Necessity of collaboration between pain physicians and orthotists in pain medicine

Abstract

In this editorial, we comment on the article by Nagamine et al, published in the World Journal of Clinical Cases. The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality. Alongside virtual reality, various treatment methods are used to effectively manage musculoskeletal pain. One such method is the use of orthoses, which are applied in clinical settings. We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management. The efficacy of orthoses is maximized when customized to the physical characteristics of each patient, type of disease, and location of pain. Orthoses are designed to restore anatomical alignment and biomechanical function; however, their success depends on the expertise of trained orthotists, who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment. The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy. Since no single treatment modality typically offers sufficient relief for musculoskeletal pain, effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.

Key Words: Pain; Physician; Orthotist; Pain medicine; Orthosis

Core Tip: Effective management of musculoskeletal pain often requires a multidisciplinary approach, combining treatments, such as drug therapy, physiotherapy, and orthotic devices. Orthoses are usefully being applied in controlling pain by restoring anatomical alignment and preventing further injury. To maximize their efficacy, orthoses must be customized to the physical characteristics of each patient, type of disease, and location of pain. Collaboration between pain physicians and trained orthotists is essential for ensuring appropriate design and application of orthoses. It leads to improved patient outcomes in the management of pain.

INTRODUCTION

When treating musculoskeletal pain, various therapeutic modalities, including drug therapy, physiotherapy, injections, and psychotherapy, are necessary to improve treatment outcomes[1,2]. Orthoses can also effectively control musculoskeletal pain[3,4]. They prevent musculoskeletal tissue injury and facilitate the recovery of injured tissues by preventing excessive joint motion or inappropriate posture and movement[5]. The efficacy of an orthosis in treating pain is maximized when it is customized based on the physical characteristics, type of disease, and location of pain of each patient, requiring collaboration between pain physicians and orthotists.

ROLE OF ORTHOSES IN MUSCULOSKELETAL PAIN MANAGEMENT

Orthoses are exoskeleton-like devices designed to control mechanical aspects of the musculoskeletal system, assisting in the restoration of anatomical alignment and related biomechanical functions. Considering these characteristics, orthoses must be fabricated by trained orthotists with a sound understanding of musculoskeletal alignment and its mechanical relationships, the ability to effectively communicate with physicians regarding prescriptions, and the ability to apply appropriate technologies in the fabrication process.

EXAMPLES OF THE APPLICATION OF ORTHOSES IN SPECIFIC CONDITIONS

Applying an appropriate orthosis to patients with carpal tunnel syndrome requires the orthosis to immobilize the wrist while stably maintaining a neutral position when worn and be fitted well for comfort[3]. Additionally, the orthosis should not cause unnecessary tension in the surrounding tissues.

In patients with tenosynovitis or osteoarthritis, an orthosis can prevent excessive use of the musculoskeletal components associated with the pain and assist in stabilizing tendons and joints to prevent inflammation and injury[4]. For an orthosis to be correctly applied, it must be fabricated based on the physical characteristics and structures of each patient, requiring a sufficient understanding of the mechanics of the forces exerted between the orthosis and the patient.

An insole device, a type of orthosis, is often essential for treating foot pain[6]. Foot pain is often caused by malalignment of the foot, such as pes cavus or pes planus, or by excessive pressure applied to a particular part of the foot. An insole device can correct malalignment of the foot, while materials, such as Poron or Plastazote applied to the part of the foot under excessive pressure can assist in reducing pain. Custom-made insoles should be fabricated considering biomechanical aspects, including alignment of the leg and shifts in the center of gravity due to weight-bearing and changes in posture. To correct misalignment, the insole must fit the shape of the foot, reflect biomechanical changes due to weight bearing, and control the biomechanical conditions. Additionally, the possibility of foot pain worsening due to an altered mechanical pattern after applying the insole should be considered, and if the pain worsens, the insole should be modified for comfort.

CONCLUSION

The professional knowledge and skills of orthotists are crucial for correctly applying orthoses to patients with musculoskeletal conditions. A single treatment modality often does not offer sufficient therapeutic efficacy for musculoskeletal pain. An orthosis is an effective pain treatment tool that, when applied correctly, can significantly enhance therapeutic outcomes. Therefore, collaboration between pain physicians and orthotists is essential to maximize the therapeutic efficacy of orthoses for the treatment of musculoskeletal pain.