Professional Documents
Culture Documents
The Evidence?
• Professor, Chief of Department
of Physical Medicine &
Rehabilitation, Marmara
University, Istanbul TURKEY
• Secretary General of
Mediterranean Forum of Physical
Medicine and Rehabilitation
• Interest:
• Algology/Pain rehabilitation
• Clinical Neurophysiology
• Osteoporosis
Gulseren AKYUZ • Cancer rehabilitation
• Enjoys : Travel, sudoku
MD
• Contact: gulserena@gmail.com
Chronic pain syndromes
• Chronic pain syndrome (CPS) is a common problem that
presents a major challenge to healthcare providers
because of its complex natural history, unclear etiology,
and poor response to therapy
• Most authors consider ongoing pain lasting longer than 6
months as diagnostic, and others have used 3 months as
the minimum criterion
Sternbach's 6 D 's of CPS
• Dramatization of complaints
• Drug misuse
• Dysfunction/disuse
• Dependency
• Depression
• Disability
http://emedicine.medscape.com/article/310834-overview
Classification of CPS
US
Rehabilitation
Chronic pain
syndromes
Physical Activity and Exercise
• Recommend activity
• Inform the patient
• Manual therapy is effective
• Exercise;
– Aerobic
– Strecthing
– Strengthening
– Arrangement of movements
– Postural control NICE 2009-LBP
Recommended
• Acupuncture can be recommended
NICE 2009-LBP
Not Recommended
• Laser therapy
• Ultrasound
• Interferential currents
• TENS
• Traction
• Orthosis
NICE 2009-LBP
Van Tulder MW, Koes BW, Assendelft WJ, Bouter LM, Maljers LD, Driessen AP. Chronic low back pain:
exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective;
traction not effective; results of systematic reviews. Ned Tijdschr Geneeskd. 2000 Jul 29;144(31):1489-94
Primary care treatment recommendations for chronic
low back pain-I
Mayer JM,Haldeman S, Tricco AC,Dagenais S: Management of Chronic Low Back Pain in Active
Individuals. Curr Sports Med Rep 2010 9 (01) 0060-66
Primary care treatment recommendations for chronic
low back pain-II
Mayer JM,Haldeman S, Tricco AC,Dagenais S: Management of Chronic Low Back Pain in Active
Individuals. Curr Sports Med Rep 2010 9 (01) 0060-66
Levels of evidence and strength of
recommendations about Fibromyalgia
syndrome
http://www.reproline.jhu.edu/english/2mnh/2ppts/evidence/gifs/slide6.gif
Fibromyalgia - Pain
Joshi MN, Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in management of
fibromyalgia syndrome: What predicts a clinical benefit? J Postgrad Med. 2009 Jul-Sep;55(3):185-
9. PubMed PMID: 19884743.
Comparison the efficacy of phonophoresis and
ultrasound therapy in myofascial pain syndrome
Ay S, Doğan SK, Evcik D, Başer OC. Comparison the efficacy of phonophoresis and ultrasound therapy
in myofascial pain syndrome. Rheumatol Int. 2010 Mar 31
Ultrasound therapy versus ischemic compression techniques for
the treatment of trapezius latent myofascial trigger points in
healthy subjects
• Aguilera et al
recommended using
ultrasound in management
of MPS
Aguilera FJ, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound
and ischemic compression techniques for the treatment of trapezius latent myofascial trigger
points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther. 2009
Sep;32(7):515-20.
Conclusion
• In recent years point of view in chronic pain
rehabilitation changed substantially
• Physical modalities seem to loose their importance
• However, therapeutic exercises, aerobic physical
activities are in the most recommended preferences
• Pharmacotherapy is not sufficient alone
• Treatmet programmes should be planned
individually and should be modified if necessary
Marmara University School of Medicine
Dept of PM&R, Istanbul, TURKEY