04 Apr Non-Pharmacological Management of Chronic Primary Pain for Under 16s
Chronic pain is pain that lasts for more than three months and can either be secondary – related to an underlying condition or primary – there is no clear underlying cause, or the pain appears to be unrelated to any evident injuries of diseases (NICE, 2021). It is estimated that chronic pain affects about one to six per cent of England population.
The following treatments are recommended by the National Institute for Health Care Excellence (NICE), for the management of chronic pain. These recommendations by NICE aim to advise on a care and support plan by setting out a comprehensive person-centred assessment of the causes and effects of pain and creating possible management strategies, including self-management.
A few non-pharmacological management plans for chronic primary pain are:
- Exercise programmes and physical activity for chronic pain.
- Acupuncture for chronic pain.
- Manual therapy for chronic pain.
- Psychological therapy for mindfulness of chronic pain.
Exercise Programmes and Physical Activity:
Exercise or physical activity is important for a healthy lifestyle and is recommended for people with chronic pain (NICE, 2021). Activities such as walking, housework and gardening can replace sporting activities or regularly attending the gym. Exercise is particularly important for people with a variety of health conditions, inducing musculoskeletal issues and cardiovascular disease.
Physical activity has shown significant improvement in the prevention and control of pain. Regular physical activity aids in preventing immobility, joint stiffness, muscle tightness and blood circulation. Bed rest for more than two days is detrimental (Physiopedia, n.d).
Activities such as Tai Chi and yoga are effective for osteoarthritis, low back pain and fibromyalgia. Other activities such as walking, or swimming are beneficial for decreasing pain and improving function.
Evidence has shown that exercise reduced pain and improved quality of life. This benefit was seen in both the short-term and long-term treatment plan and it was consistent with different types of exercise. NICE (2021) has recommended this type of treatment because not only is it cost effective, but it is also viable for all types of chronic primary pain .
Acupuncture is a method used in western medicine to treat pain and is one of the many skills utilised within physiotherapy. Acupuncture is a part of an integrated approach to pain management, inflammation, hot flushes, and general well-being (Physiopedia, n.d). Traditional Chinese medicine states that acupuncture is a technique used to balance the flow of energy throughout the pathways of the body. In a contrasting view, western practitioners view the acupuncture points as places to stimulate nerves, muscles and connecting tissue; believing that the stimulation will boost the body’s natural painkillers.
This treatment involves inserting of very thin needles through the skin at strategic points in the body and is used to relieve the discomfort from a variety of conditions, including headaches (tension headaches and migraines), low back pain, neck pain and osteoarthritis (Mayo Clinic , 2021).
Acupuncture is recommended by the NICE committee, indicating that pain is reduced, and the quality of life is improved in the short-term. However, acupuncture is dependent on the individual needs of the patient.
The International Federation of Orthopaedic Manipulative Physical Therapists defines manual therapy as “skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction”
NICE stated that manual therapy is often used to treat neurological, cardio-respiratory, and orthopaedic conditions including pain. The practitioner that delivers the therapy applies mechanical forces to the musculoskeletal structures to alter the physical and neurophysiology properties of the tissues (NICE,2021).
The effects of manual therapy include: (Physiopedia, n.d):
- Physiologically it has a positive placebo response.
- Physically it facilitates tissue repair and remodelling.
- And psychologically it relieves pain via stimulates gating mechanism, muscle inhibition, reduction noncaptive activity and reduced particular pressure.
The benefits of manual therapy compared to the usual care for pain management is promising and there was no evidence of harm caused to patients during the trial, thus this treatment was also recommended.
Psychological factors are recognised to play a role in the experience of chronic pain, as the pain impacts on the way one would think, feel, and behave. Psychological interventions have been developed to improve functioning, mood, and quality of life. These approaches are widely used for chronic primary pain. Current practice tends to focus on Cognitive Behavioural Therapy (CBT) and the Acceptance Commitment Therapy (ACT), (NICE, 2021).
CBT is focused on the short-term psychotherapy approach that urgers patients to participate in an active coping process to change their maladaptive thoughts and behaviours that either maintains or worsens the experience of chronic pain. The therapy is grounded in the idea that pain is a complex experience influenced by a patient’s thoughts and their overall behaviour (Black, 2019). CBT’s aim in pain management is to reduce the impact of pain on daily life, learning skills to cope with pain, improving physical and emotional functioning and overall well-being, whilst also reducing the reliance on pain medication.
ACT urges patients to shift their focus from reducing or eliminating the pain to fully engaging it in their lives. By changing how they associate with their internal experiences and to ultimately live a better life. Therapists aim for patients to become actively involved with what matters most in their life despite having chronic pain. ACT applies six core process to get patients to take more action in their lives (Black, 2019).
These processes are:
- Willingness to accept.
- Contact with the present moment.
- Observing the self.
- Committed action.
NICE recommendation for psychological therapy is based on the fact that both these forms of therapy improved the quality of life for people with chronic pain. As well as enhanced their sleep and reduced pain and psychological distress. Both of these therapies are also cost effective.
At OsteoVision our team of specialists are trained to help you with physical activities, acupuncture, and manual therapy. They will culminate an evidence-based treatment plan to help with your recovery. OsteoVision has established referral pathways in place to offer patients, should you require an alternative service or secondary care. Contact us to book your assessment.