Research Articles – Pain

Physical therapy leads to greater improvements
for patients with a common jaw disorder than a splint

Temporomandibular disorders (TMDs) are a set of common conditions that affect the temporomandibular joint, which connects the jaw to the skull and allows it to move in various directions. There are many treatments available for addressing TMDs, with physical therapy and occlusal splints being two options that may be utilized. Physical therapy usually consists of a variety of interventions intended to reduce pain and improve strength, while an occlusal splint is a mouth guard that prevents clenching the jaw and protects the teeth from other harmful habits. Both treatments are commonly used for treating TMDs, but there is no research that compares the two of them. For this reason, a powerful study called a randomized-controlled trial was conducted to determine whether physical therapy or a splint is more effective for patients with a TMD. Results showed that patients who underwent physical therapy experienced significantly greater improvements in pain and jaw flexibility compared to those who wore a splint. Physical therapy has also been found to be a safe, relatively easy, and inexpensive intervention, and patients with TMD symptoms are therefore encouraged to see a physical therapist for treatment.

Early physical therapy for acute low back pain associated with reduced usage of opioids, less healthcare utilization, and lower costsin lumbar spinal stenosis patients

Current guidelines state that patients with low back pain should see a physical therapist for treatment, and research shows that taking this course of action results in less pain, disability, and use of healthcare. But despite these recommendations, many physicians either do not refer their patients to physical therapy or do so in a delayed manner. Delaying physical therapy can lead to more healthcare utilization and higher costs for patients, and a powerful study called a systematic review was conducted to investigate the impact of a physical therapy referral on these factors. The results showed that early physical therapy led to less utilization of healthcare when compared to delayed physical therapy, as well as reduced chances of being prescribed opioids. With this and other data, researchers concluded that early physical therapy is a cost-effective intervention that should be recommended for low back pain patients to reduce healthcare utilization and the usage of opioids.

To combat opioid crisis, a task force recommends restorative therapies like physical therapy

Chronic pain, which is defined as pain that lasts for more than three months, currently affects about 50 million Americans. Of these individuals, 19.6 million experience high-impact chronic pain that interferes with their daily life. The U.S. is simultaneously dealing with an opioid epidemic that involves widespread drug abuse and tens of thousands of overdose-related deaths each year. In response, a task force was created, which consisted of 29 members with expertise in various fields related to the management of pain. This task force then identified gaps and provided recommendations for how to manage acute (short-lived) and chronic pain. One of these recommendations focused on restorative therapies, which include physical therapy, occupational therapy, exercise, and other movement-based modalities. The task force stated that these types of therapies play a significant role in managing acute and chronic pain, and that positive outcomes are more likely when they are used. Therefore, they recommended that physical therapy and other restorative therapies should be utilized for patients with acute and chronic pain, as doing so is associated with clear benefits and may reduce the chances of patients being prescribed other treatments like opioids.

For low back pain patients, physical therapy referral rates have been consistently low while opioid prescription rates have risen

Low back pain remains one of the leading causes for disability, doctor visits, and use of healthcare throughout the world. Many guidelines recommend education, exercise, and several physical therapy-based interventions as the initial treatment for patients with low back pain. Research has also supported physical therapy and shown that being referred to it early is associated with a quicker return to work and less use of healthcare. But despite these guidelines, the referral rates of doctors sending patients to physical therapy is generally low, and a study was conducted to take a closer look. The results of the study showed that over a 14-year span, only about 10% of 170 million patients with low back pain were referred to physical therapy. This 10% referral rate remained stable over the 14-year timeframe, while the number of visits that led to an opioid prescription increased in this same population.

Opioids are found to be no better than non-opioid medications for relieving pain

As the opioid epidemic continues to burden the country, questions are now being asked about whether these drugs should be prescribed to patients with chronic pain. Current guidelines now discourage their use in favor of other, safer alternatives, but studies are still lacking that evaluate the long-term effects of opioids on pain and other measures. For this reason, a powerful study was conducted to compare opioid therapy to non-opioid therapy for patients with back, knee or hip pain over one year. Overall, results showed that patients who received opioids improved to a very similar extent compared to those who received non-opioids. In addition, the non-opioid group actually experienced less pain intensity than the opioid group, as well as significantly fewer negative symptoms related to their medications. This is considered a landmark trial that has clearly shown patients can do just as well—if not better—with non-opioid pain medications, and these results should only continue to sway doctors away from prescribing these dangerous drugs and towards safer alternatives like physical therapy instead.

