The principles and efficacy of physical therapy (PT) in the context of patient pain management have been an area of intense interest for researchers from all over the world. This surge in attention devoted to PT aligns with the current trends according to which the systems of care reduce the use of pharmacological procedures in pain treatment, namely opioids. Pullen (2017) reports similar tendencies in the treatment of serious conditions, such as HIV. According to her findings, PT is an effective alternative to pharmacological methods of pain management that helps the patients relieve their symptoms without placing additional stress on their bodies. Thus, the importance of physical therapy is recognized across various medical context and deserves additional exploration.
The ideas presented in this study prompted its author to explore new avenues of physical therapy use for pain management. By 2020, Pullen et al. (2020), researched the benefits of an innovative PT-based intervention for the pain management among patients with the HIV-positive status. Nearly 80% of the participants reported a significant decrease in pain levels, following the physical therapy interventions. These results were combined with a lower need for the use of opioids, which reflects one of the primary objectives of PT development. Through maximizing the efficacy of such therapies, clinical experts contribute to the eradication of unneeded opioid use and corresponding societal issues.
HIV is not the only severe condition that has been reconsidered through the lens of physical therapy. The study by Manchikanti et al. (2020) concentrates on cancer patients as one of the groups that are associated with immense physical and emotional costs. Such cases require better avenues of pain management, as safer and more reliable alternatives to pharmacology need to be discovered. Physical therapy is recognized as one of such alternatives because it combines positive treatment outcomes with lower patient and system costs. Therefore, when outlining the key direction of pain management study development, the researcher emphasizes the central role of PT in this regard.
In fact, the role of physical therapy is crucial in terms of reducing the use of opioids in pain treatment. As such, a retrospective cohort study conducted by Thackeray et al. (2017) examined the impact of PT on subsequent opioid use in low back pain patients. As the analysis revealed, physical therapy proved to be an effective independent means of pain management in most situations. Furthermore, PT referrals and consultations reduced the likelihood of opioid prescription in the future, thus contributing to better patient outcomes. In this regard, the effectiveness of PT can be observed on bot the level of individual patient and systemwide.
The increasing role of PT in pain management permeates the various settings of healthcare. Simon and Hicks (2018) reflect this tendency in their exploration of the emerging trends within geriatric low back pain management. This field is highly important as it contributes to the quality of life of older residents, building a healthier society. In recent years, the central paradigm of geriatric pain management is to said to have shifted from standardized, pharmacology-based treatments. Instead, clinicians actively implement evidence-based, patient-centered interventions, which includes bespoke PT programs.
Overall, the current development of healthcare can be characterized by the ongoing pursuit of change and quality transformations. George (2017) concurs with the tendency, concretizing its idea within the framework of pain management. According to him, the time of change has arrived, meaning that the system needs to evolve and adapt to the modern trends. This implies abandoning the outdated ideas and focusing of safer initiatives. In pain management, PT is said to fit this profile, enabling effective, yet safe interventions even for severe cases. Therefore, refining and developing the methods of PT should be one of the system’s priorities in the near future.
The need for change is an overarching team of numerous articles within the current body of knowledge. Cuenca-Martínez et al. (2018) align their position with the ongoing pursuit of innovation in terms new PT interventions. Low back pain is one of the most common conditions for which physical therapy is a key method. However, Cuenca-Martínez et al. (2018) argue that classical approaches to PT gradually become outdated showing ineffectiveness for chronic non-specific low back pains. Thus, the authors of the study urge experts and scholars to concentrate on the development of new methods of PT that would build a better framework of pain management on the fundamental principles of past experiences.
There exist many factors that can either facilitate or impede better outcomes of physical therapy in various factors. However, the unity in the form of a therapeutic alliance is a key enabler of better treatment outcomes for Kinney et al. (2018). As per this systematic review, patients and medical teams need to remain aligned in their perceptions of treatment procedures. This idea implies an understanding of why certain methods are selected for an intervention, including physical therapy. When a common ground is found, PT reveals its full potential through the therapeutic alliance cooperation. In a way, the effected is directed both ways, and the use of such therapy promotes better rapport between medical units and patients, which is another important aspect of care.
As a matter of fact, patients who experience dire pain remain in need of quality help combined with both physical and moral comfort. Perrot et al. (2018) state that many individuals with musculoskeletal pain develop kinesiophobia. This psychological condition is associated with the fear of movement that is instilled by prior painful experiences. As a result, patients become reluctant to cooperate or to make efforts to regain movement abilities. According to Perrot et al. (2018), physical therapy is a major component of mitigating this situation because it addresses the roots of kinesiophobia. This way, PT improves the situation in terms of both physical condition and inner feelings.
