The current accepted definition ofpain, as recommended by the International Association for the Study of Pain(IASP) states that pain is:”an unpleasant sensory and emotional experience associated withactual or potential damage or describe in terms of such damage.”Acute pain is mainly acknowledged tobe the pain related with acute tissue damage.
Once the injured structure isre-established, the inflammation processes is settled and healing takes place.Hence the acute pain will be resolved. In this case, pain provides an essentialwarning sign, protecting the vulnerable tissues from further damage. In acutepain, pain is an outcome of a particular pathological condition or injury. Whenpain does not resolve it is then categorized as chronic pain. Different toacute pain, chronic pain constitutes low levels of underlying pathology thatcan justify the presence and extent of pain.
Hence, one can classify pain as apathological condition in itself. Physiotherapists are autonomouspractitioners, taking treatment decisions independently. Therefore, it isessential to perform an assessment to determine the patient’s problem and toestablish a treatment plan. Assessment of a patient experiencing pain isconsidered to be the basis in obtaining optimal pain management. The assessmentcarried out by the physiotherapist usually follows the SOAP approach. The SOAPis an acronym for: subjective, objective, assessment and plan. The purpose ofthe subjective assessment includes to gather all relevant information about thepain such as the nature of pain together with the onset of symptoms and anypast treatment that the patient had tried.
The physiotherapist asks questionsabout the irritability of pain, any aggravating and easing factors. After thesubjective assessment testing procedures are performed in order to support orrefute the physiotherapist’s hypothesis about the source of pain. The lastsection of the SOAP approach refers to plan, which involve the method in whichthe physiotherapist addresses the patient’s problem and reach to thetherapeutical goals. Showing emphatic understanding of the patient’s painexperience when carrying out the assessment is crucial. The patient gets thefeeling that the physiotherapist has a genuine interest, that can influence apositive pain management outcome in the long run. Pain management is an essentialaspect of rehabilitation. Components of pain management include resolving theunderlying pathology when attainable, decreasing the patient’s discomfort andsuffering, and maximizing the patient’s function within the limitations causedby the underling pathology or injury.
· ColdTherapy:Multiple modalities are commonlyused to reduce pain. One of the modalities involve the application of coldtemperatures which is known as cryotherapy. Cryotherapy has shown to be a positive treatment for pain management. Ithas the most substantial effect on conduction by myelination and small fibersand the minimal effect on conduction by unmyelinated and large fibers.
TheA-delta fibers show the greatest decrease in pain in response to cryotherapy asthey are small in diameter and myelinated. Hence, this shows that this modalityis most effective when applied to the acute type of pain. Another mechanism inwhich cryotherapy relief pain is by increasing the pain threshold and thedecrease the sensation of pain.
The suggested mechanism that bring about anincrease in pain threshold include counterirritation. Controlling the oedema atthe site of injury can also ease the pain caused by nerve compression or anyother structures that are sensitive to pressure. Therapeutically cryotherapy iscarried out either by the direct application of ice using the ice bagtechnique, by local immersion for structures in the extremities or byvapocollant spray. A study carried out by Dambros et al., investigating theeffectiveness of cryotherapy after anterior cruciate ligament reconstruction,showed that cryotherapy has a positive effect on relieving pain when comparedto the control group. · HeatTherapy:Various thermal modalities can beused in the management of pain. Several studies suggested that the applicationof local heat can increase the pain threshold. The proposed mechanism of thiseffect include the direct and immediate reduction of pain by activation of thespinal gating mechanism according to the gate control theory proposed byMelzack and Wall (1965).
This theory suggests that within the spinal cord thereis a pain gating mechanism that modulated pain transmission. Painful impulsescarried towards the spinal cord via the small diameter sensory fibers open thegate to allow the pain signals to be transmitted to the brain. In contrast,impulses carried out by large diameter sensory fibers that response to heat canclose the gate. Hence, modulating the transmission of painful impulses andleading to pain relief. An indirect mechanism, that provide a prolonged painrelief is thought to brought about by reduction of ischemia due tovasodilation.
The vasodilation brought about as a physiogical outcome of anincrease in temperature also facilitate tissue healing and flush the noxioussubstances such as substance P relieving the pain. Several modalities can beused to administer head in a controlled and save method. Superficial heat canbe delivered using techniques that use conduction such as hot packs andinfrared. On the other hand, heat to deeper structures can be delivered usingenergy conversion techniques such as short wave diathermy. A studyinvestigating the effect of infrared therapy for chronic low back pain carriedout by Gale, Rothbart and Li, (2006) showed a drop inthe numerical pain rating scale demonstrating that infrared is effectiveapplication in reducing chronic low back pain. Hydrotherapy iscommonly applied to patients with painful neurological or musculoskeletalalterations. Since, the heat and floatability of water aids in blockingnociceptors by acting on thermal receptors and mechanoreceptors.
This leads toa positive effect on spinal segmental mechanism. The warm water can alsoincrease the blood flow, helping to dissipate noxious substances are alreadydiscussed before and enhance muscle relaxation.