Low back pain patients who receive physical therapy
less likely to be prescribed opioids

Low back pain is one of the most common and expensive healthcare conditions, it can be more expensive for some patients than others depending on how it’s treated. Education and physical therapy are both frequently recommended for these patients, which have been found to improve outcomes and reduce costs overall. In particular, seeing a physical therapist early is associated with less use of health care and lower patient costs, but only 7-20% of patients actually do this. There are many factors that influence these patients’ decision, and understanding them can help to better ensure they are getting the right care. For this reason, a study was conducted to investigate these factors and how physical therapy affected the use of other treatments like opioids. Results showed that patients were less likely to participate in physical therapy if they were given multiple orders in addition to the referral to see a physical therapist, or if they had a history of opioid abuse. In addition, receiving a physical therapy consult was associated with a reduction in opioid prescriptions, and participation in physical therapy reduced these odds even more. We believe that physical therapy should be seen as an alternative to opioids for managing pain, and this study offers additional support to this concept.

Patients that access physical therapy directly spend less
and have a shorter duration of treatment than those who are referred

Neck and back pain are among the most common conditions that cause pain, and both are associated with high costs of treatment. Part of this may be due to the fact that many patients are not receiving appropriate treatment soon enough, and one way to address this is with direct access, which allows individuals to directly consult a physical therapist without a physician’s referral. Unfortunately, studies on the impact of direct access are limited, which prompted researches to conduct a trial to investigate this. Results showed that most patients with back or neck pain chose the traditional medical route of seeing a doctor first over direct access, but regardless of how they accessed physical therapy, the majority completed treatment and experienced significant improvements in disability and pain. Patients who accessed physical therapy directly also had fewer treatment sessions, days in care and lower overall costs than those who did not. This is why we encourage all individuals living with pain to see us directly for an evaluation and treatment program instead of going to your doctor.

Exercise-based therapy leads to less pain and better
flexibility in patients with jaw disorder

Temporamindibular joint disorder is an umbrella term used to describe several conditions that involve a dysfunction of the jaw. The most common symptoms of temporamindibular joint disorders are pain and decreased mobility of the jaw, both of which can have a negative impact on a patient’s quality of life. Exercise-based therapy that may include aerobic, stretching, balance and strengthening exercises is commonly used to treat these disorders, but the available research on it has produced inconsistent results. Therefore, a powerful pair of studies called a systematic review and meta-analysis was conducted on the topic. Results showed that exercise therapy reduced pain and improved the jaw flexibility of patients with temporamindibular joint disorders, and the greatest improvements in flexibility came from programs that emphasized mobility exercises and a mixed treatment programs. Based on these results, individuals with temporamindibular joint disorders are encouraged to seek out the treatment of a physical therapist for an appropriate treatment program that will help their condition improve.

Referral rates for physical therapy to treat low back pain
have remained low as rates for opioid prescriptions have risen

Low back pain is one of the leading causes of disability and reasons for visiting a doctor throughout the world. On top of this, studies suggest that this problem will only continue to grow in the future as more people become affected by the condition. Physical therapy is an effective treatment for low back pain that is commonly recommended by numerous medical guidelines, but there are many doctors that may still not be referring patients to a physical therapist for one reason or another. This can prevent patients from receiving the care they need and being treated with more dangerous interventions like opioids instead. To get a clearer idea of how many patients are actually being referred to physical therapy for low back pain over the years, a study was conducted. Results showed that about 170 million patients visited a doctor for complaints related to low back pain. Approximately 17.1 million of these patients were referred to physical therapy, which equated to a referral rate of 10.1%. From 1997 to 2010, this referral rate for physical therapy remained stable at this low percentage, while the rate for opioid prescriptions increased in these patients over the same time period. This highlights a major problem in the medical world, as more patients with low back pain are being prescribed opioids while the same number are being referred to physical therapy, a much safer and more effective treatment.

