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MANAGING CHRONIC PAIN

Is there any treatment? Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.

SOME COMMON TYPES OF CHRONIC PAIN

Cancer Spinal Injury Sports-related Injury Migraine Headaches Arthritis Fibromyalgia Degenerative Joint Disease

Treating Chronic Pain

Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.

Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.

• Biofeedback
  
• EMDR
  
• Massage
  
• Watsu
  
• Electrotherapy or Electrical Muscle Stimulation (EMS)
  
• Microcurrent/Microamerpage Electrical Neuromuscular Stimulator
  
• Acupuncture & Acupressure
  
• Hydrotherapy
  
• Physical Therapy
  
• Exercise
  
• Dialectical Behavioral Therapy (DBT)
  
• Drug Therapy

 

Biofeedback

Biofeedback refers to a person's ability to control certain biological responses that their body elicites through various means such as relaxation, breath control, or concentration. It is a promising treatment but is still considered a type of alternative medicine. Its use is becoming more widely accepted and used in many branches of traditional medicine.

The essential premise with biofeedback is that a person can have control over their autonomous nervous control: self regulation of bodily processes thought to be out of the control of a person's grasp.

A patient will be hooked up to one or more devices which measure the body's response to concentration or relaxation, such as:

• Hemoencepholography (HEG): measures neural activity in the brain.
• Electrocardiogram (ECG): measures Heart Rate Variability (HRV) using Infra-Red (IR) imaging.
• Electroencephalography (EEG): Measures brain "wave"; activity (beta, alpha, theta, and delta waves)
• Skin Temperature: Measures skin temperature.
• Galvanic Skin Response: measures perspiration via electrolytes in sweat
• Electromyogram (EMG): Measures muscle tension.

How does this function in chronic pain management? It is thought that by mindfulness, or awareness, of where pain is originating that one can go "into"; the source of the pain and then gently learn to turn the volume on it "down"; and then to "notice"; it rather than let This is especially true for pain that originates from muscle spasms and tension.

EMDR

EMDR, or Eye Movement Desensitization and Reprocessing, is a therapy developed by Francine Shapiro, Ph.D., a American psychologist. EMDR is an "information processing therapy"; which was initially used to help patients deal with trauma and PTDS (post trauma disorder syndrome).

There are 8 phases to EMDR treatment, but the hallmark of the treatment is the recounting of stressful memories in conjunction with the use of a stimulus (i.e., eye movements, auditory/sounds, tactile/touch, etc) which alternates from left to right. During these episodes of "dual attention"; the patient is directed to notice what thoughts, feelings, or perceptions arise. If the client becomes disturbed, distressed, agitated, the clinician helps the patient to discover what it is that is causing the negative reaction. Over time this helps the patient to reprocess the event.

How many sessions it takes to reprocess fully a traumatic event depends on the patient, the sort of trauma they are attempting to work through, and even how long ago the traumatic event occurred.

Clinicians are finding other uses for EMDR there days and are branching out its application to depression, stress, and even pain management.

Massage

Massage in wonderful for helping a person relax and lower stress levels, but it also has a use in helping people to deal with chronic pain. Like biofeedback, massage can help to lower heart rate, blood pressure, stress levels, increase circulation, and assists the body in producing endorphins the body's "natural painkillers";. Endorphins are produced in the pituitary and are released during times of exercise, excitement, and orgasm, and they produce a feeling of "well being";. Some athletes report feeling an "endorphin rush"; (aka, "Runner's high";) after long, continuous exercise.

Other beneficial side effects of massage therapy for chronic pain management are improved sleep, increased range of motion of distressed bodily areas,  and the reduction of anxiety and stress, both of which contribute significantly to pain. A 2001 study showed that massage for back pain yielded more effective pain management than did self-care or acupuncture.

Another type of massage that can be beneficial for pain management is "lymphatic massage";, in which the practitioner assists the patient's body in moving and circulating lymphatic fluid. This type of massage can be done manually or can be done by the use of a machine (Endermologie).

Massage therapy for pain management is indicated for patients with arthritis, fibromyalgia, headaches, sciatica, sports injuries, scar tissue, and many other ailments.

Watsu

Watsu, developed at Harbin Hotsprings in Northern California, is essentially Shiatsu, a form of massage therapy, which is done while the patient is floating in warm water. The water and, sometimes, floats support the patient while the massage therapish supports the patient while rocking and stretching their body. Many patients report that the only time that they feel pain free is during a session. Watsu is a very soothing form of massage therapy and some would say that it's not only physically pleasing, but it is emotionally & psychologically healing as well.

