ROM Ex
Acupuncture,
TENS, LASER,
US, CP, NO
NASIDs

13. Chronic Pain Cycle

15. Managementof
Chronic Pain

16. Interdisciplinary approach is needed
Physician
Physical therapist
Psychologist
Patient
Chronic
Pain

17. Common Chronic pain conditions
Headache
LBP
Phantom Pain Burn Scar
DPN
Reflex sympathetic dystrophy (RSD), or Complex
regional pain syndrome (CRPS)
Trigeminal neuralgia
Chronic whiplash pain
“Tissues are not the issue”
“CNS & PNS -sensitization -are”

18. How dose sensitization of the NS occur?
Sensitization
 Is caused by strengthening of
response to a potentially dangerous
stimulus.
 Occurs in form of short and long
term changes.
How sensitization occurs?
1) EPSP
2) Improve mobilization
of transmitters.
3) Growth of New synapses. implicit learning

19. Complex Regional Pain syndrome (CRPS)

20. What do P.Ts Do for chronic
pain?
Examine Identify
Problems
Set ttt Treat
Goals Physical
examination
Special Tests
Postural analysis
 Gait analysis
Nociceptive; Has
actual tissue
origin, e.g
myofascial trigger
point
Non-Nociceptive;
Neuropathic, e.g
CRPS, DPN
Physical
goals
Functional
gals
Scocial
goals
 Manual therapy
 ROM exercises
 Acupuncture
 Functional training
 Posture training
 Core stability exercises
 Physical conditioning
 Biofeedback
 Hydrotherapy

21. Desensitization (Habituation)
o Habituation is related to in
synaptic connectivity between
sensory & motor neurons.
o Short-term habituation =
Efficiency of synaptic connections(
Amplitude of Excitatory Post
synaptic Potential EPSP).
o Long-term habituation = Structural
changes in synaptic connections.
(They in number)
implicit learning

22. Desensitization
Training
Touch HS Pressure HS Temperature HS
Hot & Cold water,
contrast paths, 5 minutes,
2-4 times/day
Start with blunt
rubber objects
and graduate to
more pointed
and hard
objects. Light---
Deep pressure
Start with
softer fabrics
and graduate
to rougher
ones. Silk----
Wool. Slow--
Fast
“Self –stimulation and paced by
the patient”

26. Then gradually use sharper objects

28. It’s a tricky and long path, but
Be sure, it’s rewarding