Restorative Therapies for Pain Management

Pain is a multidimensional problem ranging from discomfort to agony and affecting physical, emotional, and cognitive function as well as interpersonal relationships and social roles.  Effective pain management, particularly for chronic pain, is best achieved using a patient-centered, multidisciplinary, multimodal, integrated approach that may include pharmacotherapy and restorative therapies. 

In this section you will learn more about pain, its causes, evaluation and treatment utilizing Restorative Therapies. Restorative therapies include physical therapy (PT), occupational therapy (OT), physiotherapy, therapeutic exercise, and other movement modalities that are provided as a component of interdisciplinary, multimodal pain care.

Transcutaneous electric nerve stimulation (TENS) has been applied to treat pain, but studies of its efficacy are lacking in number and design, with high risks of bias commonly reported.An evaluation of 49 systematic reviews, randomized clinical trials (RCTs), and observational studies found insufficient evidence to assess the effectiveness of TENS for acute low-back pain.

Massage therapy can be effective in reducing pain. There are a variety of types of massage therapy, including Swedish, shiatsu, and deep tissue (myofascial release). In Swedish massage, the therapist uses long strokes, kneading, and deep circular movements. Shiatsu massage uses the fingers, thumbs, and palm to apply pressure. Deep tissue massage focuses on myofascial trigger points, with attention on the deeper layers of tissues.

Traction is a technique from the PT field that is used to treat spinal pain. Review of the evidence has failed to demonstrate the clinical effectiveness of traction as an effective, evidence-based best practice; however, the filed in general lacks high-quality RCTs that examine effectiveness of traction as an isolated treatment modality for low-back or neck pain.

Cold and heat have been used in the treatment of symptoms of a variety of acute and chronic pain conditions. The application of cold has long been used as a component of the RICE (rest, ice, compression, elevation) paradigm for the treatment of acute pain syndromes.

Therapeutic ultrasound (TU) is thought to deliver heat to deep tissues for improved injury healing. A 2001 review concluded that there was little evidence that TU is more effective than placebo for pain treatment in a range of musculoskeletal conditions.

Bracing has generally been discouraged in pain management because of fears of deconditioning and muscle atrophy. However, there is evidence that, for at least short periods of time, bracing (especially nonrigid bracing) may improve function and does not result in muscle dysfunction.