Ometto AC, Marcelino GB, Pereira GCN, Rodrigues FFP, Eid RAC, da Silva AA. Physiotherapy approaches for pain control in patients who are critically ill. World J Crit Care Med 2026; 15(1): 108062 [DOI: 10.5492/wjccm.v15.i1.108062]
Corresponding Author of This Article
Arnaldo Alves da Silva, MD, PhD, Professor, Senior Researcher, Department of Critical Care, Hospital Israelita Albert Einstein, Av. Albert Einstein, Sao Paulo 05652-900, Brazil. renalmater@gmail.com
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Critical Care Medicine
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Minireviews
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Mar 9, 2026 (publication date) through Mar 3, 2026
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ometto AC, Marcelino GB, Pereira GCN, Rodrigues FFP, Eid RAC, da Silva AA. Physiotherapy approaches for pain control in patients who are critically ill. World J Crit Care Med 2026; 15(1): 108062 [DOI: 10.5492/wjccm.v15.i1.108062]
World J Crit Care Med. Mar 9, 2026; 15(1): 108062 Published online Mar 9, 2026. doi: 10.5492/wjccm.v15.i1.108062
Physiotherapy approaches for pain control in patients who are critically ill
Ana Claudia Ometto, Gustavo Brasil Marcelino, Gabriella Cristina Nogueira Pereira, Felipe Farah Pinheiro Rodrigues, Raquel Afonso Caserta Eid, Arnaldo Alves da Silva
Ana Claudia Ometto, Gustavo Brasil Marcelino, Gabriella Cristina Nogueira Pereira, Felipe Farah Pinheiro Rodrigues, Raquel Afonso Caserta Eid, Arnaldo Alves da Silva, Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Co-first authors: Ana Claudia Ometto and Gustavo Brasil Marcelino.
Author contributions: Ometto AC provided the study design and conception and performed the original writing and subsequent revision of the manuscript; Marcelina GB and Pinheiro Rodrigues FF performed the original writing and subsequent revision of the manuscript; Marcelino GB, Nogueira Pereira GC provided important intellectual contributions to the study’s performance of the literature review; Caserta Eid RA provided the study design and performed the data interpretation and revisions to the manuscript; da Silva AA provided the overall study supervision and critical revisions to the manuscript, and is responsible for all duties as the corresponding author.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Arnaldo Alves da Silva, MD, PhD, Professor, Senior Researcher, Department of Critical Care, Hospital Israelita Albert Einstein, Av. Albert Einstein, Sao Paulo 05652-900, Brazil. renalmater@gmail.com
Received: April 9, 2025 Revised: August 5, 2025 Accepted: November 17, 2025 Published online: March 9, 2026 Processing time: 330 Days and 14.3 Hours
Abstract
Pain is a significant challenge in critical care settings, affecting patient outcomes, recovery time, and quality of life. While pharmacological interventions remain the cornerstone of pain management in intensive care units (ICUs), they are associated with numerous adverse effects including respiratory depression, delirium, and prolonged ICU stays. To examine evidence-based physiotherapy approaches that can effectively complement traditional pain management strategies in patients who are critically ill. We conducted a comprehensive literature review of physiotherapy modalities used for pain control in ICU settings. The review focused on six key interventions: Early mobilization, positioning, postural management, manual therapy techniques, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and photobiomodulation (PBM). Evidence supports the efficacy of physiotherapy interventions in reducing pain intensity and improving patient comfort in critical care environments. Early mobilization prevents complications of immobility while indirectly reducing pain through improved circulation and endorphin release. Proper positioning techniques alleviate pressure on painful areas and reduce the incidence of pressure injuries. Manual therapy provides pain relief through neural mobilization and muscle relaxation. Thermotherapy offers significant analgesic effects with minimal side effects. TENS and PBM demonstrate promising results as nonpharmacological pain management options, with PBM showing efficacy through its impact on cellular metabolism and neural pathways. Evidence supports physiotherapy interventions as effective nonpharmacological adjuncts to conventional pain management in critical care, demonstrating efficacy through multiple modalities that enhance patient comfort while potentially reducing opioid requirements.
Core Tip: Physiotherapy interventions offer effective nonpharmacological approaches to pain management in intensive care unit patients, potentially reducing reliance on opioids and their associated complications. This review highlights six evidence-based modalities-early mobilization, positioning, manual therapy, thermotherapy, transcutaneous electrical nerve stimulation, and photobiomodulation-that can complement conventional analgesic strategies. These interventions demonstrate efficacy in reducing pain intensity while improving patient comfort through multiple physiological mechanisms, presenting viable options for comprehensive pain management protocols in critical care settings.
