The prevalence of chronic pain is estimated to range from 10% to over 50%. Chronic pain diagnoses may include complex regional pain syndrome, fibromyalgia, whiplash-associated pain, orofacial pain, migraines or other headaches, low back pain, etc. Most persons suffering from chronic pain conditions consult with a physical therapist. Physical therapy has been described as one of the pillars of pain management programs. According to an article in the Wall Street Journal, most patients with pain should consider physical therapy before ordering expensive tests or surgery.
Physical therapists are not always prepared to offer patients with chronic pain the best evidence-based interventions. Very few university physical therapy programs include courses in chronic pain management or even in the neurophysiologic mechanisms of persistent pain. It should then come as no surprise that many physical therapists lack up-to-date knowledge of pain management principles and may not be all that interested in working with persons with chronic pain conditions.
Fortunately, there is a growing number of physical therapists with advanced knowledge of pain management principles. Physical therapists at Bethesda Physiocare® have specialized in chronic pain physical therapy. Dr. Jan Dommerholt is a Diplomate of the American Academy of Pain Management. After a thorough examination and the formulation of a physical therapy diagnosis, chronic pain physical therapy consists of two distinct, but overlapping phases. During the first phase, the emphasis is on reduction of pain. Physical therapists may use manual trigger point therapy, dry needling, deep muscle massage therapy, or other soft tissue and joint mobilization techniques. In addition, patients will be educated about their pain problem, the role of the central and peripheral nervous system, and the importance of improved posture and early conditioning exercises. Chronic pain conditions rarely are associated with persistent tissue damage. In other words, “The issues are not in the tissues.”
During the second phase of physical therapy, the focus shifts to further improving physical function and reducing disability and suffering. It is important to learn self-pacing skills and set achievable goals. Goals should include physical goals (exercise, walking), functional goals (work, recreation), and social goals (visit friends, go to a concert).
Physical therapists can play an integral role in assisting persons with chronic pain to return to a meaningful life. Hopefully, knowledge from the pain sciences will become part of the standard curriculum of physical therapy schools to better prepare future physical therapists to become more effective pain management specialists.
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