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4.1: Acute Pain

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    The International Association for the Study of Pain (IASP) states that “pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. This definition represents a shift away from a pathoanatomical approach to contemporary view of pain recognizing that the experience of pain is multifactorial and is influenced to varying degrees by biological, psychological, and social factors (Raja et al., 2020). Six new key notes go with this new definition of pain, they are:

    1. Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
    2. Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
    3. Through their life experiences, individuals learn the concept of pain.
    4. A person’s report of an experience as pain should be respected.
    5. Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
    6. Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

    Pathophysiology

    Acute pain can be a result of various conditions including post-operative pain, muscle strains, sprains, contusion, whiplash and nonsurgical fractures. Acute pain usually lasts less than 7 days, but can in some cases acute pain can last as long as 30 days (Kent et al., 2017).

    Examination

    A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g., low self-efficacy, fear of movement, ineffective coping strategies, fear-avoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength.

    Incorporate one or more of the following outcome measurements when assessing and monitoring patient progress:

    • Pain Self Efficacy Scale
    • Patient Specific Functional Scale
    • Brief Pain Inventory (BPI)
    • Numeric Pain Rating Scale (NPRS)
    • Visual Analog Scale (VAS)
    • The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2)

    Treatment

    Education

    Provide patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms.

    Manual Therapy

    Ascribing patient’s pain solely a tissue-driven pain problem is often an oversimplification of a complex process. This insight provides us with an opportunity to re-frame our clinical models. Gently stretching the muscles, neurovascular structures, and investing fascia activates endogenous pain modulating systems that help to modulation neuro-immune responses.

    Self-Management Strategies

    To avoid harms associated with drugs, multi-modal nondrug therapies for pain are becoming more widely used, including ice, heat, acupressure, transcutaneous electrical nerve stimulation, exercise, and mindfulness-based interventions (Brasure et al., 2019; Chou et al., 2020; Hsu et al., 2019; Qaseem et al., 2020; Shires et al., 2020).

    Prognosis

    Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. Existing evidence suggests that massage therapy (soft tissue massage, neural mobilization, joint mobilization) can be used to help relieve pain, improve function, and reduce anxiety when integrated with standard care (Brasure et al., 2019; Chou et al., 2020). An interdisciplinary approach including patient education, self-management strategies and massage therapy based on shared-decision making and patient safety is best practice for acute pain management.

    Key Takeaways

    Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for acute pain based on patient-specific assessment findings including, but not limited to:

    • Manual Therapy (soft tissue massage, neural mobilization, joint mobilization)
    • Education that is Person-Centered (e.g., biopsychosocial model of health and disease, self-efficacy beliefs, active coping strategies)
    • Stretching & Loading Programs (e.g., concentric, eccentric, isometric exercises)
    • Hydrotherapy (hot & cold)
    • Self-Management Strategies (e.g., engaging in physical activity and exercise, social activities, and healthy sleep habits)

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