After completion of this chapter, the physical therapist should be able to do the following:
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”1 Pain is a subjective sensation with more than one dimension and an abundance of descriptors of its qualities and characteristics. In spite of its universality, pain is composed of a variety of human discomforts, rather than being a single entity.2 The perception of pain can be subjectively modified by past experiences and expectations.3 Much of what we do to treat patients’ pain is to change their perceptions of pain.3
Pain does have a purpose. It warns us that something is wrong and can provoke a withdrawal response to avoid further injury. It also results in muscle guarding that protects the injured part. Persistent pain can limit the participation of the patient in work, activity, and daily tasks. It can also inhibit efforts to rehabilitate the patient.4 Prolonged spasm, which leads to circulatory deficiency, muscle atrophy, disuse habits, and conscious or unconscious guarding, may lead to a severe loss of function.5 Chronic pain may become a disease state in itself. Often lacking an identifiable cause, chronic pain can totally disable a patient.
Research has led to a better understanding of pain and pain relief. This research also has raised new questions, while leaving many unanswered. We now have better explanations for the analgesic properties of the physical agents we use, as well as a better understanding of the psychology of pain. Newer physical agents, such as laser, and recent improvements to older agents such as diathermy and transcutaneous electrical nerve simulators offer new approaches to the treatment of musculoskeletal injury and pain.6 The evolution of the treatment of pain is, however, incomplete. Not even the mechanisms for the analgesic response to the simplest therapeutic modalities, heat and cold, have been fully described.7
The control of pain is an essential aspect of caring for a patient. Physical therapists working in collaboration with providers who can administer or prescribe analgesic medications are best positioned to most effectively manage a patient’s pain. The clinician may choose from several therapeutic agents with analgesic properties.8 The selection of a therapeutic agent should occur within the context of each patient’s plan of care. Some medications including opioid analgesics may blunt the response ...