Older adults with headaches benefit from
a physical therapy treatment program

Headaches are common in all age groups, but they affect people of different ages in unique ways. Secondary headaches, in which the cause of the pain is from something other than the headache itself, and associated neck pain tend to become more common with older age. There are many treatments available for headaches and associated neck pain, but it’s not completely clear which is most effective for older adults. Physical therapy is generally considered a safe and effective treatment option, but more research is needed to study how far its benefits go. For this reason, a powerful study was conducted to evaluate the effectiveness of physical therapy for older adults with headaches and associated neck pain. Results showed that participants who received physical therapy improved more significantly than those who underwent a usual course of treatment. In particular, the frequency of their headaches was significantly reduced after 11 weeks, and remained at this level up to nine months later. The intensity and duration of their headaches also decreased after physical therapy.

Physical therapists may be an alternative to seeing
a doctor first for painful conditions

A large percentage of the population is getting older, and as a result, there will also be an increase in the number of health conditions related to old age. Currently, most individuals with painful conditions like back or knee pain see their general practitioner first for treatment or a referral to another doctor. But with the growth in the population of older adults, there will come a time when general practitioners won’t be able to handle this amount of patients. One possible solution is to have patients see a physical therapist for these conditions instead, which can help them get the care they need more quickly. Since evidence is lacking on this type of approach, a study was conducted in which patients were given the option of seeing a physical therapist instead of their general practitioner for a painful condition. Results showed that this approach was safe, effective and less expensive, and also led to complete satisfaction in 70% of patients. Patients may therefore consider making an appointment with a physical therapist rather than their general practitioner the next time they experience a painful condition.

New guidelines from the CDC are designed
to help doctors prescribe opioids more safely

Opioids are natural or synthetic chemicals – such as hydrocodone (Vicodin), oxycodone (OxyContin), methadone and fentanyl – that are used to reduce pain. Today, there is a major problem with the over-prescription, overuse and abuse of these drugs. Part of this is due to the fact that many primary care doctors having difficulty treating patients with chronic (long-term) pain. This highlights the need for more guidance to assist doctors managing patients in chronic pain. Therefore, the Centers for Disease Control and Prevention (CDC) created an updated set of guidelines. This included 12 important recommendations on when and how to prescribe opioids, such as using non-opioid drugs and other treatments first before opioids, establishing treatment goals with patients before starting the use of opioids, prescribing the lowest effective dosage and immediate-release opioids to patients, evaluating the harms of benefits of these prescriptions over time, and arranging appropriate assistance to patients with opioid use disorder.

Hands-on therapy applied to the upper spine
helps reduce headache occurrence

A cervicogenic headache is a headache that’s caused by a problem with the bones or other structures within the neck. Cervicogenic headaches account for as many as 20% of all headaches, and they are especially common in patients that have experienced whiplash. One of the more common treatments for cervicogenic headaches is called spinal manipulative therapy, which includes mobilizations and manipulations performed by the hands of a physical therapist. Although some research has evaluated the effects of mobilization and manipulation, no studies have directly compared them in treating cervicogenic headaches. For this reason, a study called a randomized-controlled trial (RCT) was conducted, which randomly assigned 107 patients to two separate treatment groups. Results showed that although both groups experienced improvements, patients who received manipulations had less headache duration, intensity and frequency. The study shows that spinal manipulation can be effective for cervicogenic headaches, and patients who suffer from this condition should therefore consider seeing a physical therapist for appropriate treatment.

