Physiotherapy approaches for pain control in patients who are critically ill

Table 1 Non-pharmacological interventions for pain management

Intervention	Level of evidence	Key findings	Pain reduction	Main barriers
Early mobilization	Moderate	Helps prevent complications associated with immobility and offers indirect pain relief	Not quantified	40%–60% of patients may have contraindications; typically requires 2-4 staff for implementation
Positioning	Strong	Fundamental for pain management and significantly reduces pressure injuries (up to 45.5%)	Not quantified	May conflict with other clinical priorities; limitations due to medical devices
Manual therapy	Limited	Effective for both nociceptive and neuropathic pain	Not quantified	Requires specialist availability; contraindicated in 25%–35% of patients
Thermotherapy	Moderate	Provides significant analgesia with minimal adverse effects	Not quantified	Challenges include maintaining proper temperature and monitoring patients
TENS	Strong	Demonstrates the most robust, quantified outcomes, with pain scores reduced by 1.8–2.0 points and a 31% reduction in opioid use	Pain score reduced from 6.9 to 3.5 (0–10 scale)	Potential interference with equipment (18% of cases); requires patient feedback for optimal use
PBM	Limited–moderate	Produces sustained pain relief and leads to a 62% reduction in pressure injuries	Pain reduction of 3.7 vs 1.2 points compared to placebo	Most costly intervention; requires personnel with specialized training

TENS: Transcutaneous electrical nerve stimulation; PBM: Photobiomodulation.