MANAGING PAIN WITH THERAPEUTIC MODALITY

Rezki Amalia Nurshal Pembimbing : Prof. DR. dr. Angela BM Tulaar, Sp.KFR-K

OVERVIEW
1. PAIN

2. THERAPEUTICAL MODALITIES 3. PAIN MANAGEMENT

PAIN
• Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain) • The most chief complain • Subjective sensation

Prentice WE, Therapeutic Modalities in Rehabilitation, 3ed.2005

3ed.PAIN Can persist after its no longer useful Warning Protection Enhancing disability Inhibiting efforts to rehabilitate Prentice WE. Therapeutic Modalities in Rehabilitation.2005 .

3ed. Chronic : lasting for more than 6 months. Persistent : Pain that Referred : defies intervention pain that is Radiating pain from perceived to : irritation of conditions be in an area nerve root where that seems to can cause continuing have little radiating (persistent) relation to pain. the existing pain is a pathology symptom of a treatable condition Prentice WE. Therapeutic Modalities in Rehabilitation.PAIN Acute : tissue damage and after injury.2005 .

10 • 1 -> NO PAIN • 10 -> SEVERE PAIN • To asses the location of pain and a number of subjective components.2005 • A tool with 78 words that describe pain • Commonly administered to LBP patients. • Blue -> aching pain • Yellow -> numbness or tingling • Red -> burning pain • Green -> cramping pain Prentice WE. 3ed. • May take 20 minutes and often frustating the patient .PAIN ASSESMENT SCALES Visual Analog Scales Pain Charts McGill PainQuestionnaire • Using a line : 1 . Therapeutic Modalities in Rehabilitation.

PAIN ASSESMENT SCALES Activity Pain Indicators Profile • Measures patient activity. Numeric Pain Scales • The most common • Pain scale 1-10 Prentice WE. Therapeutic Modalities in Rehabilitation. 3ed. • 64 question. self report tools.2005 .

2005 . 3ed.PAIN PERCEPTION Sharp (tajam) Dull (tumpul) subjective Aching (nyeri) Throbbing (berdenyut) Burning (terbakar) Piercing (menusuk) Prentice WE. Therapeutic Modalities in Rehabilitation.

cold. Managing Pain with Therapeutic Modalities.2005 Prentica. WE. CR. 3ed. . massage Prentice WE.to Attention. Past pain stimuli – to impending experiences.Sensory Receptors PAIN PERCEPTION Pain receptor / nociceptors / free nerve endings  noxious stimuli = extreme mechanical. sprains. burns. respond noxious Depression. Denegar.g Influences damage cuts. or actual tissue Cultural(e. chemical Influences energy Anxiety. analgesic balms. etc) -> superficial heat. Cognitive thermal. Therapeutic Modalities in Rehabilitation.

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C fibers (small. Aβ (large. 2. Spinothalamicus Lateralis Tract (effect of concious sensation of pain) Spinoreticularis Tract (arousal emotional aspects of pain) . Aδ. C fibers ) • Nociceptive specific (Aδ.PAIN STIMULATION 1st order neuron • Aα. fast) • Aδ. noxious stimulation) 1. slow) 2nd order neuron • Wide dynamic range (Aβ. C fibers .

3ed.Prentice WE.2005 . Therapeutic Modalities in Rehabilitation.

Therapeutic Modalities in Rehabilitation.Nociception Prentice WE.2005 . 3ed.

Therapeutic Modalities in Rehabilitation.2005 .SYNAPTIC TRANSMISSION • Neuroactive peptides can facilitate or inhibit synaptic activity ◦  Enkephalin ◦  Serotonin ◦  Norepinephrine ◦  β-endorphine ◦  Dynorphin Prentice WE. 3ed.

2005 . Prentice WE. Wall and Castle) The Gate Control Theory of Pain Descending Pain Control Β-endorphin & Dynorphin Prentica. Denegar. Therapeutic Modalities in Rehabilitation. CR. Managing Pain with Therapeutic Modalities. WE. 3ed.PAIN CONTROL (Melzack.

The Gate Control Theory of Pain Rubbing Moist Heat Massage Cold TENS Ultrasound Prentica. WE. 3ed. CR. Rehabilitation. Therapeutic Modalities in Therapeutic Modalities. Denegar.2005 . Managing Pain with Prentice WE.

Managing Pain with Therapeutic Rehabilitation. Denegar. .2005 Modalities.HOT AND COLD MODALITIES APPLY TO THE SKIN HEAT VASODILATATION COLD VASOCONSTRICTION SKIN RECEPTORS GATE CONTROL THEORY ANALGESIC EFFECT Prentice WE. CR. 3ed. Therapeutic Modalities in Prentica. WE.

Denegar. CR.Descending Pain Control TENS Prentica. Therapeutic Modalities in Therapeutic Modalities. Managing Pain with Prentice WE. WE. Rehabilitation. 3ed.2005 .

CR.Β-endorphin & Dynorphin Release TENS Prentica. 3ed. Denegar. Therapeutic Modalities in Rehabilitation. Managing Pain with Therapeutic Modalities. WE. Prentice WE.2005 .

