Pain Management by Physical Therapy: Alternative Methods to Opioids

A few months ago, I wrote about why we should try to avoid pain management with medicines like “opioids”. I briefly described a few alternative pain management in that article. Physical therapy is well known for pain management. Depending on the diagnosis and therapists, physical therapy can do miracles with pain in as short as one session. How do we physical therapy work on pain? Here, I want to discuss few pain management methods that physical therapy use. Some of these treatment options are very easy to utilize at home with no extra supervision.  On the other hand, other options need a close supervision of licensed health care professionals or may even need a physician’s order to initiate one.

  • Heat:

Heat therapy is well known to treat muscle or ligaments sprains or strains. It is also very useful to reduce pain and swelling symptoms present in degenerative diseases like arthritis. Heat is used in the ER as an alternative pain treatment method for postoperative pain.

A person can use heat therapy at home without the help of any licensed clinician. It is available in different forms like sand packs, hot packs, hot baths, hot patches, heat wraps as well as electric heating pads. A physical therapist may choose to combine heat therapy with joint stretching, manipulation, ultrasound etc to gain better results.

How Does Heat Therapy Work? 

The main mechanism of action for heat therapy is to increase the blood supply. This increases the temperature at the cellular level. Increase in temperature washes out the waste and painful substances from the bloodstream locally. Thus, heat therapy helps to reduce pain, reduce inflammation, and increase the tissue healing.

I said that a majority of the time, you can use hot packs or heating pads at home without a licensed health practitioner. The crucial thing is to check the skin after the application of heat. A person with impaired sensation or impaired cognition may not notice when it gets “too hot” or “forget “ that a heating pad is on, and this can cause actual harm (like burns) to a patient. So it is important to supervise a person whose sensation or cognition is impaired while they are using a heating pad.

  • Cryotherapy:

For all those cold lovers, cryotherapy is just for you. Bringing the body temperature down (to a certain degree of course) at the cellular level has useful therapeutic gains. Using ice as a therapeutic treatment is beneficial to reduce pain, muscle spasm, reduces fatigue, helps with the management of inflammation, spasticity, and edema, as well as reduces fever. As per research, cold treatment is significantly effective in patients with Multiple Sclerosis.

Cryotherapy can be used in form of cold packs, ice packs, ice massage, or gel – filled packs.

  • Iontophoresis:

This is another pain management method. Contradictory to the treatment methods defined above, Iontophoresis introduces the medicines directly into the affected area with the use of electrical channels.

So this is not an option for one to use at home independently. Rather, you need a licensed health care professional to provide you with the treatment. And depending on state regulations, you may even need physician prescription to use certain medication. Now, there are portable machines available which may allow you to continue your work with electrodes on after your visit with a physical therapist.

Iontophoresis help reduces pain, inflammation, swelling, muscle spasm etc. It is also a popular tool among lab technologists, the dentistry industry, and other medical professionals to deliver the local anesthetic agent.

  • Sensory Re-Education:

Sensory re-education or sensory retraining is a treatment method mainly for brain injury, spinal cord injury, nerve injuries, amputation etc. As the name suggests, it retrains the different senses like tactile, auditory, visual, proprioception, olfactory and orofacial. There is conflicting research regarding its effects, use, and benefits of sensory re-education. A patient or family members can perform sensory reduction with proper training and education from a physical therapy.

  • Mirror Therapy:

Mirror therapy helps to reduce pain and improve range of motion in acute or subacute cases of stroke or amputation. A family member can perform this independently after proper education and training by a physical therapist. I am not going into detail regarding how exactly mirror therapy works as there are conflicting theories regarding its benefits, use, and effects.

Importantly, Mirror Box is a tool that you will need to use to perform a mirror therapy. Rehab professionals use mirror therapy mainly during acute rehab inpatient stay to assist with stroke recovery and to reduce phantom limb pain after amputation.

  • Electrical Stimulation:

Electrical stimulation is a famous pain management approach among rehab professionals. A person can utilize this after proper education and training. Electrical stimulation serves a good pain management option for patients suffering from chronic types of pain, recurring episodes of pain, or wants to reduce the use of constant use of pain medications.

Different electrical waves have different therapeutic effects. Depending on the waves and their property, a therapist may choose an appropriate form of electrical stimulation. For instance, Infrared current therapy (otherwise known as IFC) can reduce acute as well as chronic pain. Russian current, Infrared current, Transcutaneous Electrical Nerve Stimulation (TENS) are all different kind of electrical stimulation. They help reduce pain, inflammation, muscle training, and retraining, nerve training, nerve retraining, as well as reduce muscle spasm.

Ultrasound is another pain management method where we use Ultrasonic waves for their therapeutic gains. Now, this ultrasound is different than what a lab technicians do for the diagnostic purpose. A licensed health care professional should administer Ultrasound treatment to reduce pain and to improve tissue healing.

  • Hydrotherapy:

Water has many therapeutic properties in many different forms. It is a good alternative pain management for the patient with arthritis, chronic pain syndrome or patients with musculoskeletal disorders. Since Hydrotherapy reduces stress level, it is also helpful as a relaxation technique. A certified aquatic therapist can prescribe aquatic therapy but anyone can use a spa or swimming pool to relax and reduce recurring episodes of pain.

  • Joint Mobilization and Manipulation:

A physical therapist performs different grades of joint mobilization to reduce pain. Joint Mobilization breaks down the adhesions and improves range of motion. Although all Joint mobilizations cannot be done in acute pain, grade V joint mobilization can be used in acute musculoskeletal pain.  This is otherwise known as joint manipulation. This is similar to what a Chiropractor performs to “adjust” the painful area.

  • Therapeutic Exercises:

Exercises can help to reduce pain, swelling, muscle spasm and increase muscle range of motion as well as muscle strength. With balanced exercises, one can gain a proper posture that in turn, reduces episodes of pain. Therapeutic Exercises include Strengthening exercises as well as Stretching exercises. One can perform a home exercise program with stretching exercises after a PT consultation.

One can perform regular walking, jogging, swimming, yoga or other forms of exercises at home or at the gym. Personal trainers or excises physiologists can also provide you with a safe and effective exercise regime which concentrate on improving muscle strength. Unlike, an exercise regime prescribed by PT, these exercises are not aimed to reduce pain.

Stretching Exercises: 

Gentle and Prolonged Stretching exercises hold the muscle tendons into the lengthened position for a few seconds. This hold helps increase the muscle length, reduces muscle spasm and thereby reduces pain.

Isometric Exercises: 

Isometric exercises are another form of exercises that can reduce pain significantly. These are best when you are not around any other types of equipment, or medicines, and need a quick relief of pain. I have discussed different isometric exercises for different body parts in my past articles. Remember, the effects you get from isometric exercises can last only for few hours (up to 8 hours at max). And you may have to perform them again.

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NOTE: The contents of this blog are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.