What studies have been done on the impact of a physical therapy (PT) program in the treatment of chronic pain syndrome (CPS)?

Updated: Jan 14, 2020
  • Author: Manish K Singh, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

A literature review by Andrade et al did not find clear evidence regarding exercise’s impact on inflammatory markers in patients with fibromyalgia. However, none of the studies used in the report indicated that treatment-related exercises caused patients’ symptoms to worsen. [26]

A study by Grinberg et al of female patients with chronic pelvic pain syndrome indicated that myofascial physical therapy (MPT) is not only associated with long-lasting alleviation of pelvic pain, but also with anatomic, neurophysiologic, and psychological benefits. The investigators state that MPT leads to hypertonicity relief, reduction in sensitivity to experimental pain, improvement in endogenous inhibitory system functionality, and lowering of psychological distress (with regard to anxiety, pain catastrophizing, somatization, and depressive symptoms). [27]

A literature review by Haller et al indicated that in patients with chronic pain, craniosacral therapy (CST), which employs fascial palpation, is superior to sham treatment with regard to improvement in pain intensity and disability at 6 months. The study included patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain. [28]

A randomized, controlled trial by Rodríguez Torres et al indicated that a neurodynamic mobilization program can reduce pain and fatigue and improve neurodynamics and function in patients with fibromyalgia. The study included 48 patients with fibromyalgia who were randomized to a twice-a-week active neurodynamic mobilization program or to a control group, with results evaluated using the Brief Pain Questionnaire, the Pain Catastrophizing Scale, neurodynamic tests, the Health Assessment Questionnaire Disability Index, and the Fatigue Severity Scale. [29]

A phase II, randomized, sham-controlled clinical trial by Mendonca et al indicated that the use of a combination of transcranial direct current stimulation (tDCS) of the primary cortex and aerobic exercise is more effective in managing in fibromyalgia than is either of these modalities by itself, having significantly impacted pain, anxiety, and mood. However, motor cortex plasticity response did not differ between the three groups, with the investigators suggesting that perhaps the combination of tDCS and aerobic exercise influenced other neural circuits. [30]

A literature review by Knijnik et al indicated that repetitive transcranial magnetic stimulation (rTMS) has a better effect on quality of life than does sham stimulation in patients with fibromyalgia, with the superior impact seen after 1 month of treatment. However, although reductions in pain intensity were found, changes in depressive symptoms were not. [31]


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