Physio Pain Management for Chronic Pain

Chronic Pain FAQ

• How do Physiotherapists Measure Pain?

  Pain levels can be quantified using outcome measures. These are validated questionnaires used to grade pain. Pain levels are measured before and after therapy, thus determining if the therapy is demonstrably effective.

  Examples include –

  Oswestry Disability Index – used to assess chronic lower back pain and its effects on pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life & travelling

  Brief Pain Inventory (BPI)

  Pain Self Efficacy Questionnaire (PSEQ)

  It is possible to use a variety of outcome measures simultaneously and aggregate the results, however, this would be more common at hospitals, over one-to-one Physiotherapy engagements.

• Why is Overcoming Pain so Challenging?

  As indicated above, feelings, emotions, actions and subsequent pain are all interconnected – meaning that purely addressing the musculoskeletal component is not enough.

  For some who have undergone trauma, they can post-traumatic neuropathic pain in that area, leading to pain that is disproportionate to the event that has occurred. The awareness of pain is referred to as the pain gait – the understanding of how pain is perceived in our minds.

  In simple terms, we form a blueprint (medically referred to as neuroplasticity) between our mind and body, this connection is developed from years of repetition. For example, in amputee patients, there are neural pathways left intact, so the nervous system can still generate pain for that limb. Pain is a protective mechanism, so it is very rapid and responsive.

  Additionally, there is often a sense of fear associated with pain that affects people in different ways. For example, back pain sufferers often have a fear of bending forwards, so the chronic pain has taken over their life and may prevent them from performing rehabilitation for some time.

  Retraining the central nervous system is a long, ongoing process. Physiotherapists use what is called pacing to greatly assist with this. Pacing refers to performing rehabilitation in a structured, and typically low intensity, thus repairing the connection between neurons in an optimal way.

• Can you describe a clinical case relating to chronic pain?

  We met a lovely gentleman in his 50s, he had a work injury ten years prior and had been through many programs. A referral was made to Vista Healthcare.

  While we were contacted regarding pain, we tend to look more optimistically, we saw it as ‘what we wanted to achieve together’. Having lived with pain for so long, he was initially very depressed about his condition. He was unable to perform paid employment, as his capacity to stand was under 2 hours, of course, this was not good for his self-esteem.

  We set the following goals together –

  • To travel to and play lawn bowls
  • To improve his physical capacity to volunteer at the local RSL
  • Leaving his house once per day for a walk

  We worked together for several months, over that time, his level of depression reduced significantly, and his perception of his pain changed. His ability to engage in functional activities and access the community had improved, he was socialising more, meeting lovely people and his self-reflective well being had improved as well.

  It’s a lovely story and we’re thankful to have restored quality of life.

• When is Pain-Specific Physiotherapy Prevalent?
  • Foot/ankle pain
  • Lower back pain
  • Complex Regional Pain Syndrome (CRPS)
  • Allodynia or for Greek ‘ other pain’. This is when pain is felt and caused by things that do not otherwise lead to pain such as pulling socks or sheets
  • Phantom Limb Pain
  • Neuropathic Pain – peripheral or central nervous system damage resulting in neuropathic pain
  • Physical ailments – poor posture, obesity, degenerative changes, acute injuries, fractures
  • Neurological conditions – Multiple sclerosis, Motor Neuron Disease, Peripheral neuropathy, Chronic Fatigue Syndrome etc
• How do Physiotherapists Help with Pain?

  Based on an assessment, a Physiotherapist would then implement a progressive graded exercise program to improve the deficiencies of that person. When dealing with chronic pain, Physiotherapists tend to prescribe high repetition, low-intensity exercises.

  For example, if on admission, a patient could perform 3 sets of 10 bicep curls at 15kg (Volume: 450kg, Grade:100%). The Physiotherapist would reduce the weight, and start the rehabilitation baseline at 70% (315kg volume) grade or so. Starting at a very low grade will likely prevent any rehabilitation relapses. The graded program would then list the progressions thereafter.

  The purpose of graded exercise programs is rehabilitating without initialising a pain response. The length of the program is individualized to the patient and their status. A Physiotherapist would use dynamic smart goals to record their progress.

  Staff from Vista Healthcare have worked as chronic-pain Physiotherapists in NSW hospitals, we ran 8-week pain education programs to patients.