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Physical Therapy for Pain

Physicall therapy is generally used to help restore physical strength and functioning after injury or surgery. Physical therapiests can also provide a lot of pain relief for patients with musculoskeletal (involving the bones and muscles) pain, some types of neuropathic pain, and sympathetically mediated pain. Physical therapiests have experience with different pain-relieving techniques and often advise doctors about treatments that may benefit a patient they are working with. Many of the techniques they use, such as ultrasound stimulation, require special equipment and a person trained in using it. Other techniques, such as exercise, range of mostion therapy, and mechanical stimulation, can be done just as effectively by the patient himself, perhaps with help from a family member.
1. Exercise
Exercise is important for both treating and preventing pain in cancer patients. Routine exercise strengthens weak muscles, mobilizes stiff joints, helps restore coordination and balance, improves circulation, and reduces swelling. Even very simple things, like frequently changing position and moving all the joints through a full range of motion, can be helpful. In one stucy, pain was reduced in 86 percent of bedridden patients by simply changing their position every hour or so. Even 25 percent of otherwise active cancer patients reported reduced pain after beginning an exercise program.
It does not require a hospital setting and special therapists to start exercising. Many local YMCAs and other community organizations have organized exercise programs for recovering cancer patients. For people who have difficulty walking, structured exercise programs performed in a swimming pool can provide dramatic relief of joint and muscle aches and pains. pool therapy can even be performed by persons who are at risk of patheologic fracture because of metastatic tumors that have invaded their bones.
When patients are too severely ill to exercise, family members should learn how to perform range of motion exercises and massage. Often, a physical therapist can make a few home visits to demonstrate these techniques. When performed regularly, simply moving all the joints through the normal range of motion can reduce swelling and pain in a bedridden patient. It will sldo preserve muscle length and joint motion during periods of severe illness, making recovery much easier. However, range of motion exercises pain severely. All forms of exercise that involve weight bearing should be avoided if there is a likeihood of pathologic fracture or tumor invasion.
2. Positionaing and Movement
Proper positioning is another simple technique that can relieve pain in bedridden patients. Many bedridden patients cannot position themselves comfortably without help. Proper position involves keeping the body correctly aligned with no twists in the back or limb. Joints should not be kept completely extended, but rather slightly flexed, which will minimize swelling of the extremity. If any area of the body has paralysis or severe weakness, a padded splint can prevent contractures (permanent shortening of tendons and muscles) and spasms. Skin condition should also be monitored, and the patient should be helped to roll or turn frequently so that pressure sores do not develop.
Immobilization or restriction of movement is often used to manage episodes of acute pain, to stabilize fractures, or to prevent fractures in patients with bone metastasis. Physical therapiests can make home visits to provide supportive devices such as adjustable elastic braces and splints to maintain optimal body alignment.
However, prolonged immobilization should be avoided whenever possible by performing range of motion therapy several times a day. For example, a patient may need to have her shoulder immobilized because of a pathologic fracture. Range of motion can still be performed on her elbow, wrist, and fingers so that these joints do not become stiff.
3. Massage and Vibration
Massage helps relax and increase circulation to the areas massaged. This can reduce the pain from muscle aches, lessen swelling, and relieve joint pain associated with immobility. Depending on the area involved and the tenderness of the skin, soft stroking, firm kneading, or rubbing with rhythmic, circular motions may give the best results. An alcohol-free lotion can reduce friction, minimizing skin tenderness during the massage. Warming the lotion for a few seconds in a microwave may make its application more comfortable. Massage should not be considered an alternative to exercise or range of motion, however.
Mechanical massagers or infrared heating massagers can help increase superficial circulation and may make it easier for the person giving the massage. Vibrators often relieve the pain of damaged nerves or peripheral neuropathy (nerve damage of the feet and hands) that sometimes results from chemotherapy. One word of caution: Infrared heating devices should not be used in area that have recently received radiation, as they may cause burns.
4. Ice and Heat
Applying heat or cold to painful areas can sometimes reduce pain dramatically. Heat increases blood flow to the skin, decreases blood flow to the underlying muscles, and reduces joint stiffness. Heat can be applied by hot packs, hot water bottles, electric heating pads (dry or moist), commercially available chemical and gel packs, and immersion in a tub or basin. Devices, can also be used, but should not be placed directly over a cancer site.
Heat should be applied for at least thirty minutes, but can remain in place longer. When used for more than thirty minutes, however, the skin should be inspected several times to make sure there is no burning. Hot packs shuold always be wrapped in a towel or cloth to prevent burns. If the patient has any nerve damage or numbness in the area, more layers of protection should be used, since skin burning is more likely. Heat should never be used in areas that have recently undergone radiation therapy because these areas are very likely to burn.
Cold causes vascoconstriction, reduces inflammation and swelling in injured tissues, and reduces some types of pain, particularly burning pain. Although most people do not realize it, cold probably relieves muscle spasms better than heat does. Ice pachs and frozen chemical gel packs are the simplest ways to apply cold. Cold packs should be sealed to prevent dripping and wrapped in cloth so tha they are not uncomfortable. The pack should be soft enough to conform to body tissues in the area. Cold should generally not be applied for as long as heat; fifteen minutes is usually sufficient.
Although cooling will increase joint range of motion and relieve muscle spasm in most conditions, in a few cases if increases joint stiffness and muscle spasm. If that occurs, cold therapy should not be used. Cold should not be applied to any area that has been damaged by radiation therapy. It also should not be used in areas with vascular problems, such as in a limb with peripheral vascular disease. Patients who have certain connective tissue diseases such as lupus may actually have more pain if they use cold.
5. Acupuncture
Acupuncture has been practiced in China for more five thousand years. It has been used to treat many conditions, but for cancer patients, the relief of pain, nausea, and vomitting are the most important. Acupuncturists place very thin stainless steel or copper needles just under the skin, and then stimulate the needles by gentle twisting, heating, or applying a weak electrical current to them. This usually produces a tingling sensation, or one similar to a mosquito bite. Acupuncture (applying pressure to designated points instead of inserting needles) may have similar effects.
According to a panel of experts at a National Institutes of Health Conssenus Conference in November 1997, acupuncture is condidered "somewhat effective" in the management of nausea and vomitting associated with chemotherapy. The conference also concluded it might have some effect in controlling postoperative pain. Much of the evidence in support of acupuncture is anecdotal (based on individual patients' reports of benefit) rather than from controlled studies. However, scientific studies have shown that acupuncture causes the release of natural opioids that can reduce the perception of pain. Anatomic studies have shown that the acupoints (location where acupuncturiest insert needles) have a greater concentration of nerve endings than do other locations on the body.
If you decide to try acupuncture, only visit an acupuncturist who is licensed (all fifty states license acupuncturiests). Also, never have an chemotherapy session if your blood count is low, as may happen after chemotherapy. This could place you at very high risk of infection or bleeding.