Chronic pain can be one of the most difficult and frustrating conditions to treat, and it presents unique challenges to both patients and therapists. Affecting an estimated 116 million Americans per year, it costs the United States over $5 billion annually in lost work, lost wages, and medical treatments. What’s more, the Institute of Medicine reports that many of those treatments are inappropriate or inadequate.
More a nervous system condition than a musculoskeletal problem, chronic pain is particularly tricky for physical therapists, who usually focus on soft tissues, connective tissues, and bones. Chronic pain patients also tend to be at their wit’s end, having been told by several practitioners that their pain is “all in their head.”
Fortunately, PTs are well-equipped to recognize and treat chronic pain — perhaps more so than any other type of healthcare provider. Following are seven chronic pain solutions all PTs should know; treatments that you can start using today to effect real change in your patients.
1. A Thorough Subjective Exam
Unlike acute pain, chronic pain does not necessarily correlate with injury. Pain is the brain’s response to a variety of stimuli, only some of which are true danger signals — muscle trauma, bone stress, and other musculoskeletal maladies. In fact, in some severe, long-lasting cases, patients with chronic pain may have completely healed injuries.
One of the best (and only) ways to distinguish chronic pain from injury-related pain is to conduct a thorough subjective exam. That is, an exam in which you ask the patient for their opinion on the pain levels, area of pain, and even cause of pain.
You may already ask your patients a laundry list of questions during their initial evaluations, but it’s easy to miss the telltale signs. In many cases, chronic pain patients will experience ongoing pain for months or even years after an injury, and they may not be able to identify any alleviating factors.
2. Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a type of psychotherapy that seeks to change patients’ beliefs, attitudes, and behaviors which practitioners believe play a key role in their overall perceptions of pain. CBT has proved effective in reducing pain and improving function in patients with a variety of chronic pain disorders, and it has gained considerable attention among PTs in the last several years. While there are concerns about time constraints and reimbursement, CBT should be strongly considered as part of a multidisciplinary approach to chronic pain.
3. Strength and Flexibility
In cases where chronic pain is due to a musculoskeletal disorder or imbalance, traditional strength and flexibility exercises can still prove useful. This is often the case with chronic low back pain, a common condition among middle-aged and older people whose muscles and tendons have lost elasticity. These exercises likely won’t improve neurogenic pain, but they can address the postural problems and functional deficits that exacerbate that pain.
4. Leveraging Placebo
The placebo effect has a bad rap among the lay community and even many therapists, often seen as something to be avoided in the selection of treatment. If a method with questionable evidence produces the desired effect, however, there’s little reason not to use it. In fact, research has shown placebo pills to be effective for pain reduction and functional improvements in chronic pain patients!
This isn’t to say you should systematically implement this kind of treatment into your chronic pain patients’ programs. Rather, if a patient notes that a certain modality unit, manual therapy, or therapeutic exercise reduces their pain symptoms — even if your experience and literature review predict otherwise — it’s a good choice for that patient. Anything that alleviates their symptoms and detrains their brain to output pain is a win.
As Hippocrates said, “Let food be thy medicine.” Nutritional improvements can reduce chronic pain in several important ways. First, a diet rich in lean proteins, fresh produce, and low in fats and processed sugars may reduce the inflammation in your patients’ joints.
A diet high in protein also provides ample amino acids for the production of endorphins, serotonin, dopamine, GABA, and other endogenous pain relievers. Finally, a well-balanced diet can reduce fatigue and lethargy, which often contribute to the perception and exacerbation of pain.
Electrotherapy — typically provided in the form of Transcutaneous Electrical Nerve Stimulation (TENS) — has long been a staple in PT practices and pain clinics. A large body of research suggests that TENS, when applied at the right frequencies, is effective for many painful conditions, including osteoarthritis, diabetic neuropathy, and postoperative pain.
High and low frequencies may also activate different opioid receptors, leading to greater pain reduction at the source of the problem: the brain.
7. Light Therapy
Searching for another effective modality in the fight against chronic pain? Look no further than light therapy. Convenient, painless and easy to apply, these therapies serve as an excellent adjunct to a pain management program that includes therapeutic exercise, cognitive behavioral therapy, and thorough patient education.
The best and most effective of these chronic pain treatments vary from patient to patient. Each person tolerates pain differently, but finding the right solution will provide your patient relief they will appreciate for a lifetime.