Physical therapists play a key role in the lives of patients suffering from osteoarthritis-related pain. Results from a new study looks at how osteoarthritic patients’ weight affects the amount of pain they can tolerate, with or without proper coping skills.
At the annual meeting of the American Psychosomatic Society, which took place March 4 in Denver, Charles Emery, professor of psychology at Ohio State University, Columbus, presented his findings of a study that measured the coping skills, associated with pain, of obese people versus nonobese people. Emery and his colleagues wanted to find out if coping-skills training, including relaxation techniques, would help people with osteoarthritis better cope with the pain the disease can cause.
“The procedure we used provided an objective indicator of pain response,” Emery says. “Our data indicates that obese and nonobese patients who use coping skills effectively should experience an increased threshold for pain tolerance. However, our data also indicates that the pain threshold among obese individuals is likely to be lower than among nonobese individuals.”
In the study, participants were given a mild electrical stimulation on their left ankle to measure their pain reflex. The stimulus was given before and after the participants took part in a 45-minute coping-skills training session that included a progressive muscle-relaxation exercise. The researchers determined the body’s response to sural nerve stimulation by measuring the reflex of the lower leg muscles that surround the sural nerve. When the brain senses pain, it sends a message to the body to contract and move the muscles to get away from the source of the pain. The obese patients showed a greater physical response to the electrical stimulation than did the nonobese people, both before and after the training session, indicating they had a lower tolerance for the painful stimulation.
Study Examines Mobility Rehabilitation
According to a study published in the February 2006 issue of Neurology, body-weight-supported treadmill training (BWSTT) is not more effective than conventional mobility rehabilitation for restoring movement to those with partial spinal-cord injury.
The study included 117 patients who had a partial spinal cord injury within the previous 8 weeks. Through random selection, 58 patients received BWSTT, and 59 patients received conventional overground mobility therapy (without the use of treadmills or body-weight support). The patients were also categorized into three groups: B (more impaired), and C or D (less impaired). All study participants received 12 weeks of therapy.
According to the study results, the majority of patients in group C were able to walk independently by 6 months following their injury, regardless of the therapy strategy (24 out of 26 were treated with weight-supported therapy, and 24 out of 26 were treated with conventional overground mobility therapy). In addition, there was no statistical difference between strategies in walking speed achieved at 6 months follow-up for those in groups C and D who were able to walk. Their average walking speed was 1.1 meters per second.
“In this study, ASIA B patients showed no benefit with either therapy—conventional overground walking and BWSTT—and the improvement in ASIA C and D was so great in the conventional therapy group that it would have been difficult to detect a difference, even if BWSTT was better,” says Michael E. Selzer, MD, PhD, University of Pennsylvania School of Medicine, Department of Neurology, Philadelphia. According to Selzer, this is called a “ceiling effect” in research.
“One question is why was conventional therapy so much more effective than expected on the basis of previous studies? A second important factor is that the time allotted to both types of therapy was equal,” says Selzer. “But one possible advantage of BWSTT, especially with the newer machines that include devices to adjust foot position, is that it might allow more intensive training than can be accomplished with conventional overground training, which is labor intensive and requires more space than BWSTT. Would this lead to improved outcomes? More research will be needed to answer these questions.”
Heat-Wrap Therapy Reduces Low Back Pain
Rehabilitation professionals may want to add continuous low-level heat-wrap therapy (CLHT) to their arsenal of treatments for acute low back pain. A Johns Hopkins study, published in the December 2005 issue of the Journal of Occupational and Environmental Medicine, has found that the use of CLHT reduces acute low back pain and related disability, and improves occupational performance of employees in physically demanding jobs.
In the study, 43 patients (age 20 to 62) who visited an occupational injury clinic for low back pain were randomized into one of two interventions: Eighteen patients received education regarding back therapy and pain management alone, while 25 patients received education regarding back therapy and pain management combined with three consecutive days of CLHT for 8 hours continuously. Both groups were assessed for pain intensity and pain-relief levels four times per day during the treatment days, followed by measures for pain intensity and pain-relief levels obtained in follow-up visits on days 4, 7, and 14.
The results found that the patients who received CLHT for low back pain over a 3-day period in conjunction with pain-management education experienced a rapid reduction in pain intensity and pain relief, compared to patients who received only pain education. Patients on CLHT showed a 52% reduction in pain intensity and a 43% improvement in pain relief within 1 day of treatment, compared to the reference group. Both pain-intensity reduction and pain relief were maintained for the 3 days of treatment with CLHT at 60% and 41%, respectively. Additionally, on day 4 and 14 after treatment was discontinued, CLHT patients maintained the benefits of pain relief and pain-intensity reduction.
“With recent concerns around the safety of oral pain medications, both patients and physicians are considering alternative treatment options for acute low back pain,” says Edward J. Bernacki, MD, MPH, associate professor of medicine at The Johns Hopkins University School of Medicine and the study’s principal investigator. “The dramatic relief we see in workers using CLHT shows that this therapy has clear benefits for low back pain and that it plays an important role in pain management. Physicians and other health care providers in an occupational environment can tell patients that CLHT is a safe and effective alternative for treating acute low back plain.”
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