Hands-on physical therapy techniques
are more effective than medications for headaches

A tension-type headache is what we think of as a normal, everyday type of headache. They are the most common type of headaches in the world, but the causes that lead to them are not well understood. Although pain medications are typically used to treat tension-type headaches, many doctors also prescribe physical therapy and relaxation therapies; however, there is a general lack of research on its effects, especially one type of physical therapy called manual therapy. In manual therapy, the therapist performs a series of mobilizations and manipulations on the patient with their hands to relieve pain. Therefore, a powerful pairing of studies called a systematic review and meta-analysis was conducted. Results found that manual therapy reduced the frequency, intensity and duration of tension-type headaches more than pain medications, which shows that physical therapy can serve as an alternative treatment to taking pills for headaches.

Treatments used by physical therapists are
effective for multiple types of headaches

Most of us experience headaches from time to time, but for others, headaches and migraines are a regular, painstaking occurrence. Most treatments for all types of headaches centers around various types of medications, but non-pharmaceutical recommendations such as physical therapy are also made in certain situations. Unfortunately, there is not much research to support these types of treatments, so a new study pairing was conducted to look into the matter in greater detail. Results showed that different types of physical therapy had positive effects on all types of headaches, and none were associated with negative side effects. Though more research is needed to evaluate other aspects of this topic, patients should be aware of the option of physical therapy to treat their headaches and know that it may be an effective to address their condition without medication.

Manual manipulations are effective
for treating jaw disorders

Temporomandibular disorders are a group of any disorders or dysfunctions that affect the temporomandibular joint, which connects your jaw to the side of your head. Treatments for temporomandibular disorders include education, home care, physical therapy and manual techniques, and it’s not known which is the most effective. One option is musculoskeletal manual approaches, in which a physical therapist mobilizes and manipulates the jaw, but research to support this approach is lacking. Therefore, a study was conducted, and results showed that these manipulations were effective in reducing pain and increasing range of motion of patients’ jaws after being performed. This study suggests that this manual type of approach from physical therapists may be effective for temporomandibular disorders, and patients should consider them as an option if they’re experiencing jaw issues.

Rehabilitation leads to better overall
outcomes than surgery for athletic groin pain

Athletic groin pain, a general term used to describe any long-lasting injury to the groin area, has become more prevalent in recent years and is especially common in athletes who play soccer, Australian rules football and ice hockey. The condition is usually treated either with surgery or rehabilitation like physical therapy and exercises, but the two options have never been directly compared. For this reason, a powerful review was conducted that analyzed the results of 57 studies on the topic to determine if surgery or rehabilitation is more effective for athletic groin pain. Results showed the recovery times for those who underwent rehabilitation were half of those who had surgery, and the two interventions led to similar return-to-play rates. This suggests that rehabilitation has at least a slight advantage over surgery in treating athletic groin pain, and since it costs less and is associated with fewer side effects, researchers recommend it as the best treatment option for this condition.

Runners with hip pain should be evaluated
fully and treated non-surgically

Running is one of the best possible forms of physical activity you can get, but running regularly also comes with a high injury risk, especially for long-distance runners. Hip pain is fairly common in runners, and femoroacetabular impingement (FAI) is one of the many conditions that can cause it. FAI usually leads to pain in the groin and/or deep in the hip that’s typically described as a dull ache that gets worse when running on inclined surfaces. But the only way to determine if FAI is actually present is to have a full-scale evaluation by a physical therapist. If FAI is diagnosed, it’s important to realize that surgery is not necessary, and the best way to treat it is with strengthening and stretching exercises and education on how to modify their running style to reduce pain and aggravation. That’s why it’s important to see a physical therapist first for any hip pain you may be having.

Acetaminophen not found to be very effective
for low back pain or osteoarthritis

Low back pain and osteoarthritis of the hip and knee are two of the leading causes of disability. Treatments vary widely for these conditions, but in many instances, doctors recommend that patients take pain-relieving drugs like acetaminophen. Guidelines generally support these recommendations, but some evidence has emerged recently that has started controversy regarding the safety of acetaminophen and if it should be so routinely recommended. This led to a comprehensive study called a systematic review, which evaluated all literature on the topic. The review found high-quality evidence that acetaminophen had a significant but small effect on hip or knee osteoarthritis, but it also found high-quality evidence that it was not effective for low back pain and that it increased the risk of having abnormal results on a liver function test by nearly fourfold. This does not necessarily mean that acetaminophen should not be taken, but that it should be done so in moderation and also supplemented by physical therapy to address these conditions.

Adding acupuncture-like dry needling to a physical therapy
program may help reduce headache symptoms

Headaches are very prevalent in the general population, as they account for about 40% of all neurological (nervous system-related) complaints. Of the more than 100 different types of headaches, the most common are called tension-type headaches, in which a tightening sensation occurs across the forehead or the sides or back of the head. There are a number of different treatments available for tension-type and cervicogenic headaches (another common type), but an emerging technique called dry needling may hold some promise. Dry needling is fairly similar to acupuncture in that a thin needle is inserted into muscles in order to “reset” them, which is believed to reduce pain and increase function as a result, and it’s possible that combining it with physical therapy can lead to even better results. This has not yet been clearly proven, so a study was conducted that evaluated the effects of dry needling combined with physical therapy. Results showed that the dry needling was in fact effective at reducing headache symptoms, but evidence was lacking on their combined use. This suggests that dry needling may be a useful tool for physical therapists to add to their repertoire, but more evidence is still needed to confirm this.

Patients with painful conditions have poorer physical
fitness and do less vigorous exercise than others

The health benefits of regular physical activity and good physical fitness seem to be countless. Some of these include better respiration, increased strength and a reduced chance of developing diseases and other painful conditions. Data from hospitals shows that some patients with certain conditions are less physically active than healthy people. But for patients with various musculoskeletal conditions—which consists of nearly any type of pain or disability in bones, muscles or joints—who are receiving physical therapy, it’s not known if the same is true. Therefore, a study was performed to compare the levels of physical activity and physical fitness between patients with various long-term musculoskeletal conditions receiving physical therapy and a random selection of other people.

Patients with heel pain for shorter duration
respond better to physical therapy

Plantar heel pain (PHP) is an umbrella term that includes plantar fasciitis and any other conditions that cause pain in the heel or the plantar fascia, a thick band of tissue that supports the arch of the foot. PHP is the most prevalent foot condition treated by podiatrists and physical therapists. Though many patients are able to improve with conservative (non-surgical) treatment like physical therapy, up to 50% of them continue to have symptoms afterwards, and for 30%, it’s a recurring issue. One explanation is that certain characteristics of patients like age, weight or duration of PHP could make them more or less likely to respond well to treatment, but no evidence exists to support this. Therefore, a study was conducted to investigate these factors and determine if they play a part in each patient’s response to physical therapy.

Manual therapy leads to various improvements
for patients with fibromyalgia syndrome

Fibromyalgia syndrome, or FMS, is a painful condition that is more prevalent in women than men and usually leads to other symptoms such as fatigue and sleep disturbances. Manual therapies like massage and manipulations performed by a physical therapist are often recommended for FMS and are known to be effective for treating women with the condition, but evidence is lacking regarding its effectiveness for men. A study therefore set out to compare the outcomes of these treatments for both sexes. Though some important differences were found that need to be considered in revising current treatments, manual therapy was effective for treating both women and men with FMS, and should be encouraged as a useful tool for physical therapists treating patients with this condition.

Listening to music lowers the level of pain experienced during physical therapy

One of the most difficult parts of receiving physical therapy for patients is the pain that comes with it. Though it’s necessary in order to make physical therapy effective, this pain may turn some patients away and cause them to lose interest in treatment. To test out a simple solution, one study had some patients listen to music through iPods during treatment sessions. They found that patients reported significantly less pain while listening to music compared to without it, which means music may be an inexpensive way to help patients cope with the pain experienced during physical therapy.

Physical therapy significantly improves
musculoskeletal disorders for dentists

As a result of the physical requirements and repetitive motions of being a dentist, many in the profession (roughly 70%) suffer from musculoskeletal problems such as low back, neck and shoulder pain. Though a number of treatment options exist for musculoskeletal disorders, physical therapy is widely considered to be one of the most effective, often leading to notable improvements. To evaluate the effects of physical therapy on dentists with musculoskeletal pain, a study was conducted and found dentist’ conditions improved significantly and they missed fewer days of work as a result of the intervention. Dentists who experience similar issues should therefore regard physical therapy as a reliable option to reduce pain in their lives and profession.

Arthritis, back pain biggest burdens on quality of life for older adults

Coping with pain from a variety of causes is an unfortunate part of the aging process, and it generally tends to get worse the older we get. While it’s impossible to eradicate all types of pain, there are many ways to treat it, and that comes from first understanding the source of pain. From a massive survey distributed to Medicare subscribers, it was made clear that arthritis and back pain are the two leading causes of pain for older adults, and these conditions both have a major negative effect on overall quality of life. By better targeting these conditions, physicians should strive to help the elderly live with less pain and more enjoyment in their lives.

Do you suffer from migraines? Try exercising
more, and you may be doing yourself two favors

Migraines, which are severe headaches associated with a throbbing in one region of the head, can make one nearly useless while experiencing an episode. If you happen to experience migraines, even on a seldom basis, then you know how debilitating they can be on your life at those times. To combat these problems, the most popular treatments are a drug called topiramate, and relaxation therapy for those who prefer not to take medication on a regular basis. Some doctors are also instructing migraine patients to increase their regular physical activity, but evidence to support this treatment is lacking, until now. According to a new study, increased exercise and physical therapy was shown to be associated with a similar decrease in migraine episodes compared to patients taking topiramate and with a greater decrease for those engaged in relaxation therapy. Read on for more details about how exercise may reduce migraines while also improving your overall health.

Patients and care providers have different
perceptions of pain from exercise and mobilization

For patients with chronic, painful conditions such as neck pain, back pain, or osteoarthritis, there may be instances of pain from either the diagnosis or in the treatment itself. While this is completely normal, helping care providers to diagnose a condition and necessary to make exercise and mobilization techniques effective, some patients may not be aware of this, and instead take it as malicious and fail to comply with their therapy as a result. To get a better impression of how feel about pain experienced during therapy, a series of interviews was conducted with both patients and care providers. Results showed that most patients viewed the pain as a necessary part of therapy, but a select few reacted negatively and were driven away from therapy due to it if their therapist didn’t explain it properly. This highlights the importance of communication from care providers, especially physical therapists, when it comes to thoroughly explaining the role and necessity of pain in the treatment of certain conditions.

Caffeine use can be either beneficial or detrimental, depending on how it’s used

Caffeine is far and away the most widely consumed drug in the world, with an estimated 85-95% of Americans using it on a regular basis. While most people drink it for a morning or mid-day pick-me-up in coffee, tea or soda, it can also be used in conjunction with pain medications to increase effectiveness. On the downside, regular caffeine intake can also be detrimental to some when use is stopped after a long period of habitual consumption, possibly leading to withdrawal and headaches. The effects of caffeine such as these and others, on both the positive and negative end of the spectrum, are given sufficient in this review, with the intention of better educating those who use caffeine so regularly.

The relationship between chronic pain
and obesity in the elderly

Chronic pain, defined as pain lasting for more than three months, occurs in the elder population more than any other age group, as some figures report more than half of seniors experience chronic pain regularly. Dealing with chronic pain on a regular basis can be an extreme burden and have a negative impact on elders’ health-related quality of life (HRQoL), and it unfortunately only gets worse with age. The exact reasons why this pain plagues older people, however, are not clearly defined, leading some researchers to investigate the matter in greater detail. Results showed that greater abdominal obesity and associated osteoarthritis were high indicators of chronic pain and depression based on HRQoL, and that exercise programs catered towards elders should therefore be implemented to address this issue.

Effectiveness of electrical nerve stimulation
(ENS) for musculoskeletal pain

A meta-analysis was performed intended to conclude if electrical nerve stimulation (ENS), a pain treatment that applies electrical energy to nerves through either electrodes or needles, was indeed effective in its treatment of musculoskeletal pain. The study proved both transcutaneous ENS (TENS) and percutaneous ENS (PENS) to be legitimate, quality treatments of pain.