title: Physical agents used in the management of chronic pain by physical therapists.
abstract: Evidence supporting the use of specific physical agents in the management of chronic pain conditions is not definitive; it is largely incomplete and sometimes contradictory. However, the use of agents in chronic pain management programs is common. Within the broad use of physical agents, they are rarely the sole modality of treatment. A 1995 American Physical Therapy Association position statement asserts that "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy". Physical agents may serve as useful adjunctive modalities of pain relief or to enhance the effectiveness of other elements in therapy geared toward resolution of movement impairments and restoration of physical function. Given that a conclusive aggregate of findings is unlikely to exist for all permutations of patient conditions, combined with interacting therapeutic modalities, an evidence-based approach to pain management is not always possible or beneficial to the patient. In the face of inconclusive evidence, a theory-based approach may help determine if the therapeutic effect ofa given physical agent has the possibility of being a useful clinical tool in the context of treating a particular patient's mechanism of pain generation. Until controlled efficacy findings are definitive, careful individual patient response monitoring of thoughtful theoretical application of adjunctive physical agents may be a prudent approach to the management of chronic pain.
authors.affiliation: Department of Physical Therapy, University of Puget Sound, 1500 North Warner, CMB 1070, Tacoma, WA 98416, USA. rallen@ups.edu
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D017679:Cryotherapy / Q000379:methods*; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000592:standards* / Q000639:trends; D012307:Risk Factors; D012720:Severity of Illness Index; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*