Physical therapies for chronic pain
Many of the people that we talked to had received physical therapies including manipulations, mobilisations, massage, electrical stimulation (TENS), acupuncture, heat and cold treatment and ultra sound.
These are usually given in combination with exercise and are used to reduce pain so people can get mobile again. Physical therapies are provided by NHS and private physiotherapists and by chiropractors, osteopaths and other complementary therapists (see also 'Complementary approaches' and 'Physiotherapy').
Physical therapies are sometimes referred to as 'conservative therapies' because they are considered a safer option than medical interventions. Several people felt that they are worth trying and in particular were a better option than undergoing unnecessary surgery.
Although there is some evidence that manipulation may have a short term effect for some people with back pain, healthcare professionals disagree about whether physical therapies are useful in the management of chronic pain. In contrast, people with chronic pain tend to believe that different approaches work for different people.
Transcutaneous Electrical Nerve Stimulation (TENS) was one of the most common physical therapies talked about.
TENS is the use of safe amounts of electrical current to try to reduce pain. TENS machines are usually a small battery operated device which can be worn on a belt or put in a pocket. They have wires leading to gel-covered pads which are stuck to the skin near the painful part of the body.
Some people found that TENS helped their pain, but others did not get any relief and a few people found it uncomfortable. A man who found TENS helpful said it was easy to use but not very practical to carry around. Others said it was a lot of hassle putting the pads on, particularly if the pain was in their back.
- Age at interview:
- Unemployed plant mechanic; married; 3 children, 2 stepchildren.
The TENS machine, is a small electrical device that sends out pulses... electricity, whether it's current or voltage or whatever, it's a very, very small amount, so I find it's not actually dangerous and this machine, I would say is pocket sized actually but it's got cables and it's got sticky pads that you place on areas or the surrounding areas to give an electrical pulse, or a rhythm that's required.
I can set this to time it myself and I find it really does aid the worst of my pain when I'm actually using it and I find that a device that should probably be looked into further for some kind of aid, especially as it's, you're not actually taking anything orally that could maybe effect you like any kind of other day to day business that you may be doing, like driving or whatever or operating machinery. But the only thing with it is, it's not really that practical to be carrying about with you all the time.
TENS machines were sometimes provided by physiotherapists or borrowed from pain clinics and support groups. A few people bought their own from shops or catalogues. A man who found TENS and ultrasound helpful recommended trying out a TENS machine before buying one as they don't work for everyone.
- Age at interview:
- Retired risk management/human resources, Voluntary work for Action on Pain; married; 2 children.
Ultrasound yeah. Certainly in terms of using an ultrasound, I get sort of very sort of tender soft tissue problems and I find an ultrasound machine is quite useful to ease those out and then a TENS machine again for areas of isolated pain, that's quite useful as well, but only on certain parts, because on other parts of my injuries it can sort of trigger off other bits and pieces which aren't very comfortable.
What I do always stress is what works for one person may not work for somebody else. Pain's very much an individual thing and so it's important to, yes you can try TENS machines and most suppliers will say try and if it doesn't work in say twenty eight days, you can send it back and get your money back, just less the cost of the pads. The electric, you know, the pads, and that's fair enough.
Or some physiotherapy departments or pain clinics will actually loan you a machine for a while to see how you get on with it and then they sell them on at reasonable prices. And they work for quite a few people. As I say, I do stress not for everybody.
A woman had bought a device called a Pain Gone Pen which works on a similar principle to TENS and provided a short blast of pain relief. A few people had attended physiotherapy for a form of TENS called inferential or had been to a pain clinic for a technique which combines acupuncture with electrical stimulation.
- Age at interview:
- Home carer (not working); married; 3 children.
Yeah. The Pain Gone Pen I use when I go on holiday. I find it wonderful when on a plane. It's no good for me long term but for short term, for a quick short sharp blast of pain relief, I find that quite good. So I use that when I'm on a plane. When I'm on holiday it fits into your handbag and it doesn't help me a lot but it does help a bit and I think a lot of these things are psychological anyway. I feel that it's doing me good.
How does it work?
You click it into the skin between your thumb and forefinger fifteen times, push it in, and then you put it onto the point of pain and click it for another fifteen clicks. It works like acupuncture. And I think it does work a little bit. So as I say, I do use that when I'm on holiday.
