The current presentation accentuates on some modern methods: Transcutaneous electroneurostimulation (TENS), Deep Oscillation, Lasertherapy, Schock wave therapy; Cryotherapy; Post-isometric relaxation, Stretching and other soft-tissue techniques. 

Ivet  Koleva¹,  Borislav Yoshinov² 
² Professor, Doctor-es-Medical-Sciences; Medical University of Sofia; 
¹Student, Medical University of Sofia

The Declaration of Montréal of the International Pain Summit of the International Association for the Study of Pain (IASP) recognizes the deficits in knowledge of health care professionals regarding the mechanisms and management of pain.  
Physical analgesia (or analgesia using physical modalities) is traditionally applied in rehabilitation practice, due to its clinical efficacy, capacity of combination with other therapeutic methods, restricted contra-indications and absence of side effects. 
For physical analgesia we use: preformed modalities (electric currents, ultra-sound; magnetic field; light); natural modalities (kryo and thermo-agents; hydro- and balneotechniques; peloids; physiotherapy); reflectory methods. 

The current presentation accentuates on some modern methods: Transcutaneous electroneurostimulation (TENS), Deep Oscillation, Lasertherapy, Schock wave therapy; Cryotherapy; Post-isometric relaxation, Stretching and other soft-tissue techniques. 

We consider that physical analgesia involves a lot of pathogenetic mechanisms and we explain our own hypothesis about the influence of different physical modalities: blocking the nociception, inhibition of the sensitization (peripheral and central), modulation of the paintranslation at the level of the posterior horn of the spinal medulla – using the root of activation of encephalic inhibitory system of the brain (by increasing the peripheral afferentation) and modulation of the descending systems for pain control; influence on the psychic state of the patient – the drug «doctor» and the drug «procedure».

We propose some concrete combinations of physical analgesia methods, destinated to patients suffering from osteoarthritis (spondylo-, hip and knee OA), verified during our modest clinical experience, observations and investigations (of 30 years).

Pain reduction ameliorates significantly the quality of life of rhumatological patients.