Physiotherapy manages both new and old injuries. An injury may be deemed as ‘chronic’ if pain or uncomfortable symptoms persist more commonly beyond 3 – 6 months of onset or beyond. Patients who have experienced extended periods of chronic pain are typically unable to maintain a healthy lifestyle or achieve a state of general fitness. As a result, they are often more susceptible to injury because of weakened joints and tissues. Patients with extreme forms of chronic pain are often unable to tolerate even the lightest touch, even in areas that are not directly associated with the primary sensations of pain.
In such cases, the physical therapist must first interact with the patient to achieve a level of trust and belief: A belief that physical therapy will yield positive results, that a reduction or lessening of the pain is achievable, and that there will be progress – albeit slow and steady. Chronic pain that has been present for years may take significant time before noticeable improvements are realized. Small successes should be celebrated and built on to achieve a longer-term positive outcome.
A patient with hypersensitivity to touch often requires gentle, hands-on treatment to determine levels of sensitivity and to establish trust and confidence. Light massage, stretching and perhaps gentle traction can be effective in treating pain along the spinal column. If the patient tolerates this well, additional modalities may be introduced, including moist heat, hydrotherapy, therapeutic ice, electrical stimulation and ultrasound. Each of these can relieve pain, reduce inflammation and edema, and relax tense and spasmodic muscles.
Once the patient is comfortable with these stimuli, a low-intensity exercise program may be introduced. If pain persists at high levels, a focus on exercising a non-painful area may work best at the outset. For example, patients with shoulder pain might do well with exercises for strengthening the core. If back pain is the issue, lower extremity exercises can be effective. The idea is to get the patient comfortable with establishing a routine and then gradually increase the exercises in intensity and, eventually, focused on the painful areas themselves.
Chronic pain patients are often caught in a cycle of pain avoidance, which leads to inactivity. This creates an unhealthy lifestyle, which in turn reduces strength, endurance, range of motion and overall confidence. Patients become more susceptible to injury and unable to work through the healing process. And so the cycle continues.
When the patient begins to believe that freedom from pain is possible, and that a healthy lifestyle, routine exercise, and proper nutrition leading to overall fitness will help maintain that freedom, they will develop the confidence they need to incorporate these elements into their daily lives.
Referemce: published by Scott Dehorty MSW, LCSW-C on Jul 08, 2015 in Chronic Pain 360
