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Cited by 300Musculoskeletal pain and rehabilitationPain Mechanisms and TreatmentsPain Management and Treatment

A Mechanism-Based Approach to Physical Therapist Management of Pain

Open access
Chimenti, Ruth L, Frey-Law, Laura A, Sluka, Kathleen A·2018·Physical Therapy
DOI 10.1093/ptj/pzy030PMC PMC6256939
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Abstract

Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.

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Crossref · 10.1093/ptj/pzy030

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  • MSK providers have addressed the mental factors that influence pain using three primary frameworks: the fear-avoidance model, pain neuroscience education and cognitive behavioural therapy (CBT).

    “Musculoskeletal (MSK) providers have addressed the mental factors that influence pain using three primary frameworks: the fear-avoidance model, pain neuroscience education and cognitive behavioural therapy (CBT) (Archer et al., 2016;Chimenti et al., 2018;Leeuw et al., 2007;Moseley & Vlaeyen, 2015;Stearns et al., 2021).”

    From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Chimenti et al., 2018

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Authors
Chimenti, R. L., Frey-Law, L. A., & Sluka, K. A.
Affiliations
  • University of Iowa (US)
  • Department of Physical Therapy and Rehabilitation Science, University of Iowa
Corresponding author
Sluka, Kathleen A
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2018-04-16
Volume
98
Issue
5
Pages
302-314
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.1093/ptj/pzy030
PMC
PMC6256939
OpenAlex
W2800618530
Cited by
300
References
19
Citations by year
2026: 35 · 2025: 46 · 2024: 47 · 2023: 44 · 2022: 36 · 2021: 44 · 2020: 22 · 2019: 15 · 2018: 10 · 2013: 1
FWCI
2.66
Type
journal article
Language
en
Open access
Locations
  • Physical Therapy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Neurological Disorders and Stroke (T32NS045549)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R03AR065197, K99AR071517, UM1AR063381, R00AR071517, R01AR061371)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
pain mechanisms, nociceptive pain, central sensitization, neuropathic pain, psychosocial factors in pain, central inhibition, manual therapy, exercise therapy, transcutaneous electrical nerve stimulation, patient education, individualized care
MeSH terms
Transcutaneous Electric Nerve Stimulation, Humans, Pain Measurement, Patient Education as Topic, Physical Therapy Modalities, Pain Management, Physical Therapists

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