There is currently a great deal of new information emerging from the CDC in regards to their recommendations on pain management. The article "CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" discussed that statistics are showing an increase in the number of patients who are prescribed opioids to treat their chronic pain.
The article reported that overuse of opioid medications are leading to addiction, depression, and increased deaths from overdose. The CDC suggested that chronic pain is better managed through treatments like cognitive behavioral therapy, exercise therapy, or any approach of multimodal therapy.
Physical Therapists are experts in movement science and biomechanics, who utilize many non-pharmacologic strategies to help relieve pain. These strategies, when prescribed appropriately, are very safe with minimal risks and no long term side effects. There are three main treatment strategies used to accomplish this- modalities, manual therapy, and exercise.
The modalities group includes, but is not limited to: ice, heat, electrical stimulation (tens) unit, and ultrasound. The use of a tens unit is very effective for controlling pain through the gate-control theory. This theory states that by causing a low level (comfortable) pain-like sensation with electrical stimulation, the body releases endorphins that help decrease pain. Heat placed over the injured area improves blood flow, which enhances the body’s natural healing ability by getting oxygen to tissue so it can heal. Ultrasound works also by heating tissue which gives the same effects as heat. Ice relieves pain by slowing down the body’s pain response, decreasing swelling. Modalities are utilized to help complement and enhance the effects of manual therapies and exercise.
Manual therapy techniques include, but are not limited to: massage, myofascial release, and using tools like Hawk Gripstm. Manual techniques allow physical therapists to manipulate soft tissue to promote healing. When muscles are injured, the damage to the muscle cells causes the pain. The pain is often your body’s way of saying this place is injured. Injury triggers the body to start the inflammatory response to heal itself, which causes it to fill in the damaged muscle area with scar tissue. What the body is supposed to do later is to remove scar tissue and replace it with healthy muscle cells. When this doesn’t occur, the scar tissue will turn into a trigger point or “knot.” Manual techniques work to help promote healing and pain relief by re-starting or enhancing the body’s inflammatory response by breaking up the scar tissue, which allows the body to begin healing again.
Exercise is also a very effective pain mediator as it causes the body to release endorphins. The feeling of “good” after a workout is often due to the release of endorphins throughout the body. Exercise is excellent for building good posture, promoting good body mechanics, and peak efficiency to move better without pain.
The American Physical Therapy Association (APTA) publishes a monthly research journal "PT Journal" (PTJ), which provides continuous updates on effectiveness and safety of these various techniques. For more information check out www.apta.org or www.MoveForwardPT.com/ChoosePT.