In general, physical therapy is researched and applied across various settings and for different painful conditions. Osteoarthritis is one of such conditions, as it is associated with severe physical discomfort. It has become the central point of research for Chen et al. (2021) who review the evolution and current state of osteoarthritis-related pain management. The most prominent trends reported by them show an increasing role of physical therapy as an instrument of commendable efficacy. As per the global trends, patients with osteoarthritis benefit from a higher prevalence of PT-based interventions as compared to pharmacological treatment. This way, they have a better quality of life with fewer repercussions in the long term.
Another common case of serious pain is associated with the CPPS, or chronic pelvic pain syndrome. This syndrome is prevalent among men with chronic prostatitis, being diagnosed in 90-95% of all cases. According to Hu et al. (2019), in spire of the widespread character of the condition, its exact pain management directions remain vague and underexplored. The authors of this study argue in favor of physical therapy as an effective component of CPPS treatment. From this perspective, PT is associated with high efficacy in most cases of prostatitis and pelvic pain, while remaining safe for the patient.
A similar direction of research was taken by the authors of the next piece of knowledge. Grinberg et al. (2019) equally acknowledges the damaging impact of CPPS on the life of a patient. The central concept of their study revolves around the use of myofascial physical therapy to improve the functioning of the pelvic muscle and alleviate some of the pain. Based on the examination of 50 female patients with CPPS, Grinberg et al. (2019) observed major improvements in terms of pain frequency and intensity after three and nine months of PT. Therefore, adequately selected physical therapy has a multifactorial effect even in the cases of serious pain.
The incidence of the pelvic pain is alarmingly high in the current environment. In a way, this prevalence is conditioned by the extensive array of factors that can instigate the development of CPSS in both men and women. The study by Scott et al. (2020) is focused on the application of individualized physical therapy on post-prostatectomy men with pelvic pains. The authors support bespoke, individual treatment plans that adapt the arsenal of modern PT to each specific case. As per the findings, physical therapy is proved to be effective for alleviating pelvic pains in such cases, at least as a complementary intervention.
The next area of interest in terms of the physical therapy efficacy is related to the instances of lower extremity pain. Mirek et al. (2019) examine these issues in the context of pediatrics, assessing the clinical utility of five key outcome measures of PT. The cross-sectional, retrospective study followed 173 patients across the period of five years. Based on the analysis of the key indicators, Mirek et al. (2019) statistically significant improvements of the pediatric patients’ conditions. Thus, the results are in favor of the extended clinical use of physical therapy for the lower extremity pain management.
Another common case of pain is experiences by patient in their lower backs. As observed by Leysen et al. (2021), while such conditions are prevalent in the current landscape, the situation remains on the sub-optimal level. More specifically, physical therapy students do not appear to follow the existing guidelines within this area of expertise. The adherence appears to improve with experience, but the average performance still leaves much to be desired. This way, the overall efficacy of PT is compromised, preventing it from reaching full potential.
The subsequent study has been executed along similar lines, focusing on the lower back pain. Şahin et al. (2018) investigated the cases of 104 patients from various age groups in a practical environment of randomized control study. The comparison of the results between the PT and control groups revealed the high efficacy of physical therapy across one year of follow-up. Thus, this methodology is clearly applicably for the effective treatment of low back pain.
The neck is also a vulnerable part of human body that is often subject to severe pains. Van Tulder et al. (2018) rely on the academic evidence in favor of physical therapy for such conditions. According to them, timely diagnosis and precise use of PT enables better outcomes for patients with neck pains. This evidence became the foundation for the guidelines provided by the Royal Dutch Society for Physical Therapy. As such, in some nations, the efficacy of physical therapy is officially recognized on the state level.
In fact, the status of physical therapy has been on a stable increase within the clinical expert community. Based on its efficacy for the lower back pain treatment, Frogner et al. (2018) refer to it as the key point of pain management improvement. Furthermore, high-quality PT is said to promote the efficacy of healthcare, in general. Considering its impact on the prevention of major complications, physical therapy can be used to optimize the delivery of services from the resource and financial points of view. For example, evidence suggests a lower level of the expensive material and equipment use after the implementation of PT. Thus, healthcare becomes more affordable and more efficient for both the system and the patients.
Accordingly, it is vital to concentrate on the quality development of physical therapy competencies from earlier stages of professional education. Hush et al. (2018) argue in favor of the IASP Pain Curricula embedded in the three-year pre-licensure PT program. According to them, the use of the IASP and similar pain management education initiatives is indispensable because it helps students acquire and develop their key skills in this regard. Consequently, the efficacy of PT increases, leading to better clinical outcomes and prompting researchers to advance the procedures in this area.
