Applications of physical and occupational therapy in chronic pain syndrome

This article will describe how to approach the prescription of physical therapy for 'chronic pain syndrome'. Initial sections will describe script writing for physical and occupational therapies, and review types of exercise and physical therapeutics. Exercise regimens that the literature supports for patients with chronically painful syndromes will also be discussed. The author emphasizes that the practitioner cannot write a therapy script for 'chronic pain syndrome.' Instead, the practitioner should understand that physical and occupational therapy can remedy impairments of flexibility, strength and endurance and the patient should be examined to identify these impairments. When the practitioner has identified poor flexibility or contracture, weakness or loss of strength, or poor endurance in the patient with chronic pain, the practitioner can then write a physical therapy or occupational therapy script with goals to improve these impairments. It is not necessary for the practitioner to be familiar with the nuances of exercise application; it is only necessary for the practitioner to identify contracture, weakness and poor endurance, and to direct the therapist's attention to these deficits via a therapy script. The practitioner should include precautions on a script to a therapist. These precautions are based on the patient's concurrent medical and surgical diagnoses. Lastly, the literature describing therapeutic interventions in patients with chronic pain syndromes is poor because the painful conditions are poorly characterized and the therapeutic interventions are poorly described; however, where specific exercise programs for specific diagnoses were identified, the exercise regimens are discussed.