{"id":4924,"date":"2021-05-03T16:31:04","date_gmt":"2021-05-03T14:31:04","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=4924"},"modified":"2023-05-05T15:51:20","modified_gmt":"2023-05-05T13:51:20","slug":"physiotherapy-for-painful-radiculopathies","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/physiotherapy-for-painful-radiculopathies\/","title":{"rendered":"Physiotherapy for Painful Radiculopathies"},"content":{"rendered":"\n

Jesson et al (2020)<\/p>\n\n\n\n

Peripheral neuropathic pain is common with an estimated population prevalence of 6.9%-10%. Currently, treatment of this condition largely depends on pharmacology, however with modest effects. This narrative review aimed to describe the current evidence for physical therapy in patients with chemotherapy-induced peripheral neuropathy (CIPN) and radicular pain.<\/p>\n\n\n\n

Physiotherapy for Chemotherapy-Induced Peripheral Neuropathy<\/strong><\/h2>\n\n\n\n

Key mechanisms in developing CIPN include microtubule disruption, mitotoxicity, and the neuroimmune response. They experience pain or a combination of numbness, tingling, or hot or cold sensations. This review described the aforementioned symptoms with the umbrella term \u201cCIPN pain\u201d.<\/p>\n\n\n

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Natural history is favorable in two-thirds of patients.<\/span><\/h4>\n <\/div>\n
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Prevention of CIPN<\/strong><\/h3>\n\n\n\n

Several studies investigated the preventative effect of predominantly exercise. However, no meaningful effects to this date were found.<\/p>\n\n\n\n

Treatment of CIPN<\/strong><\/h3>\n\n\n\n

Some studies suggest an easing of symptoms due to exercise. Studies were small and had a modest to high risk of bias, meaning further research is required to confirm this hypothesis.<\/p>\n\n\n\n

Effects of QOL<\/strong><\/h3>\n\n\n\n

Effects look similar to those of the treatment of CIPN. Although even more research is required in this field.<\/p>\n\n\n\n

Physiotherapy for Radicular Pain<\/strong><\/h2>\n\n\n\n

The underlying mechanism of radicular pain is caused by mechanical or chemical irritation of spinal nerves or nerve roots, mostly cervical and lumbar. Natural history is favorable in two-thirds of patients. Common causes are disk herniations, spinal canal stenosis, and spondylolisthesis. One would think symptoms would occur in the corresponding dermatome, yet extra dermatomal pain is more often the rule, rather than the exception.<\/p>\n\n\n

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CENTRAL SENSITIZATION IN PATIENTS WITH PERSISTENT PAIN: FROM THE LAB TO THE CLINIC<\/h2>\n\t\t\t\t\t

Learn to Provide the Best Evidence-based Care to Help Patients with Chronic Pain<\/strong><\/p>\n

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Stabilization and Motor Control<\/strong><\/h3>\n\n\n\n

When compared to no or minimal care (such as TENS), spinal stabilization and\/or motor control exercises provide some benefit. Although most trials report the aforementioned benefit, this clinically meaningful difference disappeared in the only trial with a low risk of bias (Hahne et al 2017). <\/p>\n\n\n\n

\"Fig1
From: Jesson et al (2020), Pain Reports<\/figcaption><\/figure>\n\n\n\n

When stabilization and motor control exercises are compared to more substantial care (such as general exercises), there\u2019s no evidence to suggest one is superior to the other.<\/p>\n\n\n\n

\"Fig2
From: Jesson et al (2020), Pain Reports<\/figcaption><\/figure>\n\n\n\n

Interventions Directed at Neural Mechanosensitivity<\/strong><\/h3>\n\n\n\n

\u201cPhysiotherapeutic techniques addressing neural mechanosensitivity include specific movements of peripheral nerves in relation to their surrounding tissues (neural sliders and tensioners) of interface techniques that are directed at the tissue surrounding the nerve.\u201d<\/em><\/p>\n\n\n\n

\"Fig3
From: Jesson et al (2020), Pain Reports<\/figcaption><\/figure>\n\n\n\n

Similar to stabilization and motor control exercises, these techniques provided additional benefits compared to no or minimal care. When compared to substantial treatment, results were mixed with a large range of plausible outcomes. This conclusion is in conjunction with a recent systematic review (Su and Lim 2016).<\/p>\n\n\n\n

\"Fig4
From: Jesson et al (2020), Pain Reports<\/figcaption><\/figure>\n\n\n\n

Effects of Physiotherapy on Disability for Radicular Pain<\/strong><\/h3>\n\n\n\n

Trends for the effectiveness of physiotherapy on pain and disability were similar although disability decreased to a lesser extent. When disability is improved, pain improves as well. When pain improved, disability wasn\u2019t necessarily better.<\/p>\n\n\n\n

Do you want to know how to treat lumbar spinal stenosis conservatively? Be sure to watch this video!<\/p>\n\n\n\n

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