Physiotherapy Interventions for Pain

Peripheral sensitisation

Normal, acute, inflammatory response that serves as a protective process - prolonged and intense noxious stimuli sensitise the first order nociceptors making them more excitable
Lower threshold for activation
Hypersensitivity to non-noxious stimuli, not normally painful stimuli (allodynia)
If prolonged can lead to abnormal pain state

Central sensitisation

Increased sensitivity of central nervous system
Basis for chronic pain (pain lasting longer than six months)
Increased sensitivity of CNS is relative to the presence and intensity of noxious peripheral stimuli
Hypoalgesia is an increased pain response to normally painful stimuli
Pain outlives pathology
Pain perceives more tissue damage than there actually is
Physiological changes to CNS - brain becomes more aware of stimulus, association of stimulus with type of pain (changes sensitivity)

Habituation

Opposite of sensitisation - getting used to stimuli that aren’t important such as feeling your clothes on you

Exercise and pain

Exercise induced hypoalgesia
Endogenous pain modulatory process
Triggers the endogenous opioid system

Challenges when dealing with pain

Understanding parameters of therapeutic exercise for pain relief (mode, frequency, duration, intensity)
Ability to modify exercise parameters to take into account patient factors such as age, condition, pain levels, health status and biopsychosocial factors
Additional barriers and considerations such as biopsychosocial, fear avoidance, catastrophising, CBT
Patient education
Motivation