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What Is Chronic Pain?

Chronic pain refers to any pain or discomfort that persists for a period longer than three months, that is often associated with injury or tissue damages. However, it can occur in the absence of injury and tissue damage. Chronic pain can be experienced by anyone, at any age.

While any condition can lead to chronic pain, individuals suffering from the following conditions are more likely to experience chronic pain:

Reflex sympathetic dystrophy
Amputation of a limb
Fibromyalgia
Diabetes
Trauma or injury

Chronic pain changes the brain in the following ways:

After injury or development of a painful condition, the nerves of the injury site send signals to the brain
This information is analyzed by the brain to determine if there is a threat to the body and determine what needs to be done to prevent harm
If the pain is constant, the nervous system and the brain go into a high alert mode, making them more sensitive
Sensory nerves can also become highly sensitive during this high alert period, which makes the brain interpret the sensations as a threat and cause more pain – the changes in the nervous system and brain induce and maintain symptoms of chronic pain
If the pain is constant, sensations of pain are activated in the brain, even when there is no tissue damage occurring
The nervous system and brain continue to react, causing continued pain. At this point in the pain cycle, any sensory input can activate the pain centers in the brain resulting in increased pain symptoms

Research has identified various signs that may be associated with chronic pain syndromes, including:

Increased medication use
Deconditioning
Fearfulness
Decreased circulation
Body stiffness
Weight gain
Worsening of other medical conditions

Each person affected by chronic pain is affected differently. Some individuals may suffer from depression due to their chronic pain symptoms. Estimates reveal that approximately 116 million people in the U.S. suffer from chronic pain every year, costing between $560 and $635 billion annually for medical treatment costs, lost time from work, and lost wages.

Overview Of Physical Therapy

Physical therapists work with patients suffering from chronic pain in an effort to reduce their pain levels, restore normal activity levels, and improve quality of life. A physical therapist will perform a detailed history and physical examination of the affected area and develop an individualized treatment plan for each patient.

Treatment plans may consist of a variety of treatments, including:

Education: Patients will be educated on chronic pain including how it occurs, why it occurs, and what they can do about it. Patients will be taught various techniques to help manage their pain symptoms and learn strategies to help reach their goals.
Flexibility and strengthening exercises: Patients will be given an exercise program consisting of graded exercises for their condition. These exercises will gradually be increased as the patient’s ability increases. These exercises will help to improve movement and body coordination, reduce strain and stress on the body, and decrease pain levels.
Manual therapy: The physical therapist will use specific, hands-on techniques to mobilize or manipulate affected soft tissues and joints. Manual therapy is utilized to increase range of motion, enhance tissue quality and decrease pain.
Modalities: Various therapies including heat, ice, electrical stimulation, ultrasound, and transcutaneous electrical nerve stimulation (TENS) may be used to help with pain management for some conditions.
Posture and ergonomic instructions: Patients will be given postural and ergonomic training to improve postural control and movement. These instructions will help the body to move more efficiently during activity and at rest. The physical therapist will make recommendations for the patients’ movement at work, at home, and during recreational activities to help reduce pain and improve function.

Research Into Physical Therapy

Research has shown that physical therapy using exercise and manual therapy is superior to general practitioner or placebo management for chronic neck and back pain. The strongest evidence for an effect on pain levels includes strength and endurance training. However, optimal benefit is achieved if treatment is given over a prolonged period of time and it has been found that patients who are left to exercise independently fare worse than those who are under continual supervision. In regards to manual therapy, myofascial therapy (massage) seems to have a positive effect on patients suffering with chronic, non-specific neck pain and thoracic manipulation seems to have a positive effect on pain levels.

The use of TENS therapy for the management of chronic pain is based on the gate control theory of pain, with electrodes placed at peripheral sites to provide recurrent stimuli to block nociception. While there have been conflicting reports regarding the benefit of TENS therapy, two studies have shown clear advantages. In one retrospective study including over 1,500 participants over the course of ten years, it was found that TENS was successful for 59% of the participant sample. Another study found that 47% of the participant sample reported that their pain was reduced by more than half. These results suggest that for some patients TENS therapy can be an effective treatment option.

A multimodal approach to the treatment of some chronic pain patients [i.e whiplash associated disorder (WAD)] may elicit the best response according to some researchers.

What Are The Risks Of Physical Therapy?

Research has shown that physical therapy is considered a safe treatment when performed by a fully trained and qualified practitioner. However, as with all therapies, complications may arise in some cases. In some cases, physical therapy may exacerbate pre-existing conditions and there have been reports of persistent pain as well as fractures of unknown origin associated with physical therapy treatment. Additionally, in some cases physical therapy treatment may increase the duration of a patient’s pain or may limit their range of motion.

Further, patients undergoing certain types of physical therapy (i.e. chest) may experience an increase in heart rate, blood pressure, metabolic rate, and oxygen consumption. In the elderly population, there is an increased risk of falls when performing certain activities during physical therapy treatment (i.e. walking backwards).

Learn More

For more extensive information on the role of physical therapy in chronic pain management, visit the links below. If you suffer from chronic pain, speak to your healthcare professional to learn how physical therapy can help manage your chronic pain condition.

Damgaard P, Bartels E, Ris I, Christensen R, Juul-Kristensen B. Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials. ISRN Pain. 2013;2013:1-23. doi:10.1155/2013/567175. Available here: http://www.hindawi.com/journals/isrn/2013/567175/
com. Physical Therapy : Side Effects | Florida Hospital. 2015. Available at: https://www.floridahospital.com/physical-therapy/side-effects. Accessed December 20, 2015.
Gatchel R, McGeary D, McGeary C, Lippe B. Interdisciplinary chronic pain management: Past, present, and future. American Psychologist. 2014;69(2):119-130. doi:10.1037/a0035514. Available here: https://www.apa.org/pubs/journals/releases/amp-a0035514.pdf
Low Back Pain: Low Back Pain: Journal of Orthopaedic & Sports Physical Therapy: Vol 42, No 4. Journal of Orthopaedic & Sports Physical Therapy. 2015. Available at: http://www.jospt.org/doi/full/10.2519/jospt.2012.42.4.A1. Accessed December 20, 2015. Available here: http://www.jospt.org/doi/full/10.2519/jospt.2012.42.4.A1
com. Physical Therapy Information From Physical Therapists: MoveForwardPT.com – MoveForwardPT.com. 2015. Available at: http://www.moveforwardpt.com/Default.aspx. Accessed December 20, 2015.
Naidoo V, Mudzi W, Ntsiea V, Becker PJ. Physical modalities used in the management of chronic low back pain. SA Journal of Physiotherapy. 2012;68(1):42-46. Available here: http://www.sajp.co.za/index.php/sajp/article/viewFile/8/7
Smith B. Chronic pain in primary care. Family Practice. 1999;16(5):475-482. doi:10.1093/fampra/16.5.475. Available here: http://fampra.oxfordjournals.org/content/16/5/475.full