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      A Mechanism-Based Approach to Physical Therapist Management of Pain

      1 , 2 , 3
      Physical Therapy
      Oxford University Press (OUP)

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          Abstract

          <p id="d3798993e143">Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made. </p>

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          Most cited references102

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          Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.

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            Do we need a third mechanistic descriptor for chronic pain states?

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              Can we conquer pain?

              Pain can be an adaptive sensation, an early warning to protect the body from tissue injury. By the introduction of hypersensitivity to normally innocuous stimuli, pain may also aid in repair after tissue damage. Pain can also be maladaptive, reflecting pathological function of the nervous system. Multiple molecular and cellular mechanisms operate alone and in combination within the peripheral and central nervous systems to produce the different forms of pain. Elucidation of these mechanisms is key to the development of treatments that specifically target underlying causes rather than just symptoms. This new approach promises to revolutionize pain diagnosis and management.
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                Author and article information

                Journal
                Physical Therapy
                Oxford University Press (OUP)
                0031-9023
                1538-6724
                May 2018
                May 2018
                May 01 2018
                April 16 2018
                : 98
                : 5
                : 302-314
                Affiliations
                [1 ]Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
                [2 ]Department of Physical Therapy and Rehabilitation Science, University of Iowa
                [3 ]Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242 (USA)
                Article
                10.1093/ptj/pzy030
                6256939
                29669091
                fbef1538-f419-473e-a44b-0523507738fa
                © 2018
                History

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