Pain Management  Anesthesiologic Approaches  Neurostimulatory Approaches  Pharmacological Approaches  Psychological/Mind-Body Therapies  Rehabilitative Approaches  Surgical Approaches Conventional Approaches Rehabilitative Approaches Some types of pain therapies have been classified as rehabilitative because they are performed or directed by physiatrists (physicians who specialize in rehabilitation medicine) or by physical or occupational therapists, or because they have the specific goal of improving function as well as relieving pain. The injection therapies described above are also commonly performed by physiatrists or other trained physicians and could also be classified as a rehabilitative approach. Physical therapy (PT) PT can be an important part of the treatment strategy. PT techniques are useful in teaching patients to control pain, to move in safe and structurally correct ways, to improve range of motion, and to increase flexibility, strength and endurance. " Active" and "passive" modalities can both be used, but active modalities, such as therapeutic exercise, are particularly important when the goal is to improve both comfort and function. Exercise Exercise can have a variety of benefits. It has been suggested that regular exercise could activate pain control systems in the brain, possibly by affecting endorphin levels, and also improve the functioning of the immune system (Jonsdottir, 2000) (Goldfarb, 1997) (Vuori, 2001). Although these benefits are uncertain, a very large clinical experience indicates that patients can benefit from exercise in terms of better stamina and function. Exercise may reduce the risk of secondary pain problems like muscle strains, and may also lead to improved confidence and sense of well-being. A supervised exercise regimen may include range of motion maneuvers, strengthening techniques, and aerobic conditioning. Exercise programs are particularly useful for chronic musculoskeletal pain including back, neck and shoulder pain, rheumatoid and osteoarthritis pain and fibromyalgia. Thermal Modalities Thermal modalities include a variety of methods that produce heating and cooling of the tissues to manage acute and chronic musculoskeletal pain. Superficial heat, such as moist hot packs, increases skin and joint temperature and blood flow, and may decrease joint stiffness and muscle spasms. However, the use of superficial heat has not been studied extensively and there is little scientific evidence to support its use in the treatment of pain. In early injury, it may actually increase swelling at the injury site (whereas cold would reduce swelling). Diathermy involves the use of high-frequency oscillating current and ultrasound (inaudible sound wave vibrations) to create deep heating. The deep heating may reduce the perception of pain. It is believed to promote healing and decrease inflammation. While there has not been a great deal of research on the effectiveness of diathermy and ultrasound for pain relief, it appears that there are short-term beneficial effects with the use of diathermy and significant improvement in pain relief with ultrasound, as with other heating modalities (Wright, 2001). Cryotherapy, the use of cold for the treatment of pain, decreases skin and joint temperature and decreases blood flow to the affected area. It has short-term benefits including pain relief and reduction in swelling.