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The growing recognition of physical therapy and other nonpharmacological approaches as effective responses to musculoskeletal pain isn't just helping patients in the here-and-now: it's fueling research efforts that explore the potential for future advances. The latest issue of Pain Reports, the journal of the International Association for the Study of Pain, offers a glimpse into some of those directions. APTA has collaborated with IASP on multiple projects to highlight physical therapy's role in pain management.

The open-access issue covers a range of topics, from animal-based research on the analgesic properties of physical activity to a discussion of whether physical therapy and opioids are "competitors or companions" in the management of MSK pain. Here's a snapshot of some of the themes you'll find in this 10-article collection.

Exercise as Pain Relief, and the Mind's Role in Staying Physically Active

It's been well-documented that exercise can reduce pain over time, but less investigated are ways in which even small amounts of exercise can induce short-duration reductions in pain sensation, known as exercise-induced hypoalgesia, or EIH. Two articles in the IASP special issue cover exactly that topic: one, a clinical overview of EIH, its manifestations, and level of pain reduction achieved; and a second study that dives deeper into the mechanisms of EIH through an analysis of studies on animals.

In a different area of physical activity-related study, researchers from Australia report on an exploration of "unhelpful pain beliefs" among participants with knee osteoarthritis, and whether addressing those beliefs can increase physical activity levels. For the study, authors divided 20 participants with knee OA into two groups, both of which received physical therapy, exercise and physical activity programs, and weekly home phone calls. The difference between the groups: One was provided with education on pain science, and the other was administered sham ultrasound. Researchers then monitored physical activity levels as recorded on wearable devices. Did the education component make a difference?

Integration of Cognitive and Behavioral Considerations and Techniques

Physical therapists understand that the mind and emotional states can figure heavily into the effectiveness of any intervention — but that relationship is particularly strong when it comes to pain management. The special issue looks at that relationship through several different lenses.

In addition to research on pain science knowledge and physical activity mentioned, the special issue also offers a systematic review of recent research on psychologically informed physical therapy for MSK pain, including a discussion of future directions for the approach. A second article looks at behavior medicine in physical therapy by way of a scoping review that evaluates recent studies and assesses the degree to which standard concepts of behavior medicine were applied, and the effects of those applications on patient outcomes.

Models of Care

We know generally what works and what doesn't when it comes to management of MSK pain, but could there be more work to do? Articles in the special issue indicate the answer is yes.

Authors of an analysis of risk-stratified and stepped models of care for back pain and OA put it bluntly: "The overall quality of care for musculoskeletal pain conditions is suboptimal." To help rectify that perceived problem, they examined commonalities between various models of care, the false either-or mindset when considering stepped care and stratified care, the specific uses of risk stratification, and future directions.

Another study included in the special issue focuses specifically on how physical therapy "may be used to increase exposure to nonpharmacological treatments for MSK pain," particularly through early physical therapy, and thereby reduce opioid use. The article looks at current evidence around early exposure to physical therapy and aims to shape the future of study on the topic by providing a set of clinical research questions. Authors believe addressing those questions could lead to "an evidence base of nonpharmacological care options."

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