Physical Therapy: Why it Works and why it doesn't work... in chronic pain

What makes the difference? My staff says I give you too much information... but our goal is to teach you to manage your own pain... and not need our help as much. We want to be there for you when you need us, but if we teach you what is causing your pain, you will be managed much better than if we make you dependent upon us.

So, let us teach you about physical therapy... why it works and why it doesn't. Oh yeah, nothing we tell you is 100%... there will always be exceptions. However, for the vast majority of our patients the following information is very true.

The first things must do before strengthening a muscle is to manage the resting pain and the moving pain. You can not stregnthen a muscle that is in pain when not moving (resting pain) and you cannot strengthen a muscle that does not have pain free range of motion (ROM).

Many Physical Therapy procedures such as rehabilitation after knee surgery. While this works well for surgery rehabilitation, it is the wrong treatment in chronic muscular pain, especially in the head and neck... causing pain gives you pain... Be proactive with your therapist.

Narcotics and chronic pain....a short history of treatment before narcotics were withheld for patients in chronic pain and then because of compassion the liberal use of narcotics for patients in pain and now what long term narcotic treatment has done to the patients it was meant to help.

Back before 1990 or so it was common not to give chronic pain patients narcotics because they may become addicted. This had some merit for non cancerous pain, but it was kind of stupid (then and now) not to give a person with terminal cancer pain anything that worked to control their pain.

After this hurdle was crossed the compassionate attention was given to those chronic pain patients that could not be helped by traditional medicine.

This act of compassion, however, has caused problems we could not predict. It appears that the use of narcotic for non cancerous pain can frequently cause the pain to be worse...much worse.

Here is why. For some reason the narcotic turns on Glial cells in the spinal fluid. These Glial cells then deactivate the narcotic and what we used to think was tolerance to the narcotic is actually the glial cells causing the narcotic not to work. Now to make matters worse, the glial cells cannot presently be turned off.

What this means is the patient is actually in more pain because the glial cells act to oppose the narcotic. On top of that the patient becomes hypersensitive to any kind of pain.

To illustrate this I routinely have patients in for trigger point injections. Occasionly I will also have a patient in for trigger point injections that are also taking narcotics. The patient on the narcotics will experience 10 times the pain from the injections then the patient not on narcotics. Last week it was a muscular man in his 20's who was on Percocet and lady in her 60/s who was not taking any narcotic pain medication. He squirmed and groaned with every shot....She did not move a muscle or utter a sound!

Researchers are working on how to deactivate the glial cell but it may be years off before we have a medication. For those of you who want more technical information here is a link: http://www.neurologyreviews.com/09mar/C1.html.