PAIN AND ITS TREATMENT MODELS

Pain affects everyone at one time or another. Many diseases and disorders of the human body are accompanied by pain. It is feared by many people, as much as or more than the disease itself. What is pain? What purpose, if any, does it serve? What happens in the body when a person feels pain? How is pain assessed? What are the different types of pain? Can pain be treated? If so, how? These are some of the questions addressed in this chapter.

Pain is an expanding science, and an increasing number of specialty clinics are emerging. The International Association for the Study of Pain (IASP) identifies the following four models for pain treatment:

  • Single service clinics are normally outpatient clinics providing specific pain treatment with the goal to reduce pain. These do not provide comprehensive assessment or management. Examples include a nerve block clinic and a biofeedback clinic.
  • Pain clinics also are outpatient, but their focus is mainly on diagnosis and management of individuals with chronic pain. These might focus on such specific pain issues as back pain or headache but also can provide treatment for general pain conditions.
  • A multidisciplinary pain clinic may be inpatient or outpatient and includes specific treatment. These provide services from different healthcare professionals who can assess and manage physical restoration or rehabilitation and medical needs and provide educational and psychological services.
  • A multidisciplinary pain center is usually found in a medical school or teaching hospital. The pain center provides the most complex model for managing and treating pain. Pain centers also engage in research. Two of the earliest multidisciplinary pain centers were the University of Washington in Seattle and the City of Hope Medical Center in Duarte, California.
READ:   The Intervertebral Disc
Spine Health. PROCEDURE 8 — EXTENSION MANIPULATION There are many techniques devised for manipulation of the lumbar spine in extension. It is not important which technique is used, provided the technique is performed on the properly selected patient and applied in the correct direction. The technique that I recommend is similar to the first two manipulations described by Cyriax for the reduction of a lumbar disc lesion. The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the affected segment, places the hands on either side of the spine as for the technique of extension mobilisation (procedure 7), which is always applied as a premanipulative testing procedure. If following testing the manipulation is indicated, the therapist leans over the patient with the arms at right angles to the spine and forces slowly downwards until the spine feels taut. Then a high velocity thrust of very short amplitude is applied and immediately released. Fig. Extension manipulation. The eff...
Spine Health. PROCEDURE 7 — EXTENSION MOBILISATION The patient lies prone as for procedure 1. The therapist stands to one side of the patient, crosses the arms and places the heels of the hands on the transverse processes of the appropriate lumbar segment. A gentle pressure is applied symmetrically and immediately released, but the hands must not lose contact. This is repeated rhythmically to the same segment about ten times. Each pressure is a little stronger than the previous one, depending on the patient’s tolerance and the behaviour of the pain. The procedure should be applied to the adjacent segments, one at a time, until all the areas affected have been mobilised. Fig. Positioning of hands prior to extension mobilisation. Extension mobilisation. Effects: In this procedure the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. In general, symmetrical pressures are used on patients with central and bilateral symptoms. Therapist-...
Spine Health. PROCEDURE 13 — FLEXION IN LYING The patient lies supine with the knees and hips flexed to about forty-five degrees and the feet flat on the couch. He bends the knees up towards the chest, firmly clasps the hands about them and applies overpressure to achieve maximum stress. The knees are then released and the feet placed back on the couch. The sequence is repeated about ten times. The first two or three flexion stresses are applied cautiously, but when the procedure is found to be safe the remaining pressures may become successively stronger, the last two or three being applied to the maximum possible. Fig. Flexion in lying. Effects: Flexion in lying causes a stretching of the posterior wall of the annulus, the posterior longitudinal ligament, the capsules of the facet joints, and other soft tissues. As the movement takes place from below upwards the lower lumbar and lumbo-sacral joints are placed on full stretch at the beginning of the exercise as soon as movement is initiated. Thus, the procedure is very i...
Recovering From Acute Low Back Pain. General Instructions You have recovered from the acute episode because of your ability to master the exercises which relieved your pain. These exercises must be repeated whenever situations arise which have previously caused pain. You must perform the corrective movements before the onset of pain. This is essential. If you carry out the following instruction, you can resume your normal activities without the fear of recurrence. SITTING When sitting for prolonged periods the maintenance of the lordosis is essential. It does not matter if you maintain this with your own muscles or with the help of a supportive roll, placed in the small of your back. In addition to sitting correctly with a lumbar support, you should interrupt prolonged sitting at regular intervals. On extended car journeys you should get out of the car every hour or two, stand upright, bend backwards five or six times, and walk around for a few minutes. BENDING FORWARDS When engaged in activities which require prolonged fo...
Spine Health. PROCEDURE 11 — SUSTAINED ROTATION/MOBILISATION IN FLEXION The patient lies supine on the couch, and the therapist stands on the side to which the legs are to be drawn, facing the head end of the couch. The patient’s far shoulder is held firmly on the couch by the therapist’s near hand, providing fixation and stabilisation. With the other hand the therapist flexes the patient’s hips and knees to a rightangle and carries them towards himself, causing the lumbar spine to rotate. With the patient’s ankles resting on the therapist’s thigh the knees are allowed to sink as far as possible and the legs are permitted to rest in that extreme position. The lumbar spine is now hanging on its ligaments in a position which combines side bending and rotation. By pushing the knees further towards the floor the therapist applies overpressure to take up the remaining slack in the lumbar spine. Depending on the purpose for which the procedure is used, the position of extreme rotation is maintained for a shorter or longer period. Fig. Sustained rotation/mob...