Introduction
Pain is generally characterized as an emotional, sensitive, and unpleasant experience associated with a potential or an acute injury. Pain can manifest as acute or chronic pain based on different variations, including location characterized as generalized or localized pain, threshold, often linked to aging, or duration that involves the time of its occurrence. Specifically, chronic pain is one of the most prevalent public health concerns currently, which is frequently associated with the aging or senior population. In particular, chronic pain can be defined as pain of a recurrent or continuous nature lasting for at least three months and without a single state of intensity (da Silva Marques et al., 2022). According to Danilov et al. (2020), long-term clinical practice indicates that typical biomedical interventional measures for the relief of chronic pain, like the use of opioids, stimulation, surgical interventions, anticonvulsants, and antidepressants, are not effective in the long term and might expose the patient to adverse health risks. In this context, a multidisciplinary approach is essential for managing chronic pain to improve the patient’s quality of life (QoL). In particular, the interdisciplinary assumption for the management of chronic pain includes the use of physical therapy, occupational therapy, and behavioral modification therapy that leverages the use of physical exercises to alleviate chronic pain. Specifically, physical exercises have been widely recognized as a non-pharmacological interventional strategy for preventing chronic pain because they enhance the production of endogenous opioids that inhibit pain sensitivities (da Silva Marques et al., 2022). In this context, this paper suggests that chronic pain management requires an interdisciplinary interventional approach that integrates pomological, physical, and occupational therapy, all of which leverage physical activities to manage chronic pain effectively.
Physical Therapy in the Management of Chronic Pain
Physical therapy generally involves the use of various approaches, including education and physical exercises, to help alleviate pain among patients experiencing chronic pain. In particular, exercises are recommended as the primary physical therapy tool for treating any underlying pain, such as pain associated with injury and traumatic events, since they aid people in improving their mobility functions and strength in the musculoskeletal tissues. According to Noe (2020), physical activity is essential in alleviating pain by releasing endogenous opioid ligands that block pain-sensitive areas within the brain. Precisely, physical exercises elicit a morphine-like action involving the activation and stimulation of the production of endogenous opioids, including endorphins, dynorphins, and enkephalins that block opioid receptors at the brainstem region of the brain within the human body’s CNS (Central et al.). This blockade of morphine-like action decreases pain sensitivity, resulting in the overall inhibition of pain through antinociception (Gong et al., 2021).
Physical activity has also been found to alleviate chronic pain through the activation of the non-opioid endocannabinoid system. In particular, according to da Silva Marques et al. (2022), physical activities alleviate pain by promoting the activation of the neuromodulator function of cannabinoid receptors, including CB1and CB2, along with their endogenous ligands such as 2-arachidonoylglycerol endocannabinoids and N-arachidonoyl ethanolamine. Once these receptors and proteins are activated within the spinal cord and brain’s nociceptive processing areas, they contribute to alleviating and controlling chronic pain. However, it is essential to note that physical activity alone is not a practical therapeutic approach to the management of chronic pain. It necessitates an interdisciplinary approach that emphasizes the use of both physiotherapy and occupational therapy to alleviate chronic pain effectively.
Psychotherapeutic Management of Chronic Pain
Psychological intervention for the management of pain is essential in alleviating and treating chronic pain because chronic pain is sometimes associated with cognitive and behavioral factors that contribute to the exacerbation of pain, especially in the long term. Precisely, according to de C Williams et al. (2020), the non-pharmacological psychotherapeutic management of chronic pain is a valuable interdisciplinary modality for preventing social, behavioral, emotional, and cognitive factors that contribute to pain-associated distress and dysfunction by self-management practices that often involve engaging in physical exercises and activities. Specifically, recurrent pain, also known as chronic pain, can easily lead to the development of maladaptive behavior or cognitions that can potentially prolong pain experience, increase psychiatric distress, or worsen daily functioning (Driscoll et al., 2021). Moreover, people suffering from recurrent chronic pain might exhibit increased vulnerabilities to different psychiatric illnesses, including anxiety disorders, PTSD (Posttraumatic Stress Disorder), or depressive disorders. In particular, the association between chronic pain and depression is likely bidirectional since the presence of MDD (Major Depressive Disorder) is generally a significant risk factor associated with the behavioral and social influences contributing to the evolution of chronic pain from acute pain. Therefore, cognitive behavioral therapy, commonly known as CBT, is an essential interdisciplinary modality for the effective management of chronic pain as well as the prevention of the transition from acute pain to chronic pain.
