Monthly Archives: January 2015

Physical Therapy offers a non-drug alternative to Pain Management

NIH Says Current Treatment of Chronic Pain Has Created ‘Silent Epidemic;’ More Focus Needed on Non-Drug Approaches

News Now Staff – APTA

According to a report recently released by the National Institutes of Health (NIH), it’s time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of non-pharmacological approaches, including physical therapy.

The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel’s work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

Much of the report is focused on the use—and possible overuse—of opioids as the “go-to” approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” authors write. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”

The answer to that question, the panel found, is no. Patients with chronic pain are typically “‘lumped’ into a single category, and treatment approaches have been generalized with little evidence to support this practice,” they write.

Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These non-pharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that “lack of knowledge or limited availability of these non-pharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids.”

An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that “clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches.” The solution, he believes, is to ensure that “every patient’s individual needs are met by a patient-centered health care system.”

The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans’ resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which “large numbers of Americans are receiving suboptimal care.”

The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, and a new film starring Jennifer Aniston as a woman with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a “blended approach” to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled “8 ways to deal with chronic pain.” The article’s first recommendation: “embrace physical therapy.”

“The more you move, the better you feel,” reporter Rachel Noble Benner writes in the article. “Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.”

The Physical Therapists at Blue Ridge Orthopaedic & Spine works exclusively in the treatments of Orthopaedic conditions and have experience working with patients who have chronic pain. In conjunction with your doctor and using evidence-based treatments, we create treatment plans to treat the patient as a whole, not just the injury, and to restore full functionality.

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center is Northern Virginia’s premier facility for diagnosing and treating back pain and spinal disorders. In addition to our regionally renowned Spine Center, our practice features Joint Replacement, Sports Medicine, Pain Management, Physical Therapy, Trauma Center, Shoulder Care, a Hand Center and a Foot and Ankle Center.

We are committed to treating not just injuries and physical ailments, but rather the whole person, by offering a wide range of specialty programs designed to support treatment. Specialty programs include Massage Therapy, Medical Nutrition and Aquatic Physical Therapy.

APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist’s guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT’s role in chronic pain management was featured in the September issue of Motion magazine.

Basic Knee Pain & Issues

Brief anatomy of the knee

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The knee is a vulnerable joint that bears a great deal of stress from everyday activities, such as lifting and kneeling, and from high-impact activities, such as jogging and aerobics.

The knee is formed by the following parts:

  • Tibia. This is the shin bone or larger bone of the lower leg.
  • Femur. This is the thighbone or upper leg bone.
  • Patella. This is the kneecap.

Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments on the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

What are some common knee problems?

Many knee problems are a result of the aging process and continual wear and stress on the knee joint (such as, arthritis). Other knee problems are a result of an injury or a sudden movement that strains the knee. Common knee problems include the following:

  • Sprained or strained knee ligaments and/or muscles. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.
  • Torn cartilage. Trauma to the knee can tear the menisci (pads of connective tissue that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace during an activity to protect the knee from further injury. Surgery may be needed to repair the tear.
  • Tendonitis. Inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper’s knee. This often occurs with sports, such as basketball, where the force of hitting the ground after a jump strains the tendon.
  • Arthritis. Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight.Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.

How are knee problems diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for knee problems may include the following:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope), which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.
  • Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

Treatment for knee problems

Specific treatment for knee problems will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease, injury, or condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease, injury, or condition
  • Your opinion or preference

If initial treatment methods do not provide relief, and X-rays show destruction of the joint, the orthopaedist may recommend total joint replacement for the knee.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

 

Online Medical Reviewer: Kolbus, Karin, RN, DNP, COHN-S 
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.