**7. Pathogenetic base of PRM-programs for pain management**

The influence of physical modalities on the interstitium (*milieu intérieur* of Claude Bernard) is the theoretical base for combination of drugs and physical modalities [53, 54].

The synergy between different physical modalities is the logical base for prescription of complex rehabilitation program. According the theory of Ferreira (1983) pain is a consequence of the combination of algesic and hyperalgesic stimulation [54]. Natural physical modalities (physiotherapy, hydrotherapy, ergotherapy) provoke a block of the hyperalgesic stimulation. The algesic stimulation is influenced by preformed physical factors (electric currents, magnetic field, light, etc.). The combination of natural and preformed physical modalities can reduce pain, using different paths.

**Figure 3.** *Synergic combination of physical modalities in pain patients.*

The construction of a complex physical and rehabilitation programme is needed, because the mechanism of action of different procedures is diverse (**Figure 3**).
