TENS and acupuncture therapy for soft tissue pain

Acupuncture and transcutaneous electrical nerve stimulation (TENS) are two commonly used physical therapies in the management of soft tissue pain. Stimulation is used to provide analgesia in the treatment of both acute and chronic soft tissue pain.     

Soft tissue pain and physical therapy

Soft tissue pain is one of the most common reasons for consulting a physiotherapist. Physical therapy management of the condition in the acute (injury) stage is focused on the management of inflammation to reduce further damage and promote healing. Treatment soon after injury and in the subacute stage focuses on functional rehabilitation to restore normal strength and biomechanics to the injured part. Adjuncts to treatment such as electrotherapies and acupuncture are often used but lack rigorous scientific evidence. In patients with chronic pain arising from soft tissues a rehabilitation approach that identifies barriers to normal function, both physiological and psychological, is adopted. Although pain reduction is one aim of management in chronic pain, treatment is designed to restore function and achieve patient-valued goals, even if complete pain relief is not achievable.     

Soft tissue pain and physical therapy

Pain is a natural response to soft tissue injury but when it is unresolved, neurophysiological changes can occur to establish chronic pain. Acute pain is usually linked with a specific incident, though in repetitive or overuse injuries this is not obvious. With chronic pain there is a prolonged period of pain, frequent and unsatisfactory healthcare use and, often, negative psychosocial factors. The cause of soft tissue pain is identified by history, palpation and selective stressing of structures. The overriding aim of acute and subacute pain management should be the prevention of chronicity, and careful questioning is indicated to identify psychosocial predictors of chronicity. Confirmation of chronic pain is primarily a case of elimination and history, and failure or reluctance to diagnose chronic pain impedes rehabilitation. Physical therapy for the acute pain of soft tissue injury aims to manage healing and restore function by early rehabilitation. Various physical, electrical and thermal methods are used, though the evidence for these is questionable. The traditional biomedical approach of physical therapy is inappropriate for someone with chronic pain. A wider biopsychosocial approach is advocated to optimize activity and participation while living with pain. The therapist should encourage education, exercise, pacing of activity, and planning for flare up. Where possible, there should be close liaison with other colleagues. Acute pain should resolve in a few weeks with restoration of function. Chronic pain is unlikely to resolve, but with appropriate management and support the person can regain high levels of activity and participation.     

Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults

Background

The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.

慢性疼痛基因治疗相关研究的进展

急性疼痛是组织损伤的生理性预警信号，而慢性疼痛则是一种病理状态。慢性疼痛常与痛觉感知、传递和调制有关的神经系统的改变一中枢或外周敏化有关。中枢敏化时神经元的反应性增加，疼痛甚至可以由非痛觉感觉神经纤维的激活产生；而神经末梢伤害感受器长期暴露在组织损伤或炎性产物（如细胞因子、缓激肽、花生四烯酸等）中将产生外周敏化，导致感受器活化阈值降低。由于慢性疼痛本身涉及到很复杂的中枢调控机制及神经元的结构重塑，目前的治疗手段和药物的疗效均尚不能令人满意，因此，基因治疗可能的有广阔应用潜在前景。     

Chronic pain management after surgery

Chronic post-surgical pain is a common problem affecting between 2% and 10% of adults after surgery and a significant health burden. The development of chronic post-surgical pain involves multiple mechanisms including peripheral and central sensitization and nerve injury, thought to be the most significant factor. There are many risk factors including preoperative pain, chemotherapy/radiotherapy, surgical, psychological and genetic factors. The prevention of chronic post-surgical pain is challenging but progress is being made in identifying at risk groups, improved surgical technique and preventative analgesia including regional analgesia. Accurate diagnosis is essential for proper management, including identification of neuropathic pain. Management involves identifying any surgically or medically treatable cause, followed by pharmacological, psychological, physical and interventional management. It is essential for all clinicians involved in the care of surgical patients to have an awareness of chronic post-surgical pain, its prevention, diagnosis and treatment.     

Chronic pain management after surgery

Chronic post-surgical pain is a common problem affecting between 2% and 10% of adults after surgery and a significant health burden. The development of chronic post-surgical pain involves multiple mechanisms including peripheral and central sensitization and nerve injury, thought to be the most significant factor. There are many risk factors including preoperative pain, chemo/radiotherapy, surgical, psychological and genetic factors. The prevention of chronic post-surgical pain is challenging but progress is being made in identifying at-risk groups, improved surgical technique and preventative analgesia including regional analgesia. Accurate diagnosis is essential for proper management, including identification of neuropathic pain. Management involves identifying any surgically or medically treatable cause, followed by pharmacological, psychological, physical and interventional management. It is essential for all clinicians involved in the care of surgical patients to have an awareness of chronic post-surgical pain, its prevention, diagnosis and treatment.     

Predetermined physical factors and alternative factors in the treatment of chronic pain in discogenic lumbosacral radiculitis

ObjectivesEvolution of acute pain in discogenic lumbosacral radiculopathy to subacute and chronic pain reflects pharmacotherapeutic issues and even helplessness in some cases. It has social significance since 80% of people in working age have faced it at least once in their working lifetime. Most of the acute and subacute (> 6 weeks) episodes resolve within 3 months while in 10–15% of patients their condition does not resolve and they develop chronic (> 3 months) lumbosacral syndrome.Material and methodsWe present our experience in non-pharmaceutical treatment of chronic pain in discogenic lumbosacral radiculopathy after comparison of different predetermined and alternative therapies that have been given to patients who were selected by highly informative assessment indicators for the extent of spinal root lesion. Sixty patients were enrolled in this study and were divided into two groups of 30 patients each. The first group was treated with classic acupuncture, and the second group with two predetermined factors from conventional physiotherapy. The effect of the two treatments applied was followed up after each procedure in the therapeutic course, and also a month later.ResultsAs a result of the obtained statistical data, we present a variant of non-invasive treatment of chronic pain that would be useful in clinical practice.ConclusionsIn cases of chronic pain in this particular disease, a recommendation should be given for the combination of two physical factors – paravertebral application of ultrasound in impulse mode with an appropriate anti-inflammatory medicament as a mediator in the area of the lumbosacral spine segment, by a labile method, combined with low frequency impulse magnet field in the low back area and the affected leg. Also, acupuncture could be used in fighting against pain, especially in patients contraindicated for predetermined factors (those with a pacemaker, or an oncological process in the small pelvis area).     

Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study

BACKGROUND: Nonhealing wounds are a major, functionally-limiting medical problem impairing quality of life for millions of people each year. Various studies report complete wound epithelialization of 48 to 56% over 30 to 65 d with different treatment modalities including ultrasound, topical rPDGF-BB, and composite acellular matrix. This is in contrast to comparison control patients treated with standard wound care, demonstrating complete epithelialization rates of 25 to 39%. Extracorporeal shock wave therapy (ESWT) may accelerate and improve wound repair. This study assesses the feasibility and safety of ESWT for acute and chronic soft-tissue wounds. STUDY DESIGN: Two hundred and eight patients with complicated, nonhealing, acute and chronic soft-tissue wounds were prospectively enrolled onto this trial between August 2004 and June 2006. Treatment consisted of debridement, outpatient ESWT [100 to 1000 shocks/cm(2) at 0.1 mJ/mm(2), according to wound size, every 1 to 2 wk over mean three treatments], and moist dressings. RESULTS: Thirty-two (15.4%) patients dropped out of the study following first ESWT and were analyzed on an intent-to-treat basis as incomplete healing. Of 208 patients enrolled, 156 (75%) had 100% wound epithelialization. During mean follow-up period of 44 d, there was no treatment-related toxicity, infection, or deterioration of any ESWT-treated wound. Intent-to-treat multivariate analysis identified age (P = 0.01), wound size < or =10 cm(2) (P = 0.01; OR = 0.36; 95% CI, 0.16 to 0.80), and duration < or =1 mo (P < 0.001; OR = 0.25; 95% CI, 0.11 to 0.55) as independent predictors of complete healing. CONCLUSIONS: The ESWT strategy is feasible and well tolerated by patients with acute and chronic soft tissue wounds. Shock wave therapy is being evaluated in a Phase III trial for acute traumatic wounds.     

Soft tissue management in glenohumeral arthoplasty

The soft tissue envelope is the composite of anatomic parts that includes the deltoid muscle, part of the coracoacromial arch, the rotator cuff, the capsule, and the synovium. Successful management of these parts relative to their tension, balance, competence, and quality greatly affect the function and longevity of total shoulder replacement prosthetics. This article addresses the surgical techniques required to deal with the specific soft tissue envelope problems peculiar to different disease entities.     

Chronic pain: psychological formulation and MDT working

Chronic pain is complex and often a challenge to manage. Patients’ expectations are frequently at odds with the treatment outcomes which can be a significant source of distress. Pain is best understood within the biopsychosocial model. Clinical psychologists work as part of the multidisciplinary pain team to draw together information and develop an understanding of how to support patients to live well while experiencing ongoing pain. This article presents two alternative models for formulating and providing therapy for individuals experiencing chronic pain; cognitive behaviour therapy and acceptance and commitment therapy. Psychologically informed strategies to support healthcare professionals in their interactions with people with chronic pain are presented.     

Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain,hand rehabilitation,and VR embodiment therapy for phantom limb pain

IntroductionAffordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products.Purpose of the StudyThe purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist.DiscussionThe following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions—immersive VR embodiment therapy for phantom limb (chronic) pain.ConclusionVR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients’ pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera–based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.     

基于APP的放松疗法对慢性下腰痛患者情绪、疼痛和腰部功能的影响

目的 探讨基于APP的放松治疗(relaxation therapy based on APP,RTBOA)对慢性下腰痛患者(CHRONIC LOW BACK PAIN,CLBP)情绪、疼痛和腰部功能的影响.方法 选择2018年3月至2020年3月在本院就诊的84例CLBP患者作为研究对象,采用随机数字表法分为对照组和...     

Management of acute pain

Acute pain is a common feature in the presentation of surgical and traumatic pathology and in postoperative patients. In pathological presentations acute pain may have a protective role serving as a warning sign, with muscle spasm helping to limit movement and prevent further injury. Acute postoperative pain can hinder recovery due to limited mobility and may lead to a range of complications, increasing patient morbidity and mortality. Timely and effective management of acute pain is therefore imperative. An acute pain service (APS) is able to assist in the management of complex patients and those with specific invasive analgesic interventions. However, the immediate prescribing is the responsibility of the admitting surgical doctor and therefore this article aims to give an overview of the considerations needed to ensure safe and effective management of acute pain.     

Soft tissue reconstruction about the proximal femur

The outcome of proximal femur reconstruction after resection of malignant tumors was studied in 45 patients.Clinical results, according to the Musculoskeletal Tumor Society score, were rated good to excellent in 56% of patients. Patients with primary tumors survived an average of 44.5 months and patients with secondary tumors for 32 months, with a 5-year survival rate of 20%. Aseptic loosening and tumor recurrences were not a problem for these patients. Most complications were related to material and stability. The major problem after reconstruction was lack of strength of the gluteal muscles which resulted, in part, in joint instability and impaired function. Of all reconstruction methods of the abductor mechanism, metal armed fixation devices (ie, screws, hooked plate) were found to be the best in terms of strength and overall function, and are recommended for this type of reconstruction.     

复杂性区域疼痛综合征的治疗进展

复杂性区域疼痛综合征(complex regional pain syndrome,CRPS)是一种病理机制未明,诊断和治疗都较为困难的复杂疾病.目前还没有一种治疗方式被证明能完全有效地治疗CRPS,专家们建议对患者要及早采取个体化、多学科综合治疗,选择每个患者最适合的方案才能获得较好的结果.传统治疗方法正在渐渐被新的疗法所代替,人们尝试单独或联合使用各种药物和介入治疗手段来治疗这一疾病并取得了一定的疗效,但还缺乏大样本、多中心、随机对照研究的支持.     

Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials

Background

Persistent post-surgical pain affects 10–80% of individuals after common operations, and is more common among patients with psychological factors such as depression, anxiety, or catastrophising.