Physical interventions in the management of pain in arthritis: an overview for research and practice

This paper reviews arthritis-related literature on the effectiveness of a number of physical interventions to reduce pain. Original research reports as well as information from principle texts and review articles of thermal agents, topical applications, phoresis, transcutaneous electrical nerve stimulation, cold laser, and exercise are included. Although the biophysical actions of many physical interventions are partially understood, their effects on pain and function have not been defined clearly. The results of studies of one or a combination of physical interventions were generally inconsistent and reflected a wide variety of research designs and methods. Most physical agents, used alone, had minimal effects on pain. Interventions that combined physical agents and exercise were more successful in attenuating pain and also decreasing impairment. Research and clinical experience have provided insights into appropriate selection of physical intervention and their effectiveness in achieving treatment goals in arthritis care. However, considerable investigation into the mechanisms of action, differential effects of dose, staging and treatment combinations, and the relation of pain, impairment, and function remains to be undertaken.