Regional vs global physical therapy interventions to treat chronic pain in survivors of trauma: a randomized controlled trial.

People who have lived through traumatic events often carry chronic pain into later life, and physical therapists have long struggled to find approaches that reliably help. This trial compared two ways of treating that pain: a traditional regional approach targeting specific painful body areas, versus a global approach combining pain neuroscience education, graded motor imagery, and exercise. Ninety-eight adults with chronic pain and a trauma history received one of these approaches weekly for six weeks.

Overall, the two approaches produced similar results, with no statistically significant difference between them on the main outcomes. What stood out was a difference by race: both approaches helped white participants with pain interference, but among non-white participants, only the global approach was associated with improvement. Across the whole group, people tended to improve in physical function and several other quality-of-life measures regardless of which treatment they received. Because everyone improved somewhat, it is hard to know how much of that change reflects the treatments themselves versus other factors, and the race-based difference needs further study before drawing firm conclusions.

If you've experienced trauma and also live with chronic pain, you may know how hard it can be to find a treatment that actually helps. This study looked at two different physical therapy approaches: one that focuses on treating specific painful areas of the body, and another that combines education about pain, imagery-based exercises, and general exercise.

Just under a hundred adults tried one of these approaches once a week for six weeks. The good news is that people in both groups tended to feel better over time, showing improvements in physical function and several other wellbeing measures. However, when researchers compared the two approaches directly, neither one clearly worked better than the other overall.

Interestingly, white participants improved with either approach, but non-white participants only showed improvement in pain interference with the broader, education-and-exercise-based approach. Since we can't be sure whether people improved because of the treatment or for other reasons, and the racial difference needs more research, this doesn't tell us which approach is best for everyone.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial compared a regional, impairment-based physical therapy model (REGION-PT) against a global model incorporating pain neuroscience education, graded motor imagery, and exercise (GLOBAL-PT) in 98 adults with chronic pain and a documented history of trauma, identified via the Life Events Checklist. Participants received weekly sessions for six weeks, with outcomes analyzed using linear mixed models. No statistically significant between-group difference was found on the primary outcomes, indicating the two intervention models performed comparably rather than one being superior.

A notable race-by-intervention interaction emerged: white participants showed improved pain interference with either intervention, while non-white participants improved only with GLOBAL-PT. Independent of group allocation, participants showed improvement in physical function and six of the PROMIS-29 domains, along with pain interference measures, though within-group improvement cannot be attributed to either intervention specifically given the absence of a no-treatment control. Clinicians should note the modest sample size, the six-week duration, and that subgroup findings by race, while statistically detected, warrant cautious interpretation given likely limited power for interaction analyses.

The trial does not establish superiority of either model but suggests both are reasonable options, with the racial interaction meriting further investigation.