Journal article
A Mechanism-Based Approach to Physical Therapist Management of Pain
Physical therapy, Vol.98(5), pp.302-314
05/01/2018
DOI: 10.1093/ptj/pzy030
PMCID: PMC6256939
PMID: 29669091
Abstract
Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.
Details
- Title: Subtitle
- A Mechanism-Based Approach to Physical Therapist Management of Pain
- Creators
- Ruth L Chimenti - Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IowaLaura A Frey-Law - Department of Physical Therapy and Rehabilitation Science, University of IowaKathleen A Sluka - Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242 (USA)
- Resource Type
- Journal article
- Publication Details
- Physical therapy, Vol.98(5), pp.302-314
- Publisher
- United States
- DOI
- 10.1093/ptj/pzy030
- PMID
- 29669091
- PMCID
- PMC6256939
- ISSN
- 0031-9023
- eISSN
- 1538-6724
- Grant note
- R01 AR061371 / NIAMS NIH HHS UM1 AR063381 / NIAMS NIH HHS T32 NS045549 / NINDS NIH HHS R03 AR065197 / NIAMS NIH HHS K99 AR071517 / NIAMS NIH HHS R00 AR071517 / NIAMS NIH HHS
- Language
- English
- Date published
- 05/01/2018
- Academic Unit
- Iowa Neuroscience Institute; Nursing; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
- Record Identifier
- 9984040280902771
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