- Age at interview:
- Age at diagnosis:
- Administrator (trained as nurse); single.
The other, the only other therapy I've tried is actually acupuncture. I first had it pre-surgery, because my own GP actually does acupuncture and so I had about three or four sessions of needle acupuncture before my surgery, which it helped to a degree, sort of helped with my back pain as such, but he always managed to hit the spots where the nerve pain was worse.
But, you know, it did make me, make things a little easier for a while. But then, after my surgery, I was then, that's when I was then referred to the Pain Management Clinic and they actually do what they call electronic acupuncture, which is, I mean I don't mind needles, so the needle acupuncture didn't bother me at all and, to be honest, you don't really feel the needles going in, but in the electronic one, you hold the earthing, earthing part of it? I think it's the earthing and then they basically go up and down whichever part of your back with a pen. It's not a proper pen, it's metal, but they call it a pen. And it doesn't hurt at all and they do that for about five minutes.
You know, that wasn't too bad, as I say. I've had it for a bit, but I don't have it now because again it's got to that point where it doesn't have such good effects as it did do at the beginning but then they sort of do warn you that, if you have it all the time, you can get to a point where you get used to it and then it's ineffective. So I had a sort of course of it, of four sessions in two or three months and then you have it three to four monthly after that.
Heat and cold
Physiotherapists sometimes use or recommend the use of heat or cold applied to the skin. Cold helps relieve acute inflammation but can help relieve chronic pain by reducing muscle spasms and joint stiffness. Heat also reduces spasms and stiffness and increases blood flow which removes pain producing chemicals.
Most people that we talked to felt that the use of heat or cold for the relief of chronic pain was a matter of personal preference. Some found it helpful to alternate heat and cold. Care should be taken when using heat and cold packs as both can burn the skin.
Ultrasound is used to try to speed up the healing process after injury using sound waves at a frequency too high to be audible to the human ear. A few people had been given ultrasound by a physiotherapist and some people with acute injuries and muscular pain found it helped.
Manipulation (a high velocity thrust to a joint beyond its restricted range of movement), and mobilisation (low velocity passive movements within the limit of the joint range) were sometimes used. They were usually given in combination with a programme of exercises to help get people mobile again.
A woman who was receiving intensive physiotherapy based on these principles, found it very helpful but said that she didn't know whether it would work for everybody. Osteopathy and chiropractic are largely based on manipulation and mobilisation (see also 'Complementary approaches').
- Age at interview:
- Age at diagnosis:
- Medically retired care officer; married; 3 children.
At the moment I'm attending hospital for intensive physiotherapy for fibromyalgia, and the gentleman's an absolute gem that does it. Normally when you go to physiotherapist they only deal with one part of your body that your doctor actually says is wrong. Lets say you go for a bad knee or an elbow or something that physiotherapist can only work on that part of your body that the doctor has asked them to do, but the one I'm visiting as far as I know he's the only one in Scotland and he does the whole body.
And they were actually treating me for golfers and tennis elbow and when I went to see this physiotherapist he manipulated something in my neck and miracles happened, I could bend my elbow, it was something... Whatever it was it was coming off my neck, so he manipulated my neck he went right down my spine. I go twice a week, I'm now in the gym. Whereas a year ago I wouldn't be able to walk into a gym never mind get on a bike. I can do 5 minutes, a minute on and a minute off the bike.
You get leg exercises, because I've got a bad hip and they give you arm exercises in the gym. But when you're sore all you have to say is 'Look this bits sore' and he'll take you back through to the physio bit, and work on your back so it means that you're getting a lot of relief and you're also building up the muscles that you haven't been using for a while. Its working slowly but surely, but I think, I don't know if he would do for everybody, I know he's worked wonders for me.
Some people had been given treatments which are now less common because there is little evidence of their long-term benefits. A few were given traction using a special machine which stretches the back or neck pulling the bones slightly apart to relieve the pressure on trapped nerves. Some found this gave temporary relief of their pain. A few said they found that they couldn't take it and asked that the procedure be stopped.
A few people with back pain had been given corsets to help support their back. However, it is now believed to be more effective to use exercises to strengthen supporting muscles.
Last reviewed May 2015.
Last updated May 2015.