Therapeutic Modalities in TENS Rehabilitation. Decrease pain fiber transmission velocity with cold or ultrasound. 3. This can be done with TENS. deep massage. Stimulate a release of Beta-endorphine or other endogenous opioids through prolonged small-diameter fiber stimulation with Prentice WE. 2.2005 . massage. and analgesic balms.Uses of physical agent to relieve pain: 1. 3ed. Stimulate small-diameter afferent fibers and descending pain control mechanisms with acupressure. or TENS over acupuncture points or trigger points. 4. Stimulate large-diameter afferent fibers.

tension diversion. Rehabilitation. Let the patient know what to expect following an injury. positive thinking. and reduce stiffness and guarding if the activity will Prentice WE. 3. relaxation techniques. increase metabolic activity. 3ed. and self-control. Encourage supervised exercise to encourage blood flow. promote nutrition. is very real to the patient. even psychosomatic pain. such as motivation. Maintain a line of communication with the patient. focusing.Other pain control strategy 1. 4. 2. Recognize that all pain.2005 . Minimize the tissue damage through the application of proper first aid and immobilization. thought stopping. Therapeutic Modalities in not cause further harm to the patient. 5.Encourage central biasing through cognitive processes.

SUBACUTE AND CHRONIC PAIN a. Hot Therapeutical Modalities b. WE. Laser d. Cold Therapeutical Modalities b. Managing Pain with Therapeutic Modalities. Ultrasound Prentica.2005 . Therapeutic Modalities in Rehabilitation. MWD. 3ed. Denegar. CR. Prentice WE. ACUTE PAIN a.PAIN MANAGEMENT CHOOSING THERAPEUTICAL MODALITIES : 1. SWD c. TENS 2.

WE. Tendinitis • Delayed onset muscle soreness CONTRAINDICATIONS • • • • • • • Impaired circulation (i. CR.CRYOTHERAPY INDICATIONS • Acute pain • Acute swelling (controlling hemorrhage and edema) • Myofascial trigger points • Muscle guarding • Muscle spasm • Acute muscle strain • Acute ligament sprain • Acute contusion • Bursitis. Denegar.2005 .e. Prentice WE. 3ed. Raynaud’s phenomenon) Peripheral vascular disease Hypersensitivity to cold Skin anesthesia Open wounds or skin conditions (cold whirlpools and contrast baths) Infection Prentica. Tenosynovitis. Managing Pain with Therapeutic Modalities.. Therapeutic Modalities in Rehabilitation.

THERMOTHERAPY Indications • • • • • • • • • • Subacute and chronic inflammatory conditions and pain Decreased ROM Resolution of swelling Myofascial trigger points Muscle guarding Muscle spasm Subacute muscle strain Subacute ligament sprain Subacute contusion Infectio Contraindications • • • • • • Acute musculoskeletal conditions Impaired circulation Peripheral vascular disease Skin anesthesia Open wounds or skin conditions (cold whirlpools and contrast baths Prentica. CR.2005 . 3ed. Therapeutic Modalities in Rehabilitation. Managing Pain with Therapeutic Modalities. Prentice WE. Denegar. WE.

Therapeutic Modalities in Rehabilitation.Ultrasound INDICATIONS • Soft tissue healing and repair • Scar tissue • Joint contracture • Chronic inflammation • Increase extensibility of collagen • Reduction of muscle spasm • Pain modulation • Increase blood flow • Soft tissue repair • Bone healing • Repair of nonunion fractures • Inflammation associated with myositis ossificans • Myofascial trigger points CONTRAINDICATIONS • Acute conditions • Areas of decreased temperature sensation • Areas of decreased circulation • Vascular insufficiency • Thrombophlebitis • Eyes • Reproductive organs • Pelvis immediately following menses • Pregnancy • Pacemaker • Malignancy • Epiphyseal areas in young children • Total joint replacements • Infection Prentica. Managing Pain with Therapeutic Modalities. 3ed. Denegar. WE. CR.2005 . Prentice WE.

SWD • • • • • • • • • • • • • • • INDICATIONS Postacute musculoskeletal injuries Increased blood flow Vasodilation Increased metabolism Decreased joint stiffness Muscle relaxation Increased pain threshold Enhanced recovery from injury Improved joint range of motion Increased extensibility of collagen Increased circulation Reduced subacute and chronic pain Resorption of hematoma Increased nerve growth and repair CONTRAINDICATIONS Acute traumatic musculoskeletal injuries Acute inflammatory conditions Areas with ischemia Areas of reduced sensitivity to temperature or pain Fluid-filled areas or organs Joint effusion Synovitis Eyes Contact lenses Moist wound dressings Malignancies Infection Pelvic area during menstruation Testes Pregnancy Epiphyseal plates in adolescents Metal implants Prentica. Managing Pain with Therapeutic Modalities. CR. Therapeutic Modalities in Rehabilitation. WE. Unshielded cardiac pacemakers Prentice WE. Intrauterine 3ed. Denegar.2005 devices .

Mechanisms of Pain Control • The theories presented are only models • Pain control is the result of overlapping mechanisms • Useful in conceptualizing the perception of pain and pain relief Prentice WE. Therapeutic Modalities in Rehabilitation.2005 . 3ed.

2005 .Summary • The goal of rehabilitation programs is to encourage early. pain-free exercise while promoting optimal healing processes Prentice WE. 3ed. Therapeutic Modalities in Rehabilitation.

Prentice WE. Therapeutic Modalities in Rehabilitation.2005 . 3ed.

Therapeutic Modalities in Rehabilitation.2005 . 3ed.Noxious Mediator Prentice WE.

Prentice WE.2005 . 3ed. Therapeutic Modalities in Rehabilitation.