Pharmacologic Treatment:
To include analgesics, NSAID’s, muscle relaxants.
Behavioral Modification:
Psychotherapy to rule out dual diagnosis, malingering, and prevent chronicity.
Physical Therapy:
3 times per week for 2 weeks to address myofascial components. After this the patients’ functionality should have greatly improved unless there is underlying pathology. The intent here is to eliminate or, at least, control any myofascial component to the patients’ pain complaints so that underlying pathology may be identified if present.
Re-Evaluation 3rdWeek :
Responding: If the patients’ myofascial component is responding as expected there is probably no other underlying pathology so continue the physical therapy for 2 weeks and re-evaluate for rehabilitation or discharge.
Total physical therapy = 3 per week for 4 weeks = 12 therapies
Not Responding: If the patient continues to have pain that persists beyond the anticipated time of healing the chronic pain medical treatment guidelines apply.
If self sustaining Trigger Points are found they should be injected while continuing physical therapy and re-evaluate after 1 week.
Responding: If the patients’ myofascial component is responding as expected no other underlying pathology is anticipated so continue the physical therapy for 2 more weeks and re-evaluate for rehabilitation or discharge.
Total physical therapy = 3 per week for 6 weeks = 18 therapie
Not Responding: If the patients’ myofascial component is still not responding as expected search for underlying pathology through imaging, EMG/NCV, psychological evaluation, consultations, and labs followed by treatment modalities such as injections, surgery, etc. While this workup is being done it is important to continue Physical Therapy 2 times per week to not lose the gains that have already been made.
Total physical therapy = 3 per week for 4 weeks plus 2 per week for 6 weeks = 24 therapies.