Pain management program is a multi-disciplinary approach that aims at providing pain relief and restoration of normal function by either drugs and/or interventions.. Pain management program may be desirable selected patients of back pain or sciatica, neck pain, failed back syndrome, reflex sympathetic dystrophy, myofascial pain, fibromyalgia, facial pain, neuropathic pain, headaches, cancer pain, shingles, chronic pelvic pain, spinal pain syndromes and phantom Limb pain.
The interventions include electrotherapy, manipulative therapy, hydrotherapy, nerve blocks or radiofrequency ablation, biofeedback, relaxation and stress management.
Pain management program aims to increase and reduce level of functioning and quality life while reducing your sense of suffering.
Pain management programs are designed to help a person with pain become part of the treatment team and take an active role in regaining control of his or her life in spite of the pain.
Pain management program involves a team of health care providers working directly with the person with pain with a variety of measurement, interventions, and strategies. The treatment is never focused on just the pain, but the person as well.
The team is consists patient with pain and his support system [ family, friends, neighbors], physicians, physician assistants, nurses, psychologists, physical, occupational and recreational therapists, vocational counselors, pharmacists, dieticians, social workers and other support staff.
Hydrotherapy in Pain Management
In hydrotherapy, water is used as a therapeutic measure. It includes ice water therapy and pool hydrotherapy.
The pool therapy is one wherein patients are mobilized to do activities in warm swimming pool.
This warmth of water reduces pain and relaxes muscle spasm. Water with its buoyancy counteracts gravity, provides support and relieves weight bearing in degenerated joints or unstable joints.
Pool therapy is indicated in
- Degenerative arthritis
- Neurological disorders-hemiplegia, paraplegia
It is contraindicated in
- Haemodynamically unstable patients
- Major systemic illness
- Vertigo, epilepsy
Cold therapy is used in the form of ice packs, vapocoolant sprays and ice massage.
It is most useful in acute musculoskeletal pain associated with sports injures or trauma.
Whenever cold stimulus (ice pack) is applied to skin, it melts and removes heat from tissues. This leads to vasoconstriction (The blood vesseles get constricted, their lumen and their capacity to carry blood increases), reduction of nerve conductivity (As a result the nerve becomes less sensitive), reduction of muscle spasm and spasticity. Once the cold stimulus is taken off, the temperature of the area reaches normal level by vasodilatation.
This vasodilatation bring fresh blood which flushes inflammatory mediations. Again reapplication of cold stimulus repeats same event.
Alternate vasoconstriction and vasodilatation helps in tissues healing and pain relief.
Ice can be applied in towels as a pack or by immersion in a bath. Damp towels dipped in an ice and water mixture or containing crushed or flaked ice, can be wrapped round painful and swollen joints. The towels are changed every few minutes.
In ice massage, an ice cube is wrapped in a towel at one end and the free end is massaged over the skin. This can act as counterirritant if applied for 5 to 7 minute to relieve pain and muscle spasm.
Ice therapy can alleviate pain frequently and onset of pain can be delayed by early application of therapy. This will reduce bleeding and oedema by causing vasoconstriction.
One should be careful while applying ice therapy for extremities like digits and toes for the risk of ischaemia or decreased supply of the oxygen to the tissues
Ultrasound Therapy In Pain Management
Ultrasound therapy involves production of longitudinal mechanical waves above the audible range (20 KHz). The frequencies used in physiotherapy vary from 0.75 MHz to 3 MHz. These are produced by distortion of quartz crystal, by a high frequency alternating current.
These sound waves require a conducting medium like oil or water to reach from the probe head to tissues. The probe head should be applied perpendicular to tissues to present refraction and it should be moved continuously to prevent concentration on one tissue area. Higher the frequency, greater the absorption and smaller the depth of penetration.
Guidelines for treatment
- Superficial lesions are treated with 3 MHz frequencies.
- Deeper lesions with 0.75-1.0 MHz frequencies.
- For acute injuries, starting dose may be 0.25 Wcm* for 5 minutes twice daily. Progression is made by increasing the time and reducing the frequency of treatment.
- For chronic problems, the intensity may be increased up to 1 Wcm*.
Get more stuff on Musculoskeltal Health
Subscribe to our Newsletter and get latest publications on Musculoskeletal Health your email inbox.
Thank you for subscribing.