Article

Pain reduction is a primary goal of physical therapy for patients who present
with acute or persistent pain conditions. The purpose of this review is to
describe a mechanism-based approach to physical therapy pain management. It is
increasingly clear that patients need to be evaluated for changes in peripheral
tissues and nociceptors, neuropathic pain signs and symptoms, reduced central
inhibition and enhanced central excitability, psychosocial factors, and
alterations of the movement system. In this Perspective, 5 categories of pain
mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system)
are defined, and principles on how to evaluate signs and symptoms for each
mechanism are provided. In addition, the underlying mechanisms targeted by common
physical therapist treatments and how they affect each of the 5 categories are
described. Several different mechanisms can simultaneously contribute to a
patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's
pain. Further, within a single pain mechanism, there are likely many possible
subgroups. For example, reduced central inhibition does not necessarily correlate
with enhanced central excitability. To individualize care, common physical
therapist interventions, such as education, exercise, manual therapy, and
transcutaneous electrical nerve stimulation, can be used to target specific pain
mechanisms. Although the evidence elucidating these pain mechanisms will continue
to evolve, the approach outlined here provides a conceptual framework for
applying new knowledge as advances are made.

Langue : ANGLAIS