Pain Medicine & Palliative Care: Pain Medicine
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Physical therapy and occupational therapy may reduce pain and help restore
function. Chronic pain sufferers may benefit from a supervised exercise
regimen, designed by a physical therapist trained in treating chronic
pain, that includes range of motion maneuvers, strengthening techniques,
and aerobic conditioning. Heat and cold and other so-called modalities
(e.g., vibration or ultrasound) also may help alleviate pain, although
they should not be applied to areas without sensation or in patients who
are unable to communicate. Sources of heat or cold include heating pads,
hot-water baths, ice packs or vapocoolant sprays like ethyl chloride or
fluorimethane.
Physical therapy can be an important part of the treatment strategy. Physical
therapy techniques are useful in teaching patients to control pain, to
move in safe and structurally correct ways, to improve range of motion,
and to increase flexibility, strength and endurance. "Active"
and "passive" modalities can both be used, but active modalities,
such as therapeutic exercise, are particularly important when the goal
is to improve both comfort and function.
Exercise can have a variety of benefits. It has been suggested that regular
exercise could activate pain control systems in the brain, possibly by
affecting endorphin levels, and also improve the functioning of the immune
system. Although these benefits are uncertain, a very large clinical experience
indicates that patients can benefit from exercise in terms of better stamina
and function. Exercise may reduce the risk of secondary pain problems
like muscle strains, and may also lead to improved confidence and sense
of well-being.
A supervised exercise regimen may include range of motion maneuvers, strengthening
techniques, and aerobic conditioning. Exercise programs are particularly
useful for chronic musculoskeletal pain including back, neck and shoulder
pain, rheumatoid and osteoarthritis pain and fibromyalgia.
Thermal modalities include a variety of methods that produce heating and
cooling of the tissues to manage acute and chronic musculoskeletal pain.
Superficial heat, such as moist hot packs, increases skin and joint temperature
and blood flow, and may decrease joint stiffness and muscle spasms. However,
the use of superficial heat has not been studied extensively and there
is little scientific evidence to support its use in the treatment of pain.
In early injury, it may actually increase swelling at the injury site
(whereas cold would reduce swelling).
Diathermy involves the use of high-frequency
oscillating current and ultrasound (inaudible sound wave vibrations) to
create deep heating. The deep heating may reduce the perception of pain.
It is believed to promote healing and decrease inflammation. While there
has not been a great deal of research on the effectiveness of diathermy
and ultrasound for pain relief, it appears that there are short-term beneficial
effects with the use of diathermy and significant improvement in pain
relief with ultrasound, as with other heating modalities.
Cryotherapy, the use of cold for the treatment of pain, decreases skin
and joint temperature and decreases blood flow to the affected area. It
has short-term benefits including pain relief and reduction in swelling.
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