Physical therapies for chronic pain

Many of the people that we talked to had received physical therapies including manipulations, mobilisations, massage, electrical stimulation (TENS), acupuncture, heat and cold treatment and ultra sound.

These are usually given in combination with exercise and are used to reduce pain so people can get mobile again. Physical therapies are provided by NHS and private physiotherapists and by chiropractors, osteopaths and other complementary therapists (see also ‘Complementary approaches‘ and ‘Physiotherapy‘).

Physical therapies are sometimes referred to as ‘conservative therapies’ because they are considered a safer option than medical interventions. Several people felt that they are worth trying and in particular were a better option than undergoing unnecessary surgery.

Although there is some evidence that manipulation may have a short term effect for some people with back pain, healthcare professionals disagree about whether physical therapies are useful in the management of chronic pain. In contrast, people with chronic pain tend to believe that different approaches work for different people.

Transcutaneous electrical nerve stimulation (TENS) was one of the most common physical therapies talked about.

TENS is the use of safe amounts of electrical current to try to reduce pain. TENS machines are usually a small battery operated device which can be worn on a belt or put in a pocket. They have wires leading to gel-covered pads which are stuck to the skin near the painful part of the body.

Some people found that TENS helped their pain, but others did not get any relief and a few people found it uncomfortable. A man who found TENS helpful said it was easy to use but not very practical to carry around. Others said it was a lot of hassle putting the pads on, particularly if the pain was in their back.

Finds the TENS machine easy to use but says it is not practical to carry it about all the time.

Age at interview 41

Gender Male

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TENS machines were sometimes provided by physiotherapists or borrowed from pain clinics and support groups. A few people bought their own from shops or catalogues. A man who found TENS and ultrasound helpful recommended trying out a TENS machine before buying one as they don’t work for everyone.

Recommends that people try a TENS machine before they buy one because they don’t work for everyone.

Age at interview 54

Gender Male

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A woman had bought a device called a Pain Gone pen which works on a similar principle to TENS and provided a short blast of pain relief. A few people had attended physiotherapy for a form of TENS called inferential or had been to a pain clinic for a technique which combines acupuncture with electrical stimulation.

Has used a Pain Gone Pen a device similar to TENS and find it helps for short sharp burst of pain…

Age at interview 47

Gender Female

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Received a type of electrical stimulation combined with acupuncture at a pain clinic which gave…

Age at interview 32

Gender Female

Age at diagnosis 26

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Heat and cold

Physiotherapists sometimes use or recommend the use of heat or cold applied to the skin. Cold helps relieve acute inflammation but can help relieve chronic pain by reducing muscle spasms and joint stiffness. Heat also reduces spasms and stiffness and increases blood flow which removes pain producing chemicals.

Most people that we talked to felt that the use of heat or cold for the relief of chronic pain was a matter of personal preference. Some found it helpful to alternate heat and cold. Care should be taken when using heat and cold packs as both can burn the skin.


Ultrasound is used to try to speed up the healing process after injury using sound waves at a frequency too high to be audible to the human ear. A few people had been given ultrasound by a physiotherapist and some people with acute injuries and muscular pain found it helped.


Manipulation (a high-velocity thrust to a joint beyond its restricted range of movement), and mobilisation (low-velocity passive movements within the limit of the joint range) were sometimes used. They were usually given in combination with a programme of exercises to help get people mobile again.

A woman who was receiving intensive physiotherapy based on these principles, found it very helpful but said that she didn’t know whether it would work for everybody. Osteopathy and chiropractic are largely based on manipulation and mobilisation (see also ‘Complementary approaches‘).

Attends intensive physiotherapy where she is given manipulation in combination with exercise…

Age at interview 50

Gender Female

Age at diagnosis 45

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Some people had been given treatments which are now less common because there is little evidence of their long-term benefits. A few were given traction using a special machine which stretches the back or neck pulling the bones slightly apart to relieve the pressure on trapped nerves. Some found this gave temporary relief of their pain. A few said they found that they couldn’t take it and asked that the procedure be stopped.

A few people with back pain had been given corsets to help support their back. However, it is now believed to be more effective to use exercises to strengthen supporting muscles.

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