Active vs Passive Pain Management
The most important distinction in pain management: passive modalities (TENS, heat, ice, ultrasound) provide temporary relief. Active interventions (exercise, movement therapy, pain neuroscience education) produce lasting change. Passive modalities should enable active participation, not replace it.
Electrotherapy Modalities
TENS activates gate control and endorphin release — most effective for chronic pain as an adjunct to exercise. Interferential therapy penetrates deeper than TENS. Ultrasound promotes tissue healing in tendons and ligaments. Low-level laser therapy (LLLT) reduces inflammation and promotes healing.
Manual Therapy for Pain
Joint mobilization and manipulation reduce pain through neurophysiological mechanisms (gate control, endogenous opioid release) beyond the mechanical effects. Most effective when combined with exercise therapy.
The Best Pain Management Strategy
Graded exercise, pain neuroscience education, sleep optimization, stress management, and social reconnection address the biological, psychological, and social dimensions of chronic pain — the only approach proven to produce lasting reduction.