Conservative therapies and exercise therapy

  • Chapter: Pain therapy and anesthesia

    Article: 4 of 8

    Update: Feb 24, 2021

  • Author(s): Kramer, Jens

The conservative therapeutic methods available in the treatment of various pain conditions are extensive:

  • Physical and occupational therapy
  • Cold/heat treatment
  • Positioning and compression
  • Acupuncture
  • Psychological and psychotherapeutic procedures
  • Nutrition
  • and much more

The above-mentioned methods can contribute to a positive result and course for each patient individually in a very different way. Certainly not all procedures are suitable for acute pain, but are rather used for chronic pain. The attending physician plays an important role as mediator.


Physiotherapy enables the patient to actively combat pain and can have a supportive effect on almost all types and forms of pain. A special aspect in the context of vascular malformations can be an indirectly affected joint, which is excessively spared from exercise. Early involvement of physiotherapy is certainly useful in this case in order to maintain or restore the patient's ability to cope with everyday life. However, some patients only achieve improvements with prolonged rest phases. Other patients, on the other hand, are physically very active.

Cold treatment

Cold treatment can achieve circumscribed withdrawal of heat. This leads to constriction of small blood vessels of the skin and the underlying musculature with:

  • slowing of the nerve conduction velocity in the corresponding area and
  • a consecutive decrease in the sensitivity of the nociceptors.

The intensity and frequency of pain stimuli are thus reduced.

Cold therapy, also appears to be useful as additional treatment in peri-articular pain, among other indications. Other conceivable indications are compression pain and constriction syndromes in the context of vascular malformations or supportive treatment in the context of postoperative or post-interventional pain.

The avoidance of direct skin contact and excessive cold are important for all cold applications. It is advisable, for example, to place cloth sheets between the skin and the ice pack, otherwise there is a risk of local cold damage or burn injury.

The use of cold or heat application for pain varies in patients with vascular anomalies. According to a non-representative survey of 23 patients and their relatives, heat causes pain relief in about 15% of patients. About 70% of patients were more likely to report improvement in pain with local application of cold. Around another 15% avoid both heat and cold, as this tends to increase their individual pain level.

Compression therapy

Compression bandages play an indispensable role in the treatment of phlebological and lymphological diseases. The external pressure leads to an improvement in venous and lymphatic drainage from the tissue. This can cause a significant improvement in the intensity of pain with various malformations.


In addition to compression therapy, adequate elevated positioning should be used in patients with venous or lymphatic malformations. Positioning with elevation of the limb causes additional improvement in venous outflow from the affected extremity, thereby decreasing local tissue pressure and pain.

Distraction and denial

An interesting therapeutic approach to chronic pain is a positive effect by means of distraction. This effect can be achieved by special individual concentration exercises, but also by joint activity in a group. This is an area of psychotherapy, which plays a central role in chronic pain. Attempts can thus be made to help patients handle everyday life with chronic pain by means of individual solution strategies.

In fact, many patients with vascular anomalies report that they try to maintain normal participation in daily life for as long as possible, despite sometimes prolonged periods of pain. Denial of pain tends to be the normal behavior from their perspective. Therefore, communication of an existing pain to others is perceived as rather negative and is avoided. Similarly, being reminded of pain, including by other people, tends to break through the existing denial and is thus perceived as counterproductive.