This is a guest blog from Online Pet Health.
Managing chronic pain from only a medical perspective can pose multiple challenges, not least of which is the development of potentially life-threatening side effects in our patients, as well as changes in mentation and cognition with the use of specific pain-relieving medications. The addition of rehabilitation into a pain management protocol can reduce the need for pain medication, increase the efficacy of pain management, improve the function of the patient, and ultimately result in a happier, healthier, longer-living patient.
Physical rehabilitation, when combined with medical and surgical intervention, can lead to reduced pain perception, improved neurological function, strength, flexibility and endurance in the patient, and ultimately a happier, healthier patient.
If you are still doubtful about referring chronic pain patients to rehabilitation therapists, this article will help you understand the tools they use and how they can help your patient experience less pain and, simultaneously, become more functional.
The challenges of pain control
Managing pain in either acute or chronic cases is incredibly important for patients who cannot share their pain experiences with us verbally and whose behavioural communications are often misunderstood and misinterpreted. However, using medication as the primary means of pain control, especially in chronic musculoskeletal conditions, has many drawbacks, and does not help the patient to maintain or improve their function and long-term ability to keep the pain under control.
Through physical therapy modalities and therapeutic exercise, we can achieve effective pain control, while simultaneously improving the mental and physical wellbeing of the patient through improved mentation, weight control, strengthening, endurance and function.
How pain impacts the body
Pain has a detrimental effect on most systems of the body; in this article, I focus primarily on the effect on the musculoskeletal system. When pain occurs in a specific area, the body will naturally adjust its posture and movement patterns to protect the sensitive area. This leads to changes in the myofascial and skeletal system throughout the entire body, including:
- Shortening or contraction of certain muscles or muscle groups
- Reduced motion or range of motion in certain joints, limbs or regions
- Reduced blood flow to muscles that are chronically contracted
- Disuse atrophy of muscles that are not being used
- Overuse atrophy of muscles and muscle groups that are carrying a load that they are not designed to carry
- The development of painful trigger points in remote muscles and muscle groups
- Altered muscle recruitment patterns, with postural muscles often ‘switching off’, while the primary movers start to act like stabilisers
- Dehydration of the fascia and
- Reduced ability of the nerves and blood vessels to glide between fascial and muscle layers.
All of these effects lead to a loss of function, a breakdown of tissues remote from the original injury or site of pain, and, most importantly, more sites of pain spread throughout the body. The initial injury compounds, as does the pain, becoming harder and harder to control while also maintaining the gastro-intestinal, mental and physical health of the patient.
This is where rehabilitation plays a crucial role. Many of the effects listed above can be lessened or resolved with rehabilitation.
A variety of modalities
Physical therapy or rehabilitation incorporates a range of different modalities and methods, including manual therapies such as massage, mobilisation and manipulation, along with electrotherapies such as laser, PEMF, TENS and ultrasound, and exercise therapy. Our patients are all individuals, and a combination of modalities can be used to find the ones that allow us to optimally manage an individual patient and their needs.
Manual therapies
Manual techniques such as massage, mobilisation and stretching allow us to correct many of the effects of pain in the myofascial system discussed above, as well as improving joint range of motion where restrictions occur, increasing hydration of the fascia and the tissues, and inducing healing in areas that have been damaged.
Manual therapies also affect the nervous system, helping to modulate pain signals and assisting in returning the nervous system to a parasympathetic state to allow rest and digestion.
These manual techniques are essential to breaking the cycle of pain and dysfunction, allowing the tissue to come back to a neutral place where it can begin to function correctly again.
Exercise therapy
When we follow manual therapy with targeted therapeutic exercise, we go a long way to restoring functional movement and controlling pain over the long term. Exercise allows us to retrain movement patterns, strengthen postural and joint stabilisers, improve the endurance of the muscles, improve flexibility and, most importantly, retrain functional movements that will minimise the breakdown of the compensatory musculoskeletal tissue in the body.
Implementing a targeted home exercise programme can also be incredibly rewarding for both owner and patient.
Additional targeted pain control
All of the above has been about treating the body as a whole – maintaining its function at an optimal level to manage pain. We have not yet considered the primary cause of pain or dysfunction. In the case of chronic pain, these secondary areas of breakdown and dysfunction are equally as important to manage as the primary condition itself. However, in acute or post-operative conditions, the primary condition obviously takes precedent while the rest of the body is maintained at optimal functionality instead of needing to be returned to it.
Both manual therapies and exercise therapy can be used to effectively treat the dysfunction of a primary injury or surgical site, and to manage the pain in the area. In addition, electrotherapy modalities such as laser, PEMF, TENS and ultrasound can play an important role in reducing pain at a primary lesion, such as an arthritic joint. TENS and PEMF are also modalities that may be used in the home environment by the owner, making them fantastic additions to the daily management of degenerative conditions that are prone to flare-ups over the course of time.
The team approach
The best approach to managing pain is achieved through a team effort. The Veterinarian or pain specialist can provide pain management from a medical perspective, especially in acute pain, flare-ups or where the pain cycle needs to be brought under control during the start of physical rehabilitation. Rehabilitation therapists use the techniques discussed to address pain and dysfunction, and also to educate and empower the owner in the management of their pet. Complementary therapies such as acupuncture and chiropractic can add valuable layers to the pain management programme.
This approach allows the patient to continue to improve both in their perception of pain and their ability to function optimally in their day-to-day lives, even with debilitating conditions such as arthritis.
The team approach also allows us to minimise the amount of pain medication consumed on a daily or regular basis, ultimately ensuring a longer, healthier and happier life for the patient, with improved client relationships over the long term.
Conclusion
The multi-disciplinary approach to managing pain is incredibly effective, with Veterinary Rehabilitation therapists playing a vital role in the long-term control of chronic pain, and in improving the function, posture, strength and endurance of the patient.