A Narrative review of the mechanism-based approach to physiotherapist pain management : future directions in practice and research / Eunice J. Garces.

Includes appendices and bibliographical references.

Abstract: To discuss and evaluate recent evidence as well as future directions in practice and research of a mechanism-based approach (MBA) to pain management by physiotherapists. This study is a narrative review of the mechanism-based approach to physiotherapist pain management. Whether the pain is caused by injury or infection, the pain signal is transmitted from the place of origin to the brain by mechanical pathways. Various elements of pain are likely to be mediated by separate input channels, therefore pain elicited by diverse input channels implies the activity of several mechanisms. The traditional approach has been to evaluate and treat patients based on shared etiological factors or diseases, with the assumption that a single disease will cause pain via a single or common mechanism. Although such approach has merit, it misses the notion that a single etiologic component might cause pain through many pathways, which can occur singularly, sequentially, or simultaneously. For this reason, it is best to utilize a mechanism-based approach (MBA) to pain, an emerging technique powered by pain neuroscience advancements that comprise therapeutic targeting of the pathophysiologic rearrangement of nervous system structure and function that underlies pain. In accordance with the narrative review methodology, the researchers identified and summarized the available evidence. All relevant research that satisfied the inclusion/exclusion criteria were included. An electronic and manual search of English-language publications was conducted. Relevant articles were obtained through a search of the following databases: (1) PubMed/MEDLINE, (2) PEDro, (3) Google Scholar, (4) ClinicalKey and (5) Cochrane. The researchers presented the results using descriptive synthesis to give a wide variety of information and diverse integrated evidence. The findings were narrated based on the proposal flow of discussion. Understanding the anatomy and physiology of normal pain perception is crucial because chronic pain is defined by the altered structure and function of these mechanisms and pathways, which serve as therapeutic targets in mechanism-based approach to pain management. The bulk pain syndromes include several, frequently overlapping neurobiological pathways that are defined by the stage of the disease process. Pain mechanisms addressed by physiotherapists are currently classified into these types: central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive, neuropathic, cognitive-affective and movement system. There have been considerable advancements in the science of pain that are clinically relevant to physiotherapists, even if there is still much to learn about the underlying pain mechanism and optimal interventions. The mechanism-based approach gives physical therapists another conceptual framework to use when making informed treatment decisions that take into account well-known fundamental research and clinical data together with individualized assessments to improve patient care and clinical effectiveness. The strategy described here offers a conceptual framework to apply new information as advancements are achieved, even if the data describing theses pain mechanisms will keep evolving.

Thesis - School of Physical Therapy