Evidently, the general progress permeates various aspects of healthcare, which includes physical therapy. Grona et al. (2017) research the efficacy of remote formats of PT that rely on videoconferencing for better patient access. While the use of digital opportunities is generally, positive, the authors remain cautious of its wider implementation. In many situations, the delivery of health services requires the immediate physical presence of the patient. It is possible that PT is one of such cases, limiting the effect of tele-formats in terms of their efficacy and applicability.
References
Bier, J. D., Scholten-Peeters, W. G. M., Staal, J. B., Pool. J., van Tulder, M.W., Beekman, E., Knoop, J., Meerhoff, G., & Verhagen, A. P. (2018). Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Physical Therapy, 98(3), 162–171.
Chen, T., Zhu, J., Zhao, Y., Li, H., Li, P., Fan, J., & Wei, X. (2021). The global state of research in pain management of osteoarthritis (2000–2019). Medicine, 100(2).
Cuenca-Martinez, F., Cortes-Amador, S., & Espi-Lopez, G. V. (2018). Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: A literature review. Physical Therapy Research, 21(1), 16–22.
Frogner, B. K., Harwood, K., Andrilla, C. H. A., Schwartz, M., & Pines, J. M. (2018). Physical therapy as the first point of care to treat low back pain: An instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Services Research, 53(6), 4629–4646.
George, S. Z. (2017). Pain management: Road map to revolution. Physical Therapy, 97(2), 217–226. Web.
Grinberg, K., Weissman-Fogel, I., Lowenstein, L. Abramov, L., & Granot, M. (2019). how does myofascial physical therapy attenuate pain in chronic pelvic pain syndrome? Pain Research and Management, 2019.
Grona, S. L., Bath, B., Busch, A., Rotter, T., Trask, C., & Harrison, E. (2017). Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. Journal of Telemedicine and Telecare, 24(5), 341–355.
Hu, M., Wazir, J., Ullah, R., Wang, W., Cui, W., Tang, M., & Zhou, X. (2019). Phytotherapy and physical therapy in the management of chronic prostatitis–chronic pelvic pain syndrome. International Urology and Nephrology, 51, 1081-1088.
Hush, J. M., Nicholas, M., & Dean, C. M. (2018). Embedding the IASP pain curriculum into a 3-year pre-licensure physical therapy program: Redesigning pain education for future clinicians. Pain Reports, 3(2).
Kinney, M., Seider, J., Beaty, A. F., Coughlin, K., Dyal, M., & Crewley, D. (2020). The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 36(8), 886–898.
Leysen, M. Nijs, J., Van Wilgen, P., Demoulin, C., Dankaerts, W., Danneels, L., Voogt, L., Koke, A., Pitance, L., & Roussel, N. (2021). Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study. Brazilian Journal of Physical Therapy, 25(3), 319-328.
Manchikanti, L., Singh, V., Kaye, A. D., & Hirsch, J. A. (2020). Lessons for better pain management in the future: learning from the past. Pain and Therapy, 9(2), 373–391.
Mirek, E., Logan, D., Boullard, K., Hall, A. M., Staffa, S. J., & Sethna, N. (2019). Physical therapy outcome measures for assessment of lower extremity chronic pain-related function in pediatrics. Pediatric Physical Therapy, 32(2), 200-207.
Perrot, S., Trouvin, A. P., Rondeau, V., Chartier, I., Arnaud, R., Milon, J. Y., & Pouchain, D. (2018). Kinesiophobia and physical therapy-related pain in musculoskeletal pain: A national multicenter cohort study on patients and their general physicians. Joint Bone Spine, 85(1), 101–107.
Pullen, S. (2017). Physical therapy as non-pharmacological chronic pain management of adults living with HIV: Self-reported pain scores and analgesic use. HIV/AIDS – Research and Palliative Care, 9, 177–182.
Pullen, S. D., del Rio, C., Brandon, D., Colonna, A., Denton, M., Ina, M., & Lancaster, G. (2020). An innovative physical therapy intervention for chronic pain management and opioid reduction among people living with HIV. BioResearch Open Access, 9(1), 279–285.
Şahin, N., Karahan, A. Y., & Albayrak, I. (2018). Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: A randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 64(1), 52–58.
Scott, K. M., Gosai, E., Bradley, M. H., Walton, S., Hynan, L. S., Lemack, G., & Roehrborn, C. (2019). Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain. International Urology and Nephrology, 52, 655–659.
Simon, C. B., & Hicks, G. E. (2018). Paradigm shift in geriatric low back pain management: Integrating influences, experiences, and consequences. Physical Therapy, 98(5), 434–446.
Thackeray, A., Hess, R., Dorius, J., Brodke, D., & Fritz, J. (2017). Relationship of opioid prescriptions to physical therapy referral and participation for Medicaid patients with new-onset low back pain. Journal of the American Board of Family Medicine, 30(6), 784–794.
