This debate has been raging for some time with "armed camps" on either side of the debate. Insurance companies responsible for compensating people with chronic pain (ICBC, WorkSafe BC, disability providers) espouse the theory that so-called passive modalities are indicated only in the acute stage of recovery from soft tissue injuries. They would have us believe that chiropractic, physiotherapy, and massage therapy, to name the three most utilized forms of treatment, are useless once the patient enters into the chronic pain stage of recovery. By World Health Organization (WHO) standards, chronic pain is any significant pain experienced six months or more after the triggering event.
Most clinicians have empirical evidence that stands for the proposition that patients do derive benefits from these forms of treatment in the chronic pain stage and that any theory that ignores this reality needlessly condemns the chronic pain patient to a lifetime of relentless pain.
As with most things in life, according to the most recent research published in the leading musculoskeletal journals, the truth lies somewhere in the middle.
Let's take a typical car accident victim with typical accident related soft tissue injuries. In the first month or so, there is considerable swelling, spasm and reduced motion. Analgesic and antispasmodic medication as well as gentle massage therapy and cryotherapy appears to be the best course of treatment in this early stage. After the first month or so, chiropractic and physiotherapy appear to be the best choices for day to day management. Considerable benefit is derived from using these forms of treatment, either exclusively or in combination, in the early months of recovery. After six months, most patients have essentially returned to their pre-accident state. They may have some mild occasional residual pain and occasional reduced range of motion. Their work and leisure activities may be minimally affected.
However, for reasons that we don't fully understand, some of these patients do not return anywhere close to their pre-accident state at the six month post-MVA point in time. They still have daily pain of at least a moderate nature that interferes with the performance of their work, leisure activities and household chores. These are the chronic pain patients. Typically, these patients go on to experience pain on an ongoing basis for the foreseeable future with periods of waxing and waning, i.e., there will be periods of acute flare-ups of indeterminable length. The current medical literature would support the following treatment regiment for chronic pain patients:
- An active rehabilitation programme supervised by a kinesiologist, chiropractor, physiotherapist, massage therapist or qualified personal trainer followed by a gym based or home based self directed and ongoing stretching and strengthening programme.
- Medication or a passive modality or modalities of the patient's choice on an "as needed" basis during the acute flare ups to relieve pain and to reduce dependency on medication.
So, it appears that both sides of the debate are "correct". The current medical literature would stand for the proposition that passive modalities for chronic pain patients are likely more palliative in nature than curative. That is not to say that they are not indicated and any opinion to that effect flies in the face of current thinking. Many patients prefer to avail themselves of chiropractic, physiotherapy and/or massage therapy during acute flare ups of their condition as opposed to relying on habit forming narcotics with their potentially harmful side effects.