Rehab Medicine Approaches for Pain

Question 1

Heat and cold for pain

Answer 1

• metabolic processes can be slowed or sped up with temp change
• alters nerve conduction, blood flow, stretching

Question 2

Effects of cancer on MSK system

Answer 2

• altered weight bearing
• altered biomechanics that cause other source of pain from compensation
• eg:
  
  • contracted soft tissue from radiation fibrosis
  • core musle strength from extensive abdo surgery

Question 3

Stabilizing and unloading strategies

Answer 3

1. Displace loads onto external supports
2. Improve load bearing capacity
3. Immobilize painful joints
4. Reduce work required for a painful activity

Question 4

Compensatory strategies for pain management

Answer 4

• deconstruction of ADLS into constituent movements to isolate which ones cause pain
• PT/OT skills

Question 5

Therapeutic exercise

Answer 5

• Low back and knee pain
• strengthen abdo core to de weight painful vertebrae
• strengthen hip flexors to deweight painful hips
• PT
• isometric exercises to avoid painful changes in muscle length

Question 6

Orthotics

Answer 6

• braces to deweight, stabilize, protect MSK structures
• Jewett braces
  
  • apply pressure at 2 anterior points, 1 posterior point
  • limits flexion of thoraco lumbar spine
  • do not use for true instability
• Cervical hard and soft collars
• Spinal braces
  
  • moulded body jackets
  • unstable spine
• Lumbosacral orthoses - other

Question 7

Laser therapy

Answer 7

• tissue temperature elevated less than 2/10 degree celsius
• ? effects on metabolic processes and DNA synthesis
• poor evidence
• low risk

Question 8

Manual lymphatic drainage

Answer 8

• skilled massage to enhance lymph transport
• stimulates smooth muscles to increase contractility
• for lymphedema
• clinical skill = benefit
  
  • specific stroke duration, pressure, sequence

Question 9

How does the MSK system contribute to pain syndromes

Answer 9

• direct tumour invasion
• maladaptive changes to cancer treatment
• exacerbation of previous MSK pain
• secondary hypertonicity and spasm

Question 10

Myofascial pain

Answer 10

• most common in upper back
• tenderness on palpation taut bands of increased muscle tone
• trigger points
• massage, excersise, trigger point injections