09 Feb Musculo-Skeletal Pain RX: Specialized Physical Therapy
In an article published in JAMA by Dr. Benjamin Friedman MD it was reported that prescribing NSAIDs in combination with opioid pain medication was no better than NSAIDs alone for people presenting with acute non-traumatic low back pain. He stated that “The problem will be that Clinicians and patients are frustrated by not having anything very effective to treat this low back pain.” It has also been reported in other articles that the cost of treating low back pain (LBP) is much greater if a person has had diagnostic imaging. This often begins the treatment of the image, although the research has found very little correlation to the findings on imaging and the patient’s pain or functional capacity and that imaging is not suggested in the acute stages of non-traumatic LBP.
Recently reported in Spine by Eleswarapu et. al. regarding the effectiveness of physical therapy with LBP, it was found that there was minimal improvement in almost 50% of the participants. However, there was no mention or control of the interventions and the article defended this by stating that the intent was to measure ‘real world PT’. This gives the impression that the therapists are simply technicians without skills to differentiate between which patients need which intervention and when they need it.
Physical therapy is not a commodity. It isn’t all the same any more than all “medicine” or “law” is the same. The quality of the therapy is greatly dependent upon the training of the therapist, the patient’s par-ticipation and the interventions chosen for treatment. There is very limited value in passive modalities such as ultrasound, electrical stimulation or heat for the long term recovery process.
An article by Dr. Julie Fritz, Ph.D., PT reported that if a patient received early active physical therapy that the resolution of LBP was greatly enhanced compared to passive therapy or delaying treatment for several weeks. Specific education utilizing the person’s psychosocial perspective for learning body mechanics, ergonomics, posture and manual therapies and movement training in the form of specific exercise have all been found to contribute to long term health.
There are many types of pain including acute, chronic, traumatic, non-traumatic, centrally mediated pain or allodynia, which is not a result of a specific event and must not be treated as such. The confounding psycho-social issues of depression, f ear avoidance, kinesiophobia and catastophization must be considered. Each requires the rapid recognition and correct treatment. We need to be alert for the psycho-social issues as often these are the root cause of the development of chronic pain which cost bil-lions of dollars annually.
OPTM takes great pride in our investment in the education of our therapists in the specific analysis of physical function, recognition of psycho-social issues and the many varieties of pain. Managing the care of a patient is specific not only for the patho-anatomical issues but also for the psychosocial issues. OPTM is here to help you manage your patients with pain which limits their capacity to enjoy life!