1. Physiotherapy in the Management of Pain

2.  Physiotherapy has traditionally had a role based on maximising an individual’s functional movement and participation towards maintaining and improving health, well-being and quality of life  Skills employed in wide variety of fields and many settings  Many different patient groups and types of condition  Involved at all stages of dysfunction  Recognised part of MDT management  Well placed to have a role in the management of pain

3.  Pain is often accompanied by significant emotional distress, disruption in physical and social functioning, and reduction in quality of life  The causes and consequences of pain are complex and multifactorial. Pain is often difficult to assess, investigate, treat and manage  Specific role of physiotherapy dependant on the context, environment, and specific expertise of individual therapists

4. Injury / pain Rest and gentle movement Improvement Movement restored / no pain What generally happens

5. Injury /pain Attempted movement / Tried to rest More pain Fatigue, sleep disturbance, mood changes etc. Sometimes this happens

6.  Widespread pain and tenderness  Fatigue  Less movement  Sleep disturbance  Mood changes  Decreased appetite  Reduced quality of life Can lead to this

7.  Manual therapy  Electrotherapy  Exercise therapy  Rehabilitation programmes  All these have been shown to have some level of benefit but are sometimes not completely effective Going back to our traditional approach

8. RCP Guidelines CRPS 2012

9.  Altered chemical profile  Altered sensory maps  Altered response to sensory stimuli  Altered motor maps  Altered brain activation with movement In individuals with chronic pain

10.  Desensitisation  Behaviour change techniques  Exercise and movement with particular focus on application and progression  Facilitation of normal movement  Be part of an MDT approach May need to broaden our approach

11. Part of Overall Management

12.  Flexibility – stretches, active, active assisted Exercise  Strength – working all groups  Cardiovascular fitness  Posture and alignment

13.  General / mixed Programme  Include specifics – core stability  Functional  Based around goals

14. Overactivity Increased Pain Rest (with frustration) Pain Eased Beware of overdoing it

15. Boom or Bust Cycle Flare-up occurs Pain Onset Incapacitated Time Activity

16.  What does individual want to achieve ? Progression  Steps to success  Establish baseline  Start at 80 %  Increase activity level by 5-10% per week

17.  Daily gentle active stretches For example  Relaxation / supported positioning  Daily walk – given distance and time  Small number strengthening / stabilisation exercises

18.  Maintain activity level Aiming to  Don’t stop  Spread it out  If pain remains increased for 48 hours, reduce to 50%, explore options but don’t stop

19.  Advise Role of Physiotherapist  Feedback  Reassure / support  Liaise  Supervise

20. Thank you