The Physiotherapist’s Approach to the Management of Pain

South African Medical Journal of Continuing Medical Education 2000; Vol 18, No 2: 101-110

BY PHYLLIS BERGER

The role of the physiotherapist is to guide the patient (who is disabled through pain and lack of mobility and is unable to perform the daily activities of living) into a rehabilitation programme of exercise. Each patient has to be treated according to his/her own complaint. This allows the patient and physiotherapist to explore other/different methods to obtain effective treatment. All pain whether acute or chronic, can be treated with the same modalities, however a multi-modal approach may be required in a combination of electro-physiotherapy and acupuncture.

The mechanisms of acupuncture analgesia are brought about by changes in the neuronal activity at different levels of the central nervous system following certain types of afferent discharges. Acupuncture has been proven to stimulate the release of the body’s own neuro-chemicals and hormone, which among other things, have pain-relieving, anti-flammatory, immune-enhancing and beneficial psychological effects.

Electrotherapy is used to alter the electrical environment of the body. This breaks the pain cycle by the stimulation of large low-threshold fibres in sensory nerves, which are known to affect the neuro-chemicals in the entire nervous system. Action potential simulation (APS) current therapy is a recently developed low frequency current that stimulates action potentials in a neuron. The action potential is the most important discharge of energy or current release in the neuron. It is initiated by depolarisation of the nerve cell membrane. This then releases natural substances, the neurotransmitters at the local area on spinal and supraspinal levels, and releases neurohormones into the bloodstream. Another electrical device that also has an effect on action potentials is Neuro Stim 2000. This enhances the localised production of adenosine triphosphate (ATP). It promotes healing of damaged tissue and wounds and improves intrabody communication.

The pain management programme should be holistic in its attempt to address all the aspects of the patient’s physical and mental well being, aiming for a better quality of life.

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