CBT (Cognitive Behavioral Therapy) for the management of Chronic Pain
CBT is one of the widely recognized behavioral therapies essential for the management of cognitive pain to prevent its worsening into adverse mental conditions. CBT generally emphasizes altering the perceptions, thoughts, and behavior of an individual experiencing chronic pain to assist them in managing their pain symptoms better. CBT is often administered by a psychologist or relevant professionals, such as a counselor or human service providers like social workers. According to Gazzola et al. (2022), CBT utilizes a biopsychosocial interventional approach to treating chronic or recurrent pain by targeting maladaptive cognitive or behavioral responses to pain, including environmental and social contingencies that modify pain reactions, tailored to improve psychological functioning and pain management (Noe, 2020). The main principles of CBT for pain management include behavioral scheduling, assertive communication, activation and maintenance of pleasurable events, structured relaxation, and pacing of behavior to prevent exercise or prolong pain flares (Driscoll et al., 2021). Unlike other behavioral interventional approaches, like operant behavioral intervention techniques, CBT has proved to be an effective chronic pain management strategy because it also addresses maladaptive beliefs concerning general pain and pain catastrophizing by the formal use of a cognitive restructuring strategy.
According to Burns et al. (2020), this approach mainly involves identifying and replacing the unhelpful and unrealistic thoughts concerning the experienced pain with thoughts oriented towards positive or realistic adaptive behaviors for preventing the underlying biopsychosocial factors contributing to the pain or its exacerbation. In particular, patients experiencing chronic pain often tend to pay excessive and close attention to the pain subconsciously because they are unable to recognize, identify, or rectify their attention bias towards pain due to psychological concerns like depression or anxiety. In such a scenario, psychologists often employ a VAAS (Visual and Auditory Attention Shift) physical activity to eliminate any underlying condition, such as anxiety, to prevent chronic pain. Recent research conducted by Taguchi et al. (2021) indicated that the application of VAAS as a non-invasive pain relief approach for patients with chronic pain was significantly practical in the management of chronic pain among the studied population through self-touch. Therefore, CBT is an essential interdisciplinary component of managing chronic pain as a psychological interventional approach for modulating physical activity behaviors tailored to replace negative perceptions concerning the pain experienced by activities that promote adaptive or realistic adaptive behaviors.
The Occupational Component of Chronic Pain Management
The other essential multidisciplinary component of chronic pain management includes occupational therapy. In particular, occupational therapists play a crucial role in managing chronic pain by educating patients about moderation, time management, and, most importantly, physical activity modification. In this context, it is essential to note that physical activity is a necessary modulator for pain management via occupational therapy (OT). The OT element of the interdisciplinary therapeutic approach for managing chronic pain effectively emphasizes the balance and moderation of daily physical activities with modification as required and directed by the patient experiencing the pain and an occupational therapist to relieve the pain and foster functional independence and participation in daily duties. According to Noe (2020), OT may include education concerning the moderation of daily activities like laundry, kitchen-related chores, shopping, self-care practices, garbage collection actions, fall prevention strategies, vocation, time management, or workplace-related activities. These practices often require lead-time management sessions with the OT for effective planning to aid the persons experiencing chronic pain to appropriately balance their activities and moderate their schedules during their independent time away from a structured program. However, it is essential to note that even though OT has been recognized as an effective therapeutic modality for the management of chronic pain, its use alone cannot treat, prevent, or manage chronic pain effectively. Instead, it should be integrated into managing chronic pain as one of the significant interdisciplinary components for that effect.
Conclusion
The management of chronic pain requires an interdisciplinary approach that encompasses the use of physical, psychological, and occupational modalities. Specifically, this paper has shown that while either of the three methods is effective in managing chronic pain, they are not effective in alleviating, preventing, or treating chronic pain when used solely. In particular, physical therapy requires a physical therapist to administer physical exercises and educate patients on conducting them at home. These exercises are essential in alleviating chronic pain by activating both opioid endorphins and non-opioid endocannabinoid systems that block an individual’s sensitivity to pain. Psychological therapy is also crucial for chronic pain management through the use of the VAAS technique, grounded on the CBT approach to moderate behavioral responses to chronic pain. Occupational therapy is an educational tool essential for preventing and managing chronic pain by training patients on how to moderate their daily activities to avoid experiences of pain. Therefore, effective chronic pain management requires a collaborative interdisciplinary approach that integrates physical, occupational, and psychological therapies to prevent chronic pain or the transition from acute pain to chronic pain experiences.
References
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