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Physical Therapy for Chronic Pain

It is estimated that about 100 million people in America are living with chronic pain. Chronic pain can interfere with your day-to-day work and recreational activities, and it may have a profound effect on your ability to concentrate, relax, and enjoy life.

What Is Chronic Pain?

The simple definition of chronic pain is pain that has been present for greater than 12 weeks. However, it can be more complex than that, and the best way to understand chronic pain is to learn about its cousin: acute pain. Acute pain is pain that comes on suddenly and lasts for a few weeks. Typically, acute pain is caused by some traumatic event that injures your body's tissues.

Chronic pain can be confusing, and it can prevent you from moving normally and concentrating on your daily activities. Plus, dealing with chronic pain can leave you and your doctor perplexed.

Often times, pain occurs when there is little or no tissue damage. Why is the pain lasting long after the tissues are healed? Why are medicines not effective in treating your pain? Is there something really wrong? These questions may be difficult to answer, and finding the best treatment for your chronic pain may be equally difficult.

Treatments Types

There are many different treatments available for chronic pain. Finding the best one for you can take a little trial and error.

  • Physical therapy (PT)

  • Medication (oral or injected)

  • Supplements and natural remedies

  • Chiropractic care

  • Massage

  • Acupuncture

  • Exercise

  • Meditation

  • Cognitive behavioral therapy (CBT)

There are likely more items to add to this list, and you may find one remedy helpful while another may not be effective for your pain at all. Physical therapy may be an option to treat your chronic pain, and working with a physical therapist has been shown to help chronic pain sufferers improve their function while decreasing or eliminating their pain.

What to Expect

Your therapist should ask questions about your pain and how it behaves. Is your pain present constantly or intermittently, and how does it affect your life? What makes it better or worse? Your physical therapist should also ask about any previous treatments you have received.

He/she will perform various tests and measures to get a sense of any impairments that may be contributing to your pain, including:

  • Range of motion

  • Posture

  • Strength

  • Balance

  • Endurance

Some of these tests may increase your pain, while others may cause your pain to decrease. Be sure to communicate with your physical therapist how you are feeling and how sensations are changing during your evaluation.

PT Treatments

Common treatments used by physical therapists for chronic pain patients include:

  • Exercise: Exercise should be your main PT tool in the treatment of chronic pain because it can help your body improve strength and mobility. Think of exercise as a feedback loop. Your brain moves your body, so exercise is output coming from your brain. When you can move with little or no pain, you are reinforcing to your brain that the movement is not going to hurt. This positive feedback allows you to move more with less pain. So while you are getting stronger and improving mobility, you are also training your sensitive nervous system to trust that the movement is safe.

  • Ultrasound: Ultrasound is a deep heating modality that you may encounter while in PT. It is applied to your skin and as your body's tissues are heated, it is thought that this improves circulation and blood flow. It is important to note that ultrasound has not been proven to be an effective treatment for chronic pain. Still, you may encounter this treatment during your PT sessions.

  • TENS and Electrical Stimulation: Transcutaneous electrical nerve stimulation (TENS) is a therapeutic modality that uses electricity to decrease pain signals coming from your body to your brain.

  • Massage: Some physical therapists employ massage techniques to decrease pain by improving muscular blood flow and relieving tightness.

  • Dry Needling: Dry needling is a newer treatment employed by some physical therapists to decrease painful muscle knots and trigger points. This treatment involves using small needles (such as acupuncture needles) to pierce muscle tissue and knots, relieving the pain in these spots.

  • Heat or Ice: Modalities like heat and ice are often used by PTs to help decrease pain and inflammation. These treatments have not been proven to be effective with patients dealing with chronic pain, but they are often used as adjunct treatments during your PT sessions.

  • Pain Neuroscience Education (PNE): New research indicates that teaching patients about their pain and why it is happening can have a positive effect on their rehab. Your physical therapist may spend time teaching you about why you have pain, how your pain might behave, and things you can do to take control of your pain.

Each of these treatments is designed to achieve a specific goal. It is important that you discuss with your physical therapist the intent of the treatment so you know what to expect.

Overall, passive treatments like heat, ice, or massage may feel good. However, if you want to take control of your pain, more active treatments like exercise and learning about your pain are recommended.

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