April 2018

Thank you for walking with me through this blog series on chronic pain. I hope you have found it useful in discerning the optimum path for your health and wellness. This post is a general review of what we have covered.

Chronic pain includes pain that has not resolved in a normal, timely manner. In general, it is pain that lasts longer than 3-6 months although we have seen that it is actually a change in the pain state. Chronic pain is mediated through changes in the peripheral and central nervous systems. This means that the tissue injury model of acute pain no longer applies. Acute pain is directly related to a trauma to the tissue and has a normal progression of resolution. This can be greatly aided by Physical Therapy to prevent it from coming back or to address any related issues. For instance, I have had patients who successfully treated an acute injury with a steroid injection only to have the pain come back 6-12 months later. That is often due to the fact that the comorbidities surrounding the initial injury were never addressed. However, chronic pain that has been sustained for a long period of time is no longer related to a specific tissue injury. That injury was the trigger that set into motion a change in the nervous system that needs to be addressed in a new way.

Chronic pain must be addressed at multiple levels simultaneously. I have had patients who “try” one form of therapy at a time to see what works and what doesn’t. Although I agree with this scientific approach for acute pain, it does not stand up to the current understanding of chronic pain. A scientific approach for chronic pain is to add one treatment at a time. I have begun working with other health care professionals in the area to maximize outcomes for patients. When I work with a chiropractor, I focus on the exercise portion of treatment to improve the patient’s ability to “hold” manipulations and decrease their need for adjustments. When I work with a massage therapist, I focus on joint mobilization to ensure proper tissue length and exercise for patients to maintain the benefits of massage. Although I feel medications in general are over prescribed, I help assist medical doctors in ascertaining the benefits of prescribed medication to the treatment plan being carried out in Physical Therapy.

Chronic pain truly takes a village that is focused together on the goals of each patient. Every body responds differently to an intervention and this needs to be constantly reassessed. This is why I opened my company in the first place. To give each patient one-on-one access to one provider so they can be followed through a successful treatment regimen. The input I receive from each patient directly influences the treatment they receive that day. Education is always emphasized and I encourage my patients to ask as many questions as they can.

If I can be part of your team, please feel free to contact me at (360) 367-0970 or amykonvalinpt@gmail.com.

(formerly known as Reflex Sympathetic Dystrophy)

Complex Regional Pain Syndrome (CRPS) occurs after a trauma to the distal part of the extremity or after direct injury to the nerve. CRPS is associated with distal extremity pain and swelling, with the pain being disproportionate in time and degree to the injury. Patients may also have increased blood flow and swelling, abnormal hair/nail growth, loss of motion, and weakness. This is a classic example of what happens with chronic pain. The initiating event led to a sensitization of the nervous system that is now causing abnormal reactions throughout the limb.

Before we talk about Physical Therapy treatment, let me state that this is one particular case where pharmacological approaches have been well researched and proven extremely effective. Systemically administered antidepressants and anticonvulsants or topical use of capsaicin and lidocaine have been proven to significantly reduce symptoms of CRPS. I have had patients who are frustrated by being placed on an antidepressant because they feel the doctor is saying their pain isn’t “real”. However, the truth is that the antidepressants affect the processing of the pain through the nervous system and have been shown to significantly decrease symptoms. I would strongly recommend that patients discuss all pharmacological options with their doctors so they can find a path that works right for them.

Okay, back to the Physical Therapy stuff! CRPS is a challenging disease that makes slow progress no matter the treatment option. A graded exercise program to return each patient to their desired activity level has proven effective for long term management of CRPS. Along with this, instruction in home TENS use and performance of mirror therapy has proven to be effective in treating CRPS. The goal is to support each patient with pain reduction and making positive steps towards improving range of motion and strength so they can return to their lives.

If I can help you on your path, please feel free to contact Amy at (360)367-0970 or amykonvalinpt@gmail.com.