The Role of Physical Therapy in Chronic Pain Management", by Christine Zampach, BS PT, MEd, DPT

The last speaker of the day was Christine Zampach, BS PT, MEd, DPT, who is an Associate Clinical Professor, UCSF Department of Physical Therapy and Rehabilitation Science as well as Physical Therapy Consultant, UCSF Pain Management Center.  She presented on 'The Role of Physical Therapy in Chronic Pain Management'.  My earlier presentation touched upon the difficulties of chronic pain patients I had worked with in their previous pursuits to find a PT; many had tried PT but the treatment had caused a flareup so they didn't go back.  I really suggest to patients they follow up with providers, even if it's 'that didn't work for me' and perhaps even bring in resources to work with them or ask to be referred to a different PT.  This blog can serve as a resource for patients to suggest providers read to get some clues from an expert.   All therapists have things that are their 'thing' and not.  So it was good to hear how the students at UCSF are being trained.   Highlights from Christine Zampach's seminar:

Our body is not wired to understand chronic pain, so it falls back to acute pain strategies -- we start 'guarding' and not moving.  'Kinesiophobia', or fear of movement, occurs.  People will 'disassociate' and it is hard to point to where the pain is.  Much of her treatment is functional, as insurance requires functional goals.  The central nervous system changes when in pain and it gets 'all wound up' and it's 'like a ping pong ball bouncing around in your head, and it ends up 'emotional''.  And since PTs spend increased time with patients, they can catch when the nervous system is going awry (as in complex regional pain syndrome) and intervene with treatment as well as correspond with the physician.  'Neuroplasticity' occurs with pain (see previous blogs by Drs. Teitelbaum and Rand) and the nervous system is rewriting what to do, and we lose the ability to inhibit pain.   Pain patients' 'motor patterns' (how we control how we move) deteriorate, losing fine motor control and having tremors.  So a PT who can intervene with sensory and motor mapping, pacing, and developing "the inner eye" ("Where am I in space? How do I recognize it? How do I affect the space around me?") can benefit patients.  She utilizes Feldenkrais techniques as well as practicing in the mind how to move.

How she recommends PTs work with chronic pain patients: Recognize their physical limitations.  Understand the psychological piece of chronic pain.  Bring in spirituality if appropriate, which it normally is.  Have patience.  Practicing how to move effectively and efficiently (practicing mentally and physically -- it's been proven people who learn a new skill and then only imagine doing it do better on retest than those who physically practiced the new task the same amount of time). Start with TWO or THREE exercises (this is something I saw in practice as well -- PTs who treat orthopedic patients give too many exercises to chronic pain patients and set the repetitions too high, as opposed to 'until you start to tire, then 1 or 2 more).  Lastly, realize that progress can be very slow with these patients and treatment often is appropriate for far longer than the insurances typically reimburse, which can require some commitment and craft with submitting paperwork.

We hope this is beneficial to patients and PTs alike, and hope this series in the past week has been of interest and help to anyone interested in chronic pain and it's treatment.  Here's one link about Feldenkrais  www.feldenkraisinstitute.org/articles/c_clinical.html [1], and we recommend you study others if you are interested. 

Again, the link about The Chronic Pain Documentary Series is artvdo.wordpress.com/ [2], and we certainly are looking forward to it's coming to fruition after such a great kickoff converence -- it was a knowledgeable, invested group that came together in Berkeley -- providers and people with chronic pain, and a number were both!  Very interesting.