One popular definition of chronic pain is “pain that extends beyond an expected period of healing.”  Other definitions associate a time period with chronic pain so that it can be distinguished from acute pain.  The time periods most often vary between 3 and 6 months from the onset of pain, though some have even placed it at 12 months.  Regardless of the period involved, the prevalence of chronic pain in the United States combined with the impact on the quality of life of the person and health care costs associated with chronic pain make it a health issue of major importance.

In the past, health care followed a “rest for recovery” model with the patient as a passive recipient of care.  Health care has changed dramatically over time and now encourages early activity for recovery.  Multidisciplinary approaches include the patient as an educated participant and have changed the role of the physical therapist from healer to facilitator.  Physical therapists now help patients address and overcome physical and psychological obstacles, return to activities, and achieve personal goals.  The physical therapist often works collaboratively with physicians, psychologists, and other health care specialists to address the needs of a person suffering from chronic pain.  Effective pain management that emphasizes the restoration of function and mobility will necessarily include physical therapy as an important component.

Impact of Chronic Pain

People with chronic pain are often getting by day by day near their maximum capacity.   They have less energy and use it less efficiently than a healthy person.  This often means they have little left in them to use for recreation or to handle emergencies.  This leads to dramatic changes in quality of life.  Previously healthy individuals find themselves dramatically changing lifestyle to cope with their new reality.  Since many chronic pain conditions do not come with easily identifiable diagnoses or causes, this leads to confusion and frustration on the part of the sufferer and among family and friends as these lifestyle changes become necessary.  Often a person suffering from chronic pain will become depressed and start developing pain avoidance behaviors that become a further obstacle to returning to good health.

Often a chronic pain sufferer’s health further deteriorates because of a cycle of deconditioning.  Chronic pain leads to inactivity which deconditions the body and increases the potential for other health related problems.  A sufferer will recognize the deconditioning but is often unsuccessful in addressing it.  As a person tries to exercise and condition, it aggravates the pain leading to further inactivity and increased deconditioning.  One of the vital roles physical therapists play is to help the person return to greater mobility through guided, gradual exercise.

 
Central sensitization is another serious issue faced by chronic pain sufferers.  This is a phenomenon in which the person receives amplified signaling in the central nervous system.  This may lead to a cascading effect in which a person becomes increasingly sensitive to stimuli such as light, sound, and touch.   Pain becomes amplified leading to greater inactivity and further worsens the person’s condition.  A physical therapist can help by providing pain relief that will reduce the amplified pain responses and return to the person to a more positive state in which to manage the condition.

Optimal Combination of Treatments

Physical therapists are uniquely skilled and positioned to provide a variety of treatments to help the chronic pain sufferer.  A physical therapist will begin by conducting a thorough evaluation and provide a personal wellness plan tailored to the specific needs of the individual.  Instruction and education about the chronic pain condition will be an important component of that wellness plan.  An optimal combination of treatments will be designed to begin addressing the pain and conditioning issues of the sufferer.

Treatment options will include soft-tissue mobilization, motor control training, education, relaxation and stress management, low to moderate intensity exercise, and self management training.  Exercise is closely monitored to minimize relapses caused by overexertion. Patients are given counseling on pacing and self management.   These interventions are closely monitored for effectiveness and adjusted to obtain optimal results. 

This kind of treatment requires patience and perseverance by both the patient and physical therapist.  When provided in collaboration with other health care professionals, a chronic pain sufferer can return to a functional and productive state.  Chronic pain sufferers can have their quality of life dramatically improved when participating as an educated participant in this kind of multidisciplinary approach.   The physical therapist’s focus on restoration of mobility and pain management gives him/her a key role in providing hope for the future and relief from chronic pain.