Pain is unpleasant sensory and emotional experience with actual or potential tissue damage or described in terms of such damage. Pain is a major symptom in many medical conditions, the pain can significantly interfere with a persons quality of life and general functioning. Pain medicine is a sub-specialty of Rehabilitation Medicine, Neurology, Palliative Medicine and Psychiatry. Scientists have been trying for decades to know the mystery of pain. An important break through came in the mid 1960 when scientists discovered that brain could change or modulate the nervous system in response to pain. What normally occurs is that pain begins when the nocioceptors (Pain Carrying Fibers). These are small thin fibers located through out body in peripheral nerve they release a bath of chemicals to carry pain message to brain. The study of pain in recent years attracted the physiotherapy.

Pain is a major problem in our country as anywhere else but lack of formal treatment strategy has been major lacunae in health care of our country. Statistics of advance county show that 15-20% population have acute pain and 25-30% of all population have chronic pain. The annual cost of pain in U.S.A is roughly $100 billion approximately 25 million Americans suffer from acute pain due to injuries. In Australia the chronic pain cost the nation $ 34.3 billion per year.

Patients with pain, at a significantly lower level of performance with in-activity of skeletal muscles atrophy and immobilization that causes a disproportionate loss of Type -1 muscle fibers, Loss of muscle strength and endurance with in activity due to loss of muscle mass, decreased ability to use energy substrates efficiently, decreased neuromuscular transmission and decreased efficiency in muscle fiber recruitment, in activity also deprives bones, joint cartilage and connective tissue of the mechanical stress necessary to maintain tensile strength and elasticity. The motor control,proprioceptive efficiency and balance is altered. Pain is purely subjective examination, it is assessed or measured with valid and reliable tools such as Visual Analog Scale, McGill Pain Questionnaire (Sensory Form), Hamilton Depression Rating Scale, 11-Point Likert Scale.

The understanding the patho physiology, concepts of pain therapy management and maintaining a working knowledge of individual pain regimens are important to pain therapist, are key factors in reversing the pain. The Physiotherapy treatment towards the pain management is Cryotherapy ,TENS, Ultrasound , LASER, Ionotophorosis, Contrast Bath Mobilization, Bio-mechanical correction, Postural correction, Tapping, PNF Exercises, Strengthening Exercises.

The beauty of physiotherapy is with out using any chemical agent, blocking the pain at spinal cord level or brain level, where there is pain inhibiting fibers are also present through out body in peripheral nerves, which are larger in diameter and faster then the nocioceptors, these fibers can be stimulated with the help of physical agent used in physiotherapy. It is based on well accepted Pain Gate Control Theory and Central Sensitization.

Accurate diagnosis of origin of pain is depends on a meticulous medical history and an equally through physical examination. Fortunately most of painful disorders respond to Non-Operative management or may resolve spontaneously. Consequently Physiotherapist probably will continue to refine an important role in treating patients with painful conditions.

I hope that members of our profession will continue to refine their diagnostic and treatment regimen for patients with painful conditions.

I must die,
You must die,
But what a PHYSIOTHERAPIST can save us from days of torture.

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