**9. Functional assessment of pain patients**

Functional assessment in PRM-practice is based on ICF (**Figure 4**). The holistic approach to the patient must be obligatory—the complex evaluation must include:


We evaluate some problems of the pain patient: *Reduced endurance and supportability to physical activity, fatigue; Motor weakness; Coordination problems* (posture, locomotion,

#### **Figure 5.**

*Assessment of pain patient, based on ICF.*

grasping); *Pain; Necessity of preventive measures; Necessity of technical aids; Necessity of assistance; Difficulties in activities of daily living; Reduced performance and Reduced functional mobility.*

The final complex evaluation, based on ICF, have to include (**Figure 5**).

*Physical Analgesia: Methods, Mechanisms and Algorithms for Post-Operative Pain DOI: http://dx.doi.org/10.5772/intechopen.111590*


#### **10. Algorithms of pain management in post-operative cases**

In every case, including post-operative cases, we apply the same algorithm: detailed functional assessment and complex rehabilitation. This complex rehabilitation principle comprises a synergic combination of different physical modalities and techniques, accentuating on physiotherapy, ergotherapy, functional electrical stimulations and pain management with preformed modalities (**Figure 6**).

We emphasize on strictly analgesic procedures, as follows:

• *From the group of preformed modalities*: dyadinamic electric currents, transcutaneous electroneurostimulation (TENS), Trabert current, interferential currents, magnetic field, LASER, Deep Oscillation, Shock-Wave therapy;


The choice of the concrete physical factor and of the respective therapeutic method depends on the type of pain and of the principal disease or condition [55–59], as follows:


During the preparation of the rehabilitation complex, we must combine synergically procedures with three or more mechanisms of physical analgesia.

In some cases, we must combine physical analgesia and medications.

*Physical Analgesia: Methods, Mechanisms and Algorithms for Post-Operative Pain DOI: http://dx.doi.org/10.5772/intechopen.111590*

Patient's education is obligatory in cases with chronic pain, especially after surgical intervention.

In the scientific literature, exist some investigations, proving the effectiveness of physical analgesia (with different level of evidence) after surgical interventions. Some of the used combinations are:


#### **11. Conclusion**

Pain management is an important part of rehabilitation algorithms in clinical practice. PRM-programmes of care is obligatory in pain cases, especially in postoperative patients.

We could recommend our complex pain management program.

The on-time start of rehabilitation procedures in pain management (especially after surgical intervention) has a lot of beneficial consequences: improvement of patient condition and prevention of complications; increase of muscle force and range of motion; regularization of static and balance; normalization of humero-scapular and pelvi-femoral rhythm; functional recovery of the grasp and gait, amelioration of autonomy of patients and of quality of life; acceleration of resocialization and participation in functional activities, positive economic effect.

#### **Conflict of interest**

The authors declare no conflicts of interest.

*Topics in Postoperative Pain*
