Non Pharmacological Interventions

Non-Pharmacological Approaches

Non-pharmacological interventions (NPI) or non-pharmacological therapies (NPT) are any non-chemical intervention, which is theoretically supported and performed on a patient and has the capacity of benefitting the patient.

• NPI have been employed as medical interventions (predating modern pharmacology), and are intended to improve quality of life, slow down deterioration or relieve pain. NPI also reduce health costs reduced and have minimal environmental impact..
• Following a healthy lifestyle is possibly the best NPI, contributing to improved health and quality of life.

Physiotherapy Offer Non-Pharmacological Interventions

A wide range of NPI modalities are used by physiotherapists, including manual therapies, electrophysical agents, thermotherapy, hydrotherapy, therapeutic exercise, meditation, and acupuncture. The physiotherapists' goal is to reduce pain and restore (or maintain) optimal physical functioning via these NPI.

Clinical professional readers are advised to continually consider relevant and most recent available evidence in relation to their patients’ clinical situation and flagged medication. Additionally, non-prescribing clinical readers are reminded to stay within their scope of practice and always discuss any treatment options preferred as an alternative to drug therapies with the patient’s multidisciplinary team (MDT) or general practitioner (GP). Non-clinical readers are advised to discuss any preferable options with their GP before seeking treatment.

Physiotherapy interventions

Patient education

The importance of increasing a patient’s understanding of their condition and treatment plan is not only of benefit for improving a patient’s adherence to treatment, but can also improve health outcomes . Self-management of chronic conditions as well as preventative health intents rely heavily on provision of contemporary information and communication practice . Primary focus for long term conditions commonly involves promotion of informed lifestyle choices, risk-factor modification, and active patient self-management . Education can be provided through a variety of health care professionals, preferably done by providers who have undertaken adequate training for education, and patient communication. Recognized physiotherapy programmes typically include a component of patient education within their training. .

Physical Activity

Physical activity prescription (a NPI) is an under-utilised tool for improving community health. In the right dose, physical activity can help to prevent, treat, and manage a range of chronic health conditions that increasingly impact the quality of life and physical function of individuals on a global scale.

Electrotherapy modalities

Electrotherapy has a place within clinical practice. When used appropriately, the evidence supports its effectiveness.

• Electrotherapy modalities, also referred to as electrophysical agents, are terms to describe electrical devices that are safely applied by trained professionals to an injury site in effort to enhance, expedite, or improve the treatment plan and recovery process. There are a wide range of electrotherapy modalities used in physical therapy.
• Conventionally, they are used for pain management, reducing swelling, increasing local blood flow, and breaking down scar tissue and can be applied across various stages of injury recovery .
• Common electrotherapy modalities used in pain management include transcutaneous electrical nerve stimulation (TENS), interferential current (IFC), ultrasound, and laser therapy.

More information on a wider variety of electrotherapy modalities and their multitude of uses can be found here.

Thermotherapy

Thermotherapy, involves use of heat or cold

1. Heat can give relief in subacute and chronic inflammatory and traumatic disorders, Heat increases blood flow, helping reduce inflammation, oedema and exudates from connective tissue injuries.
2. Cold helps relieve muscle spasms, myofascial or traumatic pain and acute inflammation.

Thermal modalities can also be used as adjuncts to exercise therapy and/or electrophysical modalities, for a variety of therapeutic purposes .

Manual Therapy

Manual therapy can be defined differently across health professionals but can be described as another non-pharmacological, non-surgical, conservative option for management of a range of musculoskeletal conditions. These skilled, hands on techniques can be applied to patients’ spine and extremities for purpose of assessment and treatment. There are a wide variety of techniques that can be grouped into four major categories: manipulation, mobilization, static stretching, and muscle energy techniques . Commonly, manipulation and mobilization of the spine are used for treatment of low back pain by physiotherapists and other health professionals such as osteopaths and chiropractors . Although the effectiveness of these techniques is dependent on the skills of the handling clinician, it is important to look at the available evidence when deciding to implement this option into a treatment plan. . Contemporary research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention have been substantiated.

Therapeutic exercise

Therapeutic exercise techniques include passive movements, active assisted movements, active movements, resisted movements and assisted resisted movements with aims to correct impairment, improve musculoskeletal function or maintain well-being .

See also Exercise and Activity in Pain Management

Therapeutic exercise can be prescribed to accomplish the following aims : Improve and enable ambulation; Release contracted muscles, tendons, and fascia; Mobilize joints; Improve circulation and respiratory capacity; Improve coordination; Reduce rigidity; Improve balance; Promote relaxation; Improve and maintain muscular strength and endurance; Improve exercise performance and functional capacity

Evidence supporting the use of therapeutic exercise is vast and dependent upon specific patient populations.eg stroke; multiple sclerosis; balance impairment; osteoarthritis; and mental health.

Meditation and Mindfullness

See here: Meditation

• Benefits include: Removes the accumulated stress and help increase the positive energy; decreases anxiety, depression, and pain (both physical and psychological); increases regional cerebral blood flow in the frontal and anterior cingulate region of the brain; decreases sympathetic overstimulation reduces cholesterol and risk of heart disease and helps in reducing smoking; has been shown to be beneficial in epilepsy, premenstrual symptoms, menopausal symptoms, autoimmune illness, and emotional disturbance in neoplastic disease; improves telomerase activity in the body which slows down the aging process and related diseases.

Mindfulness

• Mindfulness is a stress-reducing strategy where an individual develops an awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally and accepting them as they are.
• Mindfulness Meditation in Chronic Pain Management

Other NPIs

• Alternative Therapies for Pain Conditions
• Lifestyle Medicine for Health and Disease Management
• Yoga
• Cognitive Behavioural Therapy
• Tai Chi
• Acupuncture
• Massage Therapy