Watsu is recommended for mature patients (of character, not age) who are not new to the massage experience. It requires that the patient place trust in the practitioner such that they can fully relax and melt into the experience.

Electrotherapy or Electrical Muscle Stimulation (EMS)

Electrical therapy, as a pain management therapy, utilizes mild currents of electricity to stimulate nerves and muscles. It is a type of therapy that was discovered by Dr. Robert Becker, author of "The Body Electric"; but the use of electricity for curing pain has been in use for nearly 2000 years, in fact, since the days of the Romans. There are reports from 46AD (Scribonius Largus, Compositiones Medicae) of Roman physicians using the electrical attributes of liveTorpedo Mamorate fish as a remedy for gout and headaches.

But the first modern reports of electrical therapy are from England in the 1850s where, again, electrical fish were utilized for curing maladies such as join paint, migraine headaches, and depression. It is a modality of treatment commonly used by chiropractors, physical & sports therapists, and even finds its way into Traditional Chinese Medicine (TCM) in the form of electro-acupunture.

Nowadays, the electricity is delivered by a small machine that delivers the electrical charge via sticky gel electrodes that are placed onto the patient's body in a pattern which run the current through the injured or painful area. Polarity, pulse duration, frequency, and wave shape can also be specified according to the practitioner's guidelines. These machines are larger if the procedure is done "in office"; but there are also smaller units that, with a prescription, can be used at home or work. They are small and are easily to camouflage underneath everyday clothing.

Depending on whether a patient is seeking pain relief or healing will dictate the amperage that is used on the EMS machine.

For pain management, a slightly higher setting is utilized with the TENS unit Transcutaneous Electrical Nerve Stimulator (TENS). TENS utilizes a "milli-amperage"; of electricity. It is usually necessary to turn the intensity up to the point where the patient or caregiver can visualize a muscle twitch. Electrical stimulation has helped patients with nervous system disorders such as epilepsy and Parkingson's Disease as well as acute and chronic pain management of back & joint pain, as well as headaches. TENS is effective at treating pain and can help to eliminate or reduce one's reliance on pain killers.

Microcurrent Electrical Neuromuscular Stimulator or Microamerpage Electrical Neuromuscular Stimulator (MENS)

Utilizes a "micro amperage"; of electricity and creates an electrical gradient that is similar to that which is found across areas of injured tissue. A person undergoing MENS treatment cannot feel the electricity at this low level but that is not to say that treatment in not working. Quite the opposite. MENS is widely accepted as accelerating the healing process and is demonstrated in reduced bruising time, overall increased healing time, and reduction of pain in the injured area. MENS works well for acute and chronic pain alike.

Acupuncture & Acupressure

Acupuncture and Acupressure are both components of Traditional Chinese Medicine (TCM) which sees pain as a blockage of a person's Qi, or "life force"; or "spiritual energy";. Thin sterile needles are inserted at various specific points on the body called "meridians"; in order to unblock "qi";. By the same mechanism, stimulating these points with acupressure can bring about the same release. Stimulation of points with needles or pressure causes the body to produce endorphins (natural opioids produced by the body), which, in turn can ease pain and produce feelings of deep relaxation.

There are few drawbacks to using acupuncture and acupressure. There are small risks of localized infection from needles if the practitioner doesn't use sterile techniques, a very small possibility of hitting a capillary, and a chance of bruising from acupressure, but it's an otherwise safe procedure. In the right hands, with a safe acupuncturist, the risks are infinitesimally small.

There are many studies pointing to the effectiveness of TCM and acupuncture/acupressure for many ailments ranging from weight loss to infertility to chronic pain management. That being said, acupuncture is now a commonly included benefit on many health insurance plans.

Hydrotherapy

Hydrotherapy can refer to any treatment that incorporates water as a means of therapy, such as saunas, steam rooms, water exercises, colonic irrigation, sitz baths, hot or cold moist packs, but most commonly hydrotherapy refers to a simple whirlpool.

Hydrotherapy has been a therapeutic treatment for pain relief since the days of the Romans who set up public baths everywhere they expanded into. There are famous waters in Baden Baden Germany which are world renowned for their curative effects which has more to do with the minerals. Two studies analyzing the effectiveness of  hydrotherapy (whirlpools) found that hydrotherapy didn't help chronic lower back pain but many do find it useful and so further studies are indeed warranted. Warm pulsating water can increase circulation to areas of pain and can be beneficial to patients with spinal cord injuries, arthritis, back pain, or fibromyalgia.

Water exercises as an alternative form of hydrotherapy or physical therapy are a great way of increasing strength and range of motion for sports injuries by utilizing the water's resistance. Less stress is placed on joints when a person is supported by their own buoyancy in water and low impact exercises done in this manner can be done without stress to joint and ligaments. Strengthening muscles in this manner can help one to overcome chronic pain of the affected area over time.

Physical Therapy

Physical therapy (PT) is often prescribed by physicians to their patients who have experienced a traumatic injury or strain to their bodies, or as part of a post-surgical treatment. It is a name for a broad classification of treatments and may include stretching, guided movement, massage, water therapy/hydrotherapy, ultrasound, hot/cold packs, Electrical Muscle Stimulation (EMS), or other modalities of treatment.

Physical therapists typically give their patients "homework"; or "home exercises"; to reinforce the motions taught in the treatment setting. In order to keep injured muscles from atrophying, it is important that the patient stay on the prescribed course of treatment.

PT helps patients to understand their body's limitations so that they don't push past what their body is capable of doing and create a continuum of painful episodes. Part of the therapist's job in administering PT is to get the patient to a state of accepting that they might not ever return to the same capacity as before their injury or surgery. Accepting limitations helps to ensure that a patient will not reinjure themselves by overexerting themselves prematurely.

There are few conditions of chronic pain that do not respond well to physical therapy: cancel patients are one broad category that this would apply to.

Exercise

Exercise can help immensely to reduce chronic pain. First, the body produces endorphins in response to prolonged exertion, the body's natural painkillers, which help to reduce the perception of pain. Secondly, exercise improves the quality of ones sleep. Studies show that people who experience chronic pain tend to sleep less well than others. Increasing ones ability to sleep through the night helps with a person's outlook during the day as well as to reduce their focus on pain. Exercise also helps to relieve tension and stress. Similar to biofeedback exercise can relieve tension and stress, thereby helping the patient to focus less on their pain.

A secondary side effect of exercise: for patients experiencing joint pain, especially in ankles, knees, and hips, exercise to lose excess weight can go a long way to relieving pain in damaged joints. For instance: For every pound a person is overweight, three to five pounds of extra weight is added to each knee during walking. For running this figure is much more. In contrast, a ten pound weight loss causes 30 to 50 pounds of extra stress to be relieved from the joints. Relieving your joints from this excess weight will do much for chronic pain management due to joint pain.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) utilizes cognitive therapy and behaviorist theory, but incorporates mindfulness as a key element. DBT is a psychosocial treatment modality that was formulated to help people with borderline personality disorders but works for many other diagnoses such as pain management. DBT is a well-researched approach found to be highly effective in treating pain management by teaching effective coping skills. The skills or modules of DBT are Core Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.

Drug Therapy

Drugs that kill pain are more commonly referred to as "analgesics";. There are three essential categories of analgesics:

• NSAIDS & paracetamol
• COX-2 Inhibitors
• Opiates and Morphinomimetics

NSAIDS (Non-steroidal anti-inflammatory drugs) and paracetamol/acetaminophen are prostaglandin antagonists in that they inhibit cyclooxygenase, which leads to a decrease in prostaglandins. Prostaglandins accumulate in strained and injured muscle tissues. NSAIDs also inhibit both COX-1 and COX-2 enzymes.

COX-2 Inhibitors are a class of drug that only inhibit COX-2 enzymes. They are effective analgesics in that they decrease pain, but with the added benefit of reduced gastrointestinal complications that often accompany NSAIDs. A downside is that there might be an increase in clotting and subsequent cardiac and cerebrovascular conditions due to a decrease in protoglandin. As of 2006, the jury was still out on this drug class.

Opiates and Morphinomimetics all act on the brain's opioid receptors and essentially block the brain's ability to "perceive"; pain rather than decreasing inflammation or reducing prostaglandins. The drugs in this classification are highly addictive and have common complications such as nausea, vomiting, itching, and constipation. These are only prescribed for pain that cannot be managed by less severe drug protocols.

Pain categories and their respective drugs of choice:

• Mild Paid – Acetaminophen, NSAIDs, or Ibuprofin
• Mild to Moderate Pain – NSAIDs or weak Opioids
• Moderate to Severe Pain – Morphone, Oxycodone, Fentanyl, Diamorphine, Hydromorphine, Methadone, et al.

Anti-depressants and antiepileptic drugs are also sometimes used in pain management as they can help to manages pain in CNS system.