Pain Management

What is Pain?

According to the Oxford Dictionary pain is a 'highly unpleasant physical sensation caused by illness or injury'.

However pain can be grouped into different types, namely acute pain, persistent pain and neuropathic pain. Acute pain can be pain from a specific injury which is short-term and last no longer than 12 weeks. Persistent pain is continuous, it is a term used to describe painful symptoms that have lasted a long time and typically outlasts normal tissue healing times. This is usually anything more than 12 weeks. Neuropathic pain is pain associated with dysfunction to the peripheral or central nervous system. This may include pain following trauma to the spinal cord, peripheral nerves or patients with multiple sclerosis or neuropathy from diabetes.

Pain is detected in the tissue by nociceptors which are receptors of a sensory neuron. The nociceptors then send signals to the spinal cord and brain to convey this information. This process is known as nociception and causes the perception of pain. When the pain becomes persistent the nociceptors continue to convey this message, despite there being no damage to the specific area. This is when pain can become detrimental to other parts of the body, affecting a patient's mental health and sleep pattern.

With reduced mood and increased anxiety, pain becomes worse. However when mood improves and the patient becomes more positive and happy, the pain will reduce. This shows that pain is a combination of psychological, social and biological factors.

Pain is transmitted along the sensory nerve fibres by the release of a chemical from one neuron to another. This is called a neurotransmitter and there are hundreds of different types within the body. Within the body are 'good' and 'bad' neurotransmitters. The good ones help block pain whilst the bad ones enhance the pain.

Pain killers such as paracetamol can be used to inhibit pain in this way, dampening down the bad transmitters and enhancing the good ones. Non-steroidal anti-inflammatories (NSAID's) such as ibuprofen or neurofen are also used to treat pain, however they treat pain indirectly by reducing inflammation which may be causing pain at a specific joint or tissue.

Can Physiotherapy Help Pain?:

Physiotherapy can play an important role in the management of pain. When treating persistent pain, physiotherapy aims to stimulate the 'good' neurotransmitters in order to reduce the pain signals. This can be through different pain control therapies such as acupuncture, massage, TENS or exercise.

Persistent pain conditions that we as physiotherapists typically treat include, low back pain with or without sciatica, neck pain, fibromyalgia and TMJ (tempro-mandibular joint) pain. Persistent pain treatment typically includes pain education, advice on lifestyle changes and symptom management techniques such as pacing (where tasks are divided out to enable function without aggravating symptoms) and pain control therapies.

The physiotherapist will complete a thorough assessment and then determine the most appropriate treatment methods. The World Health Organisation (WHO) recommends that pain management programs should consider psychological and sociological factors as well as biological factors when treating Persistent pain. As physiotherapists we take a biopsychosocial approach. This approach ensures that the physiotherapist examines different factors which may contribute to pain based around biological (tissue damage, degenerative joints, inflamed tissues etc), psychological (behaviours, thoughts, emotions) and social (cultural, environmental, economical) elements. Each factor will contribute to pain and it is important to discover the root of the pain in order for treatment to be effective.

Can physiotherapy help with my Persistent Low Back Pain?

Yes, evidence suggests that physiotherapy treatment comprising manual therapy, pain education and exercises can be effective in treating persistent low back pain. The physiotherapist will ensure that your pain is controlled before progressing with exercise prescription which will improve your functional ability, and in turn reduce your back pain.

I suffer with Fibromyalgia, can physiotherapy help with my pain levels?

Yes, as described above physiotherapy can be used to improve pain levels to allow the individual to function and complete daily activities. Modalities that can be used for the pain include acupuncture, massage, exercise prescription and TENS to name a few. The physiotherapist can also discuss your pain levels with you and how lifestyle changes can help. This may include pacing your activities by breaking down tasks into manageable chunks. In order to determine the appropriate treatment approach it is important to have an assessment from a physiotherapist, they can then tailor the pain management program to meet your individual needs.

If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.