Management of Persistent Nonmalignant Pain

Physical and Rehabilitative Therapies

Physical Rehabilitation and Exercise
Physical rehabilitation is a particularly common treatment for pain and is often instituted as one component of a multidisciplinary strategy in many persistent pain syndromes. Graded exercise programs seek to maximize physical functioning. Many patients with persistent pain may restrict their physical activity in the belief that activity exacerbates their pain, or that they are in imminent danger of harming themselves if pain is provoked by activity. This belief system that physical activity will cause pain results in physical deconditioning, which can complicate the persistent pain syndrome. Once serious underlying physical pathology has been excluded, patients should be educated that “hurt does not equal harm;” in fact, when physical deconditioning is reversed with gentle and appropriate exercise, pain levels may decrease. Moderate levels of physical activity should be maintained—even if the pain persists—and the program should include exercises that improve flexibility, strength, and endurance.

Coupling certain CBT strategies designed to enhance communication, control, problem-solving and coping with advice to exercise can have a clinically significant impact on reducing pain and improving functional status. Physical therapists may set functional goals for the patient, such as being able to walk a certain distance or duration, carry a certain amount of weight, or perform essential job tasks. Because engagement in a moderate exercise program should be life-long, programs should take into account patient preferences, which will promote compliance. Finally, when prescribing exercise, it is important to review the patient’s medications for agents that may increase the risk of falls (e.g., psychotropic agents, diuretics, antihypertensives).