There’s a lot of conflicting information out there about the role of passive therapies in effectively treating chronic pain conditions, so this month we thought we’d take a closer look at what it all means to you and your patients.
When it comes to effective management of chronic pain conditions, it seems that passive therapeutic applications can result a range of outcomes. Some pain patients will claim to get instant relief from a particular therapy while others might get a flare up from the same approach. One patient might swear by massage, while another might experience absolutely no change at all. And even for those who do experience positive outcomes, the longevity of the symptom relief can be patchy, so it can all seem a bit hit and miss, depending on who you talk to.
What does the research say? Well, of course it depends a lot on the particular condition and mechanism underlying pain. Having said that, there have been a number of studies looking at the efficacy of passive versus active therapies and, in general, active approaches to treatment are more effective than passive methods.
However, the big point to remember is the importance of long-term self-management. That is, each patient needs to develop a proper understanding of their unique condition, including their limitations, triggers and any present or potential risks. Passive therapies (such as massage, kinesiology or acupuncture, for example) can sometimes have a particular personal, cultural or spiritual meaning, which can be very helpful within a self-management context.
It also helps if your patient has a solid understanding of what’s likely to be achievable in their rehabilitation process as well. In particular, rather than just paying passive therapists to “do things” to them, the patient should keep in mind that they themselves are ultimately accountable for the ongoing management of their condition.
We don’t want to set up a treatment regime for patients that simply involves having things “done” to them from the outset. This really just sends the wrong message. There is no magic cure for pain – and it’s important that people understand this as a first step.
There is a growing research base of good quality (including randomised control trial) studies which clearly demonstrate the benefit of short-term active versus passive treatment interventions for management of chronic pain, which is why best practice guidelines don’t recommend passive therapies – and why we can’t advocate for passive treatment as a first point of call for pain patient.
However, when it comes time for an already actively self-managing patient to think about long-term management of pain maybe there is an argument for re-thinking passive therapy. For example, can massage help to alleviate the muscle tension that can aggravate pain? This article (also a randomised control trial research method) shows some efficacy for massage, as does this one from The Journal of Alternative and Complementary Medicine – which shows that there is some evidence for massage being useful as part of an overall plan.
The first article found no real effects of acupuncture, while this article on the impact of patient expectations on outcomes of acupuncture similarly found no real effect of acupuncture overall, but did find that in the cases where it was effective, people expected it to be. Expectancy effects have been established in the area of pain – so this makes sense when you think about it. If someone really believes in acupuncture, then they may get some good effects from it, which makes it worth considering.
Ultimately, it comes down to having a good formulation for each patient – which can then be used (in conjunction with them and the rest of the treating team) to determine a tailored management plan that is right for them and maximises the possibility of increased function over the longer term.