Physical therapists (PTs) are very comfortable treating musculoskeletal conditions and prescribing programs that restore or improve movement. When they're working with patients with persistent pain, however, Leonard Van Gelder, PT, DPT, ATC, notes that they must seek out the patients' "thoughts and feelings, and understand how they can influence their experience of pain." Accordingly, Van Gelder says his approach with these patients involves "navigating a variety of factors—physiological and psychosocial—that may or may not be affecting their pain."

One recent patient, he recalls, came to him with a history of rheumatoid arthritis and fibromyalgia. The individual's pain had worsened over time and even led to a brief hospitalization.

As with any patient, Van Gelder first conducted his evaluation to ensure "there wasn't something obvious anatomically, physiologically, or disease-related that needed to be addressed."