#PainAwarenessMonth: Physical Therapy for Chronic Pain

While pain is an important survival mechanism to protect an injured area of the body, chronic pain is persistent pain that lasts beyond the normal healing process. Chronic pain develops when the nerves that communicate pain to the brain become hypersensitive, causing the brain to perceive that area of the body as a potential threat and therefore painful even if there is no longer any tissue damage to that area. Common sources of chronic pain include back pain, neck pain, arthritis, and fibromyalgia. Physical therapy offers safe and effective treatment for chronic pain, reducing pain and improving mobility, strength, and function through therapeutic exercise, manual therapy, and aquatic therapy.

Defining Chronic Pain & Common Sources of Chronic Pain

Pain is a normal part of the human experience whose purpose is to protect an area of the body that the brain perceives as damaged. Pain functions as the body’s alarm system with the nervous system acting as the alarm. When the alarm goes off from the nerves in the injured area, the brain sends a signal for pain in the body and the nerves in that area increase their sensitivity to protect that area of the body. Normally, once the injury heals, pain decreases as the nerves reduce their sensitivity.

Chronic pain, however, develops when the sensitivity of the nerves is turned up too loud for too long, leaving the individual with an extra sensitive pain alarm system. The nerves remain in a hypersensitive state, causing the brain to continue to perceive that area as a potential threat and therefore painful, even if there is no longer any tissue damage to that area. Those with chronic pain have increased hyper-vigilance of the central nervous system. 

Chronic pain is defined as pain that lasts more than three months. It can become progressively worse or reoccur intermittently, outlasting the normal healing process. The most common source of chronic pain is low back pain. Other sources of chronic pain include headaches, arthritis, post-surgery pain, cancer-related pain, pain caused by nerve damage, pain following a fall or car accident, neck pain, limb amputation, and fibromyalgia. 

Chronic Pain in the United States

Chronic pain affects nearly 100 million Americans, more than diabetes, heart disease, and cancer combined. Adults suffering chronic pain report low back pain as the most common chronic pain issue (28.1%), then knee pain at 19.5%, severe headaches or migraines at 16.1%, and 15.1% experience neck pain.

A 2021 study revealed that chronic pain has significantly increased across all U.S. adult demographics. The study reviewed the National Health Interview Survey for each year between 2002-2018 and assessed the responses of 440,000 individuals who were asked about five common pain sites: low back, neck, face and jaw, joints, and head. Results showed chronic pain increasing across all demographics and that joint pain and low back pain were the most prevalent sites of chronic pain both at the start and end of the study (2002 and 2018, respectively).

Per the CDC, chronic pain is one of the leading reasons why individuals seek medical care. However, over the last twenty years, many chronic pain patients have been prescribed opioids to manage the pain; opioids account for 18.8% of medication prescriptions for chronic low back pain and 76.9% of opioid prescriptions are for long-term use. Per the National Institute on Drug Abuse, 21-29% of patients misuse opioids when prescribed for chronic pain and the risk of addiction is high.

In the National Ambulatory Medical Care Survey, opioid prescriptions for new chronic musculoskeletal pain conditions were present in 21.5% of visits, whereas prescriptions for physical therapy were only 10% of visits. In 2016, the CDC recommended physical therapy as a safe alternative for long-term pain management with no dependence on medication or surgery.

Physical Therapy Treatment for Chronic Pain

Physical therapy offers a safe and effective alternative to chronic pain management that focuses on decreasing pain, increasing overall function and strength, and improving the quality of life and independence of the chronic pain patient. The physical therapist first will assess the frequency of your pain and how it affects your life, your medical history, and perform tests to assess your current strength, balance, posture, range of motion, and endurance.

Physical therapists work to address the root cause of the chronic pain (damage to a joint or muscle group) and focus on improving range of motion, mobility, surrounding muscle strength, and improved function for daily and work activities.

Physical therapy treatment is tailored to your specific condition, but commonly include:

• Low-impact therapeutic exercise:  A therapist guides the patient through a low-impact aerobic exercise program to gradually increase their aerobic ability, improve movement and coordination, and reduce stress and strain on the body. The careful introduction of graded exercise allows the affected body part (that is the source of chronic pain) to move gently and safely, training the brain to sense the problem pain area without eliciting and increasing hyper-sensitive pain messaging.

• Strengthening exercises: Using weight machines, resistance bands, hand-held weights, or the patient’s own body, muscles surrounding the problem area (back muscles for low back pain, shoulders and upper back for the neck, leg muscles and ankle for the knee) are targeted for strengthening. Strengthening of the core (trunk, glutes, back, and abdomen) is also essential to build a strong base for movement.

• Manual therapy: Manual therapy involves hands-on techniques to gently move joints and soft tissue to improve range of motion and mobility and reduce pain.

• Aquatic therapy: Aquatic exercise in a warm water therapy pool lessens stress on the problem pain area and allows the patient to more easily exercise and build strength.

• Dry needling: Dry needling involves the use of filiform needles to deactivate trigger points, which area hyper-irritable taut bands of muscle that contribute to chronic pain by creating tenderness at the trigger point and producing referred pain.

• Body Mechanic Instruction: The therapist instructs the patient in proper body mechanics when lifting, pushing, pulling, and engaging in other daily actions to prevent injury. 

• Pain education and pain management strategies: The therapist provides the patient with an understanding of the science of pain, the mechanism of pain in the body, and the way that our body processes pain.  

Chronic pain can be debilitating and limit your daily activities significantly. At Mangiarelli Rehabilitation, we are here to help you reduce pain, achieve greater mobility, and improve your overall quality of life safely through a customized treatment program tailored to your specific condition and health goals. Give us a call today to learn more & start your physical therapy journey!