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Saturday, March 23, 2013

Pain Management and Complementary Health Practices

Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, nurse practitioners, and clinical nurse specialists. The team may also include other mental-health specialists and massage therapists. Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of chronic (long-term) pain, however, frequently requires the coordinated efforts of the management team.

Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering. Treatment approaches to chronic pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.

Physical Approach

  • Physiatry - Physical medicine and rehabilitation (physiatry/physiotherapy) employs diverse physical techniques such as thermal agents and electrotherapy, as well as therapeutic exercise and behavioral therapy, alone or in tandem with interventional techniques and conventional pharmacotherapy to treat pain, usually as part of an interdisciplinary or multidisciplinary program.
  • TENS - Transcutaneous electrical nerve stimulation has been found to be ineffective for lower back pain, however, it might help with diabetic neuropathy.[http://www.neurology.org/content/74/2/173]
  • Acupuncture - Acupuncture involves the insertion and manipulation of needles into specific points on the body to relieve pain or for therapeutic purposes. An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 in the British Medical Journal, was unable to quantify the difference in the effect on pain of real, sham and no acupuncture.[http://www.bmj.com/content/338/bmj.a3115]. Acupuncture and Pain [http://holisticlifestylecommunityblog.blogspot.com/2012/02/acupuncture-and-pain-applying-modern.html#.UU4CCTd3fSc]
  • LLLT/Laser Therapy - A 2007 review published in the journal Annals of Internal Medicine concluded low-level laser therapy has "not been shown to be effective for either chronic or subacute or acute low back pain;[http://annals.org/article.aspx?articleid=736834] and a 2008 Cochrane collaboration review concluded that there was insufficient evidence to support the use of LLLT in the management of low back pain.

Psychological Approach

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) for pain, helps patients with pain to understand the relationship between one's physiology (e.g., pain and muscle tension), thoughts, emotions, and behaviors. A main goal in treatment is cognitive restructuring to encourage helpful thought patterns, targeting a behavioral activation of healthy activities such as regular exercise and pacing. Lifestyle changes are also trained to improve sleep patterns and to develop better coping skills for pain and other stressors using various techniques (e.g., relaxation, diaphragmatic breathing, mindfulness, and even biofeedback).

Studies have demonstrated the usefulness of cognitive behavioral therapy (CBT) in the management of chronic low back pain, producing significant decreases in physical and psychosocial disability. A study published in the January 2012 issue of the Archives of Internal Medicine found CBT is significantly more effective than standard care in treatment people with body wide pain, like fibromyalgia. Evidence for the usefulness of CBT in the management of adult chronic pain is generally poorly understood, due partly to the proliferation of techniques of doubtful quality, and the poor quality of reporting in clinical trials. The crucial content of individual interventions has not been isolated and the important contextual elements, such as therapist training and development of treatment manuals, have not been determined. The widely varying nature of the resulting data makes useful systematic review and meta-analysis within the field very difficult.

In 2009 a systematic review of randomized controlled trials (RCTs) of psychological therapies for the management of adult chronic pain (excluding headache) found that "CBT and BT have weak effects in improving pain. CBT and BT have minimal effects on disability associated with chronic pain. CBT and BT are effective in altering mood outcomes, and there is some evidence that these changes are maintained at six months;"[http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007407.pub3/abstract] and a review of RCTs of psychological therapies for the management of chronic and recurrent pain in children and adolescents, by the same authors, found "Psychological treatments are effective in pain control for children with headache and benefits appear to be maintained. Psychological treatments may also improve pain control for children with musculoskeletal and recurrent abdominal pain (i.e. Crohn's disease). There is some evidence available to estimate effects on disability or mood."[http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003968.pub3/abstract]

Hypnosis
A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of pain in some conditions, though the number of patients enrolled in the studies was small, bringing up issