National Physical Therapy Month: it's relatively painless

A tip of the hat to my colleagues in physical therapy: October has been held up as 'National Physical Therapy Month', during which time the physical therapy profession has engaged the public with information on its mission and its value. This year's campaign by the American Physical Therapy Association  (APTA) stresses the choices consumers of services have for pain management; namely, choosing PT as an alternative to opioid reliance and/or dependence when living with pain. #ChoosePT is the designation of the campaign, designed to educate and encourage the person in need of pain management, and her/his circle of support.

The site http://www.moveforwardpt.com/choose-physical-therapy-over-opioids-for-pain-management-choosept will give the interested reader decision points and options for coordinating the process of pain management with a physician, PT or other involved health care professional. It's been my experience that a proactive plan for pain management can hardly ever be too "pro-"; that is, it will hardly ever occur too early, for the recovery process of the individual affected. Pain,whatever its etiology, can be a catalyst for the erosion of a person's quality of life, eating away at the physical, psychological and emotional reserves of the person involved - if not thoughtfully managed.

Other health professionals contribute to the management of pain in persons we serve. Crawford et al. (2016) indicated in "a systematic review and meta-analysis of randomized controlled trials", that massage therapy is weakly recommended for reducing pain, and for increasing mood and quality of life, when compared to no treatment (1). Scholten-Peeters et al. (2013) reported that chiropractic manipulation yielded a significant effect on pain relief in adults with musculoskeletal complaints (2).

In the case of the person who has physical and cognitive/communicative needs after suffering an impairment of bodily function, - when the pain management plan is incomplete or not adaptable to changing circumstances, pain-related alterations in cognition can further depress the individual's quality of life. For the speech-language pathologist treating a person for whom pain has been "socked in", being part of the pain management plan is essential. The clinical SLP who is involved with patients having frequent pain needs, should consult reviews of behavioral approaches to pain e.g. Songer (2005) (3) for insight into approaches that may help your patient.

With my person served demonstrating significant pain,  - perhaps a PT or OT session had just been completed prior to my appearance. Prevent this scheduling 'oops' whenever possible. If pain is the sole concern, then focus on being time efficient. Keep the mood light. Reinforce points you stressed vocally with a written note, left with the person at the session's end. Note any effects of positioning, behavioral or medical intervention for pain, along with the person's pain rating. Review your experiences with the person in pain with the treatment team periodically, and adapt your treatment approaches as the person's need for pain management changes. Embrace the target: be part of the solution to pain as a barrier.

(1) Crawford, Cindy, et al., "The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population", Pain Medicine, 17(7), July 2016, 1353-75. 
(2) Scholten-Peeters, Gwendolijne GM et al., "Is Manipulative Therapy More Effective than Sham Manipulation in Adults?. A Systematic Review and Meta-Analysis, "BioMed Central, 21(34), 2 October 2013. 
(3) Songer, Douglas, "Psychotherapeutic Approaches in the Treatment of Pain", Psychiatry MMC, 2(5), May 2005, 19-24.