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    Pain CME

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    Anjali Toshniwal
    This document discusses various physiotherapy modalities for pain management. It provides details on modalities like TENS, interferential currents, thermal modalities like heat and cold, deep heating like shortwave diathermy and ultrasound, mobilization and manipulation, and massage. It explains the mechanisms of pain relief for each modality, such as gate control theory, activation of pain inhibitory pathways, increased blood flow, counterirritation effects, and stimulation of mechanoreceptors.

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    Pain CME

    Uploaded by

    Anjali Toshniwal
    10 views22 pages
    This document discusses various physiotherapy modalities for pain management. It provides details on modalities like TENS, interferential currents, thermal modalities like heat and cold, deep heating like shortwave diathermy and ultrasound, mobilization and manipulation, and massage. It explains the mechanisms of pain relief for each modality, such as gate control theory, activation of pain inhibitory pathways, increased blood flow, counterirritation effects, and stimulation of mechanoreceptors.

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    Pain-CME

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    This document discusses various physiotherapy modalities for pain management. It provides details on modalities like TENS, interferential currents, thermal modalities like heat and cold, deep heating like shortwave diathermy and ultrasound, mobilization and manipulation, and massage. It explains the mechanisms of pain relief for each modality, such as gate control theory, activation of pain inhibitory pathways, increased blood flow, counterirritation effects, and stimulation of mechanoreceptors.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views22 pages

    Pain CME

    Uploaded by

    Anjali Toshniwal
    This document discusses various physiotherapy modalities for pain management. It provides details on modalities like TENS, interferential currents, thermal modalities like heat and cold, deep heating like shortwave diathermy and ultrasound, mobilization and manipulation, and massage. It explains the mechanisms of pain relief for each modality, such as gate control theory, activation of pain inhibitory pathways, increased blood flow, counterirritation effects, and stimulation of mechanoreceptors.

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    Download as PDF, TXT or read online from Scribd
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    See discussions, stats, and author profiles for this publication at: https://www.researchgate.

    net/publication/253330751

    Physiotherapy Management of Pain

    Conference Paper · July 2009

    CITATIONS READS

    0 2,855

    1 author:

    Deepak Anap
    Dr. Vithalrao Vikhe Patil Foundation's, College of Physiotherapy, Viladghat, Ahmednagar
    69 PUBLICATIONS 322 CITATIONS

    SEE PROFILE

    All content following this page was uploaded by Deepak Anap on 15 May 2014.

    The user has requested enhancement of the downloaded file.


    DR. DEEPAK B. ANAP
    ASSO. PROF.
    COLLEGE OF
    PHYSIOTHERAPY,PDVVPF,COPT,Ahmednagar
    HOW PHYSIOTHERAPY WORKS ?
    WHERE WE ARE TODAY ?

    SHORTWAVE DIATHERMY IN THE MANAGEMENT OF CHRONIC PELVIC INFLAMMATORY


    DISEASE PAIN: CASE REPORTS

    EFFICACY OF ICE AND SHORTWAVE DIATHERMY IN THE MANAGEMENT


    OF OSTEOARTHRITIS OF THE KNEE – A PRELIMINARY REPORT

    Effect of Iyengar yoga therapy for chronic low back pain -Kimberly Anne Williams
    PHYSIOTHERAPY MODALITIES

    PHYSIOTHERAPY
    MODALITIES

    ELCTROPHYSICAL PHYSICAL
    AGENTS TREATMENTS

    *MOBILISATION
    ELECTRICAL THERMAL /MANIPULATION
    STIMULATION MODALITIES * MASSAGE
    * YOGA

    HOT COLD
    TENS * HOT PACKS * ICE PACKS
    IFT * IRR *ICE MASSAGE
    * WAX BATH *COLD SPRAYS
    TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
    (TENS)

    •Any stimulation in which a current is applied across


    the skin to stimulate nerves
    •1965 Gate Control Theory created a great popularity
    of TENS
    Types of TENS :
    Parameter High-Freq TENS/ Low-Freq TENS/ Brief-Intense TENS
    Conventional Acupuncture

    Intensity Sensory Motor Noxious

    Pulse Freq 60-100 pps 2-4 pps Variable

    Tx Duration As needed 45+ min 15-30 min

    Duration of Relief Minutes to Hours Hours <30 min


    MECHANISM OF PAIN RELIEF BY TENS

    • CONVENTIONAL / HIGH TENS :


    • A Beta fibers are stimulated to SG encephalin
    interneuron (pure gate theory)
    • ACUPUNCTURE /LOW TENS:
    • Level III pain relief, A delta fibers get Beta
    endorphins
    •Longer lasting pain relief but slower to start

    ► Relatively higher freqeuncy ( >50 Hz)


    induce localized block of conduction
    INTERFERENTIAL CURRENTS

    • IFC was neglected until 1970s when work


    on pain mechanism by Melzak and Wall
    illustrate that pain could decreased by
    stimulating primary afferent neurons

    • IFC is produced by mixing two medium-


    frequency currents that are slightly out of
    phase, so that they ‘interfere’ within tissues,
    to produce Low Frequency (Beat Frequency)
    Effect inside the tissue.
    MECHANISM OF PAIN RELIEF BY IFT

    ♦ Activation of pain Gate Control Mechanism :


    Stimulation of Large Diameter affrerent nerve fibers
    closes the ‘ Gate’ to nociceptive impulse in SG.
    Beat Frequency- 100 Hz.

    ♦ Activation of nociceptive fibers: Activation of the


    nociceptive fibers diminish pain by means of
    descending Pain suppressor system.

    ♦ Physiological Block : Frequency above 50 Hz could


    cause a temporary physiological block in both
    myelinated & unmyelinated nociceptor nerve fibers
    ( A – Delta & C- Fibers)

    ♦ Increased Blood Flow : Stimulation of ANS –


    Vasodilation - removal of chemical irritants acting on
    pain nerve endings.
    THERMAL MODALITIES

    Superficial vs Deep Heating Agents

     Superficial

     Primarily causes increases in skin temp

    and superficial subcutaneous tissue

     Depths of penetration <2 cm

     Hot Packs, Wax Bath , IRR

     Deep

     Heat deeper tissues

     Depth of penetration 3-5 cm

     SWD, US
    SUPERFICIAL THERMAL MODALITIES

    MECHANISM OF PAIN RELIEF

     Stimulation of cutaneous heat receptors will produce a pain


    relieving effect via spinal segmental mechanism
     Pain associated with secondary muscle spasm or tension
    syndromes Is attributed to local ischemia resulting from partial
    occlusion of blood vessels within the muscle. Heat produces a
    hyperaemia within the muscle which resolves the ischemia and
    reduces pain.
    Local increase in circulation remove the chemicals stimulating
    nociceptors.
     Counter irritation effect .
     Psychological Reactions: Relaxation, Warmth & Sedation.
    CRYOTHERAPY

     1g of ice at 00C requires 491 J of energy to


    form water at body temp. 370C

     1g of water at 00C requires only 155J to be


    raised to 370C

     Ex. Ice vs Water

     Superficial tissue temp. drop 150C (30-


    150C)within 2-5 mins.

     Deep tissuetemp. Drop about 50C(35-300C)


    MECHANISM OF PAIN RELIEF BY COLD

    A-delta and C fibers Conduction


    velocities decreased
    Larger A fiber (alpha and beta
    affected last)
    Lager A fibers and gamma motor
    neuron important in reducing spasm
    DEEP HEATING MODALITIES

    SHORT WAVE DIATHERMY

     High Freq. 27.12 Mhz.


     Wavelength. 11.06 m
     Heat Production by : Dipole rotation
    Ionic Motion.
    ULTRASOUND

     High Freq. 1 to 3 Mhz.


     Thermal Effect
     Non Thermal effect / Massaging effect
    MECHANISM OF PAIN RELIEF BY HIGH FREQUENCY
    CURRENTS

     Mechanical stimulation provided by the


    moment of the ultrasound head over the tissue
    during treatment .
     this massaging of the tissue selectively
    stimulates low threshold mechanoreceptors &
    therefore increases large diameter afferent
    activity, with consequent activation of spinal
    segmental mechanism.
    MOBILISATION / MANIPULATION

     Mobilization - is a passive movement


    performed slowly by the therapist, it is
    controlled enough that the patient can stop
    the movement any time.
     Goal is to provide a safe and effective
    means for restoring normal joint play
    and/or decreasing pain.

     Manipulation - involves a sudden, short


    amplitude, high velocity movement that the
    patient cannot stop.
    MECHANISM OF PAIN RELIEF BY MOBILIZATION/MANIPULATION

    Decreases pain by:


     Stimulation of joint mechanical
    receptors, producing inhibitory effects
    at the spinal level
     Causing increased release of
    endorphin and encephalin
    MASSAGE

    o According to Tappan, is defined as “the


    intentional and systematic manipulation of soft
    tissues of the body to enhance health and healing”.
    o It is applying pressure, tension, motion, or
    vibration —manually or with mechanical aids — to
    the soft tissues of the body.
    o The massage technique used depends on the
    goal of the session.
    Ex. Goals like increasing relaxation, increasing
    circulation, inducing a positive emotional state,
    decreasing pain.
    MECHANISM OF PAIN RELIEF BY MASSAGE

     Stimulation of Mechanoreceptors
    Psychological – Relaxation
    Studies also showed massage therapy can
    increase the serotonin level for both infants
    (Field 1996) and adults (Ironson 1996).
    Serotonin can inhibit the transmission of
    noxious nerve signals to the brain.
    View publication stats

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