What is pain and how can physical therapy techniques assist with peripheral neuropathy?

Updated: Oct 15, 2020

What Physical Therapists can do to treat (persistent) pain and neuropathy

Many people know that physical therapists can help with pain due to sport injuries or physical post-operative procedures, but the Centers for Disease Control and Prevention recommends physical therapy as a safer alternative to Opiods for pain management for chronic conditions and peripheral neuropathy. Chronic or persistent pain according to the International Association for the Study of Pain (IASP) Task Force is defined as “pain in 1 or more anatomic regions that persists or recurs for longer than 3 months and is associated with significant emotional distress or significant functional disability (interference with activities of daily living and participation in social roles).

One of the first steps in treating and managing pain is understanding pain—that is understanding both the internal mechanisms that cause pain as well as external influences on that pain. This can be achieved through pain neuroscience and neuropathy education, and although this may sound intimidating for someone who is not “science-savvy”, your physical therapist will help guide you through this learning in a way that makes sense for you.

In short, many times chronic pain may not equate to an injury that is seen on imaging, but rather interpretation from the brain. No, this does not mean it is all in your head, but your brain and central nervous system are involved. The alarm system in the brain which is necessary to keep us alive and out of danger may over time start interpreting normal movements, positions, and environments as dangerous. According to the National Institutes for Health, peripheral neuropathy can disrupt nerve signaling in 3 ways:

  • loss of signals normally sent (like a broken wire)

  • inappropriate signaling when there shouldn’t be any (like static on a telephone line)

  • errors that distort the messages being sent (like a wavy television picture)

Do not be nervous though—it is possible to retrain your brain!

Some of the techniques that your physical therapist may incorporate in your care program are graded motor imagery, graded exposure, mirror therapy, cognitive behavioral therapy and breathing. You and your physical therapist may use one or more of these techniques in helping treat and manage your chronic pain and peripheral neuropathy.

If you would like to start learning more about pain, “Explain Pain” by Butler and Mosley is a great book to start with.

Softcover Book: https://www.noigroup.com/product/explain-pain-second-edition/

Ebook: https://play.google.com/store/books/details?id=d58cfvw8nh0C&rdid=boo k-


Each patient will have an individualized care plan depending on their needs and this will usually involve an interprofessional team. Physical therapists will guide you through both supervised exercises as well as teach you techniques for self-management at home.

So, if your x-ray or MRI comes back “negative” or someone tells you “it’s all in your head” do not give up. If you are living with chronic pain, reach out to a trusted provider.

For more information check out the International Association for the Study of Pain and the American Physical Therapy Association.

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