Principles of Pain Management

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Introduction[edit | edit source]

Pain is an unpleasant sensation ,and it is physiological and psychological experience that is subjective in nature. Accurate assessment of pain along with implementation of effective interventions is necessary for successful management program . Untreated pain can lead to reduction in quality of life for patients and their families which in turn increases the burden of health care professionals and hospitals.[1]

Persistent pain is the major cause of disability. Various factors like biological, psychological and socio-environmental play role in pain manifestation. The central principle of pain is to protect the body from perceived or real danger.[2]Studies support the use of non pharmacological strategies such as physiotherapy, cognitive behavioral therapy approaches, TENS, acupressure to reduce or cut down the use of medications.[3]

Guidelines For Pain Management In Acute Musculoskeletal Injury[edit | edit source]

There are various strategies to manage pain after acute musculoskeletal injury.

Cognitive Strategies[edit | edit source]

  • Consider using music strategy, aromatherapy and approaches based on cognitive behavioral therapy
  • Talk about reduction of pain, expected duration of recovery, patient .
  • Patients should be made to understand that they feel more pain , than the actual severity of pain. This is due to psychological involvement such as depression anxiety or post traumatic stress. Such pain perceptions are treat with psychosocial interventions and resources.

Physical Strategies[edit | edit source]

  • Use of TENS, proper elevation of the affected extremity, immobilization and cryotherapy units.[4]

Role Of Beliefs In Musculoskeletal Pain Management[edit | edit source]

  • Belief's play an important role in behavioral and emotional responses to Musculoskeletal pain.
  • The beliefs are modifiable and they are considered as first line of treatments by the clinicians.
  • Beliefs can be defined as : "fundamental truth governing behavior"[5]
  • Unhelpful beliefs convert acute pain into the chronic one.
  • Encourage patients to change their response towards pain and implement healthy life style habits such as weight loss, physical activity and good sleep habits. Family members should be involved to support the process.

Bio-Psycho-Social Model for Pain Management[edit | edit source]

  • Patients experiencing chronic pain are treated by Bio-psycho social model and others are treated by conventional model.
  • Bio-psycho-social model consist of three subdivisions:

Bio- What is the pathology and extent of it. Are other investigations or procedures indicated?

Psycho- How is the patient affected by pain? Are they having any negative emotions?

Social- How are the factors of daily living affecting them? Are they having social issues like financial problem, poor housing, family tension?[6]


From the IASP Curriculum Outline on Pain for Physical Therapy[7]

  1. Demonstrate an ability to integrate the patient assessment into an appropriate management plan using the concepts and strategies of clinical reasoning
  2. Understand the principles of an effective therapeutic patient/professional relationship to reduce pain, promote optimal function and reduce disability through the use of active and where appropriate, passive pain management approaches
  3. Assist patients to develop a daily routine to support achievement and, where necessary, readjustment of habits and roles according to individual capacity and life situation
  4. Understand the need to involve family members and significant others including employers where appropriate.
  5. Use a person-centered perspective to formulate collaborative intervention strategies consistent with a physical therapy perspective

References[edit | edit source]

  1. Alkhatib GS, Al Qadire M, Alshraideh JA. Pain management knowledge and attitudes of healthcare professionals in primary medical centers. Pain Management Nursing. 2020 Jun 1;21(3):265-70.
  2. Mankelow J, Ryan CG, Green PW, Taylor PC, Martin D. An exploration of primary care healthcare professionals’ understanding of pain and pain management following a brief pain science education. BMC medical education. 2022 Mar 28;22(1):211.
  3. Schofield P, Dunham M, Martin D, Bellamy G, Francis SA, Sookhoo D, Bonacaro A, Hamid E, Chandler R, Abdulla A, Cumberbatch M. Evidence-based clinical practice guidelines on the management of pain in older people–a summary report. British Journal of Pain. 2022 Feb;16(1):6-13.
  4. Hsu JR, Mir H, Wally MK, Seymour RB. Clinical practice guidelines for pain management in acute musculoskeletal injury. Journal of orthopaedic trauma. 2019 May;33(5):e158.
  5. Caneiro JP, Bunzli S, O'Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Brazilian Journal of Physical Therapy. 2021 Jan 1;25(1):17-29.
  6. Semmons J. The role of specialist physiotherapy in a pain management clinic–traditional and novel approaches. Anaesthesia & Intensive Care Medicine. 2022 May 20.
  7. IASP Curriculum Outline on Pain for Physical Therapy. Task Force Members: Helen Slater, Kathleen Sluka, Anne Söderlund, Paul J. Watson