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The Patient’s Dilemma: Medication, Physiotherapy, or Surgery?
- Yannick Sarton
- Mar 5, 2025
- 3 min read
Updated: Dec 16, 2025
When faced with joint pain, patients have several options. In the acute phase, pain can often be managed with medication to provide comfort while the body undergoes tissue repair. However, after three months, pain is classified as chronic, and its persistence does not necessarily indicate ongoing tissue damage.
By tissue, we refer to muscles, ligaments, vertebrae, bones, and nerves—essentially, the structures of the human body. In most cases of chronic joint pain, the physical injury has already healed, but the pain persists due to changes in how the brain processes pain signals.
The Hidden Factors Behind Chronic Pain
Chronic joint pain is often accompanied by physical limitations, such as reduced mobility, muscle weakness, and decreased flexibility. However, a patient’s perception of their condition, beliefs, and attitudes play a crucial role in recovery.
Many of my patients have suffered from chronic pain for years but have never taken decisive action to treat it properly and regain a pain-free life. The options available for managing pain typically include medication, surgery, or physiotherapy, but the path chosen can greatly impact long-term outcomes.
The Prestige of Surgery vs. The Science of Treatment Algorithms
Surgery is often perceived as a high-status solution, leading many patients—and even general practitioners—to prioritize it. However, from a scientific perspective, treatment guidelines are structured to make surgery the last resort.
Unfortunately, medical decision-making does not always follow evidence-based treatment algorithms. This can be due to:
• Limited awareness of physiotherapy’s effectiveness among some physicians.
• A misconception that physiotherapy research lacks comparison to surgical interventions, when in reality, many studies directly evaluate these alternatives.
• A misunderstanding of conservative treatment, which includes both physiotherapy and medical interventions such as injections.
Case Study: Chronic Low Back Pain
Long-term reliance on medication for chronic low back pain can have negative consequences. Many painkillers affect the entire body, and prolonged use of high-dose opioids, for example, carries serious health risks.
In low back pain management, medication may be helpful in the acute phase, but if the pain becomes chronic, the gold standard treatment is manual therapy and exercise-based rehabilitation. The goal is to restore movement and function, not just suppress symptoms.
In specific cases, such as severe muscle weakness or loss of sensation that significantly impacts daily life, lumbar surgery may be necessary. However, for pain alone, without neurological impairment, surgery is often not the best option, as it is a major intervention with substantial risks and costs.
Where Physiotherapy Stands in Pain Management
Physiotherapy sits between medication and surgery, offering a direct, hands-on approach to joint health. Physiotherapists are the only healthcare professionals trained to provide both manual therapy and exercise-based rehabilitation, making them uniquely equipped to treat chronic joint pain.
Unfortunately, outdated perceptions of physiotherapy sometimes lead to biased medical referrals. The field has evolved significantly, and patient education is now a critical component of effective treatment. Misconceptions about pain can lead to catastrophization and fear of movement, both of which contribute to pain persistence.
I provide structured and evidence-based online physiotherapy for patients worldwide, offering clinical assessment, diagnosis, and personalised rehabilitation.
I also receive patients in person at my physiotherapy clinic in Phnom Penh.
You can begin your online physiotherapy session through the dedicated platform:
More information on clinical standards and supporting evidence is available here:
Yannick Sarton, MSc Physiotherapist
International Online Physiotherapy & In-Clinic Care, Phnom Penh
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