Manual Therapy in Conjunction With Other Multimodal Interventions in a Patient With Chronic Pain and Hypertension: A Case Report

Chronic pain and hypertension (HTN) are worldwide epidemics that are difficult to manage and frequently encountered as comorbid conditions in patient care. There is a paucity of information regarding the effect that manual therapy has on blood pressure (BP), particularly in those with chronic pain and HTN. This case report describes the management of a patient with chronic pain and HTN. The patient was a 41-year-old female with chronic multisite pain and multiple comorbidities, including HTN. Her BP at the initial evaluation was 147/78 with an oscillated device and 142/82 with a sphygmomanometer in the right arm and 144/80 in the left. The physical examination of the patient warranted a mid-thoracic thrust manipulation in supine. Manual therapy, education, meditation, and aerobic exercise were used throughout the episode of care (seven visits across 9 weeks). Upon reassessment after the thoracic thrust manipulation (5 min of quiet sitting), BP in the right arm was 105/65 with an oscillated device and 105/68 with a sphygmomanometer. Significant improvements in the Patient Specific Functional Scale, Lower Extremity Functional Scale, Numeric Pain Rating Scale, and BP were noted throughout the episode of care. She was able to return to her previous walking program. Improvements in pain, BP, and patient-reported outcomes were made in a patient with chronic multisite pain and HTN. Manual therapy, in conjunction with education, meditation, and aerobic exercise, may have aided in improving this patient's function and BP. Caution should be used when interpreting results from this case report. Future studies should examine the effects of physical therapy intervention, including manual therapy, in those with chronic pain and HTN. Manual therapy could be considered as an intervention to improve chronic pain and HTN.