Physical Therapy and Rehabilitative Medicine



Physical Therapy and Rehabilitative Medicine


Hannah W. Haddad

Linh T. Nguyen

Randi E. Domingue

Elyse M. Cornett

Alan David Kaye



Introduction

Pain affects nearly everyone and is a major contributor to disability, morbidity, mortality, quality of life, and health care costs. The increase in pain prevalence has been attributed to numerous factors, including an aging population, rise in obesity, life-saving treatments in traumatic injuries, and improved surgical and medical treatments. With the prevalence of pain and the increasing incidence of chronic pain, it is essential to develop treatment plans that prevent the progression of acute to chronic pain.1 Current treatment options for pain include oral medications, rehabilitative measures, procedural options, and finally, surgical procedures.2 Pharmacologic interventions provide only temporary relief and lead to undesirable side effects.3 In the case of opioid use, the risks can be subsequent substance abuse or addiction. Injections, nerve blocks, tissue ablations, spinal cord stimulators, and pain pumps are some procedural options for pain. Surgery is often the last resort for uncontrolled pain but is costly and may not provide expected results.2

In the acute stage of pain, rehabilitative medicine is implemented with the goals of controlling pain, restoring functionality to maintain productivity, and preventing the development of chronic pain. Common interventions include physical therapy (PT) and exercise, spinal manipulation, cognitive-behavioral therapy, meditation, acupuncture therapy, and massage therapy.4 PT and rehabilitation have been used for the treatment of lower back pain, joint pain, neck pain, and headaches, which are some of the most common types of pain in the United States. PT and rehabilitative medicine are safe and efficacious treatment options that should be considered and incorporated into the treatment plan for managing pain.3

This chapter, therefore, reviews epidemiology, etiology, risk factors, and pathophysiology of pain. It also discusses efficacy of rehabilitative medicine for acute pain and reviews effects of these treatment options on the necessity of opioid use for pain control.


Etiology Epidemiology Risk Factors Pathophysiology


Epidemiology

Acute pain is one of the most common reasons why individuals seek rehabilitative care, often through PT.5 This can be attributed to the considerable prevalence of those suffering from acute pain symptoms. Because pain is an individual, subjective experience influenced by
many factors, its exact prevalence is particularly challenging to quantify. Self-reported patient surveys have been utilized to try and define pain epidemiologically. One such study in the United States documented that 126.1 million (55.7%) adults reported some pain when surveyed.5 Additionally, pain trends among Americans have shown an increase of 10% (representing 10.5 million adults) from 2002 to 2018.5

Musculoskeletal pain disorders impart the largest influence on the need for rehabilitative medicine worldwide. An estimated 1.71 billion individuals across the globe suffer from musculoskeletal pain. Roughly 79% of PT in America addresses musculoskeletal pain syndromes (MPS).6 Musculoskeletal pain encompasses a wide variety of pathologies. Frequently treated pain regions include the spine, hip, knee, and shoulder.7 Common musculoskeletal pain disorders managed in a clinical setting are summarized in Table 49.1. Other acute pain conditions regularly managed with musculoskeletal rehabilitation include amputations, sprains, strains, joint dislocations, tears, and fractures.5










Etiology

Several factors are hypothesized to contribute to the growth of acute musculoskeletal pain requiring rehabilitation. The current focus on increased involvement in physical activity has consequentially led to an increase in MPS. These exercise-related pain conditions are often a result of overuse or accidental injury.9 The expansion of desk jobs and increased office screen time has also led to a greater incidence of musculoskeletal pain, particularly of the upper extremity. Prolonged desk and computer work have been linked to neck, wrist, and back pain as well as carpal tunnel syndrome.10 Increased and excessive mobile phone usage has similarly been associated with higher rates of neck and upper back pain.11 Furthermore, the increased average lifespan has led to more elderly individuals seeking rehabilitation for MPS associated with degenerative change.12


Risk Factors

Multidisciplinary rehabilitative medicine aims to address both the primary drivers in acute pain, anatomical or physiological pathology, as well as other contributing psychological risk factors.13 Workplace environment and occupation present a potential biomechanical risk, as prolonged sitting, repetitive movements, awkward posturing, and excessive use of force have been indicated as workplace hazards that contribute to acute musculoskeletal pain.14 Physical activity and participation in sports is a commonly associated risk factor for biomechanical injury resulting in acute pain.15 Surgery frequently causes postoperative pain and stands as a risk factor for both acute and chronic pain.16 Other common risk factors of acute pain disorders treated with rehabilitative medicine include obesity, pregnancy, childbirth, rheumatic disease, fibromyalgia, and cancer.17

The influence of psychological factors such as depression, stress, anxiety, fear, and catastrophizing are a factor in intensifying and prolonging pain.18 Additionally, few studies have implicated psychosocial difficulties and adverse health behaviors in adolescents as a risk for developing musculoskeletal pain in adulthood. These risky behaviors include externalizing symptoms (poor impulse control, noncompliance, aggression), internalizing symptoms (anxiety, sadness, social withdrawal), smoking, alcohol use, and physical inactivity.18 Emerging evidence shows that a strong therapeutic alliance between patient and practitioner may help mediate negative psychological symptoms and improve pain outcomes during rehabilitation.19


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May 8, 2022 | Posted by in PAIN MEDICINE | Comments Off on Physical Therapy and Rehabilitative Medicine

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