Hello, in today's video I will talk about the different physiotherapeutic treatments for pain. The objective of this lesson is to comprehend the different types of physiotherapeutic treatments for pain, it's modalities and its effects on patients according to their pain mechanism. First, let's understand a bit about what physiotherapy is.
Physiotherapy is a profession in the health field that prevents and treats human movement dysfunctions whether caused by problems in organs, genetic problems, injuries, trauma and, also, after surgeries. In general, patients come to physiotherapy complaining about pain, whether acute or chronic, this symptom is the main reason for patients to seek physiotherapeutic treatment. Physiotherapists cares for patients in primary health care, but also at clinics, offices and rehabilitation centers.
They work at primary health care and tertiary care hospitals, in the nursing ward and in intensive care units. What is physiotherapeutic treatment like? What resources are used in this type of treatment?
Physiotherapists, when treating a patient, will, first, perform a broad evaluation based on the biopsychosocial model, thus, uncovering their individuality, preferences, physical condition, psychosocial condition and the environment, but there are techniques. And the techniques, procedures and devices we use are, in general, considered to be conservative treatments, meaning they're not invasive. I'm going to share a few examples of resources we may use in physiotherapy.
One of the main resources is exercise, physical exercise. We also educate them on pain and on health in general, we use manual therapy and devices, called electrothermal and phototherapeutic resources. These resources are biomodulators, used to improve pain and, also, to improve tissue healing processes.
How do we choose the best physiotherapeutic treatment option for an individual seeking physiotherapeutic health care? We first choose a treatment by performing a broad evaluation based on the biopsychosocial model, then we consider the patient's objectives and preferences. In addition, more modern works have brought up the idea that we should understand pain mechanisms so we can choose interventions based on pain mechanisms.
Then, we can choose physiotherapy techniques for pain through the mechanisms that cause pain. These pieces of information come from the main articles available today. But I can give you an example to make this easier to understand.
When we visit a doctor, for example, they prescribe us pharmacological treatment, They choose a medicine based on what the illness has caused in the organism, but this isn’t the only motivation since they also evaluate the medicine's side effects. In the case of an allergy, in addition to giving allergy medication, the doctor may ask, for example, if the patient works during the day because, if this medicine lists drowsiness as a side effect, they won't prescribe this kind of medicine, they will choose something else. What I'm saying is that, in addition to knowing the mechanism that causes pain, we also need to understand the patient's context.
But here I will guide you on the physiotherapy treatments based on pain mechanisms. And, later on, I will share the five categories of treatments. So, based on the five categories of pain mechanism, I will choose the best physiotherapy intervention option based on the best scientific evidence.
We have already studied the types of pain in our course, so I will remind you that, for example, in nociceptive pain we see clinical conditions, such as sprains, osteoarthritis, fractures, rheumatoid arthritis and other health conditions. In nociplastic or central sensitization pain, we see clinical conditions such as fibromyalgia and non-specific lumbar pain, so I need to choose other intervention options, since the mechanism that causes pain is different. Neuropathic pain, which was also conceptualized in a previous video, is the result of clinical conditions such as nerve compression in carpal tunnel syndrome, spinal cord lesions, peripheral nerve injuries and other conditions.
Another mechanism that causes pain is of biopsychosocial origin, associated to the limiting beliefs we talked about, to pain-related fear, to factors such as avoidance, catastrophizing, hypervigilance, generalization, disuse and disability. The last of the five mechanisms that cause pain that I want to tell you about is pain associated to the movement system itself, to the musculoskeletal system. So, it refers to pain caused by mechanisms associated to the movement system, such as muscle tension, trigger points, stiffness, joint locking, post-surgery pain, pain from clinical conditions such as adhesive capsulitis too.
Now, we need to reflect on something important. I'm talking about five mechanisms that may cause pain, five separate mechanisms. But I want to make it clear to you that we are complex human beings, so someone may have two associated mechanisms.
So, mechanisms aren't necessarily isolated conditions for some people. We need to look at it this way, as in the figure here in the slide, that our patients may have various associated mechanisms. So, clinical conditions need to be evaluated individually, for each person, and the characteristics of the context the person is in also need to be taken into consideration.
It's also important to understand that we already have, in physiotherapy, scientific literature describing what each intervention is for and their effect on tissue, so it's easy to choose an intervention according to the best scientific evidence when we know the pain mechanism in question. We should also understand that a same physiotherapeutic treatment or intervention may work for various mechanisms, this is called multimodal treatment. So, some resources in physiotherapy work for several mechanisms.
I'm going to give an example, exercise is a physiotherapeutic resource proven to help with the five mechanisms that cause pain. So it can be applied to patients dealing with any of the five mechanisms. Now, with a general and quite simple approach, I will share some treatment options backed by scientific evidence and known to work for each category of mechanisms that cause pain.
For example, you can use exercises for nociceptive pain. We can also, as I said, use exercise for the five mechanisms that cause pain. We can also use pain education, massages, transcutaneous electrical neuromuscular stimulation, a small device with electrodes that you can place on your skin to relieve pain, we also use other electrothermal and phototherapeutic resources to improve tissue healing.
For nociplastic or central sensitization pain mechanism, there’s the possibility to use exercises, pain education, cognitive-behavioral therapy, manual therapy and transcutaneous electrical neuromuscular stimulation, TENS. For neuropathic pain, we tend to use lots and various modalities of exercise and, also, electrostimulation. For pain with biopsychosocial origin we tend to use exercises, such as gradual exposure to movement, motor imagery, but we need to use pain education, pain resignification and we may also use massages.
For pain associated to the movement system, we also use exercises, pain education and manual therapy. As I said, it's very important to go beyond pain mechanism, to have a broader perspective of what else is associated with the patient's pain. So, we know that all interventions mentioned here are efficient and we can use other techniques and devices to treat patients with chronic pain.
So, we have reached the final reflection of today's lesson, which is: it's very important to understand pain mechanisms and, also, how physiotherapeutic treatments influence pain so we can choose the most appropriate option. But, it's even more important than that to understand the patient and work with them to choose the best intervention for them so they feel safe and adhere to the treatment. I hope you enjoyed today's lesson.
I appreciate it, thank you. [Well, I hope you enjoyed it. Thank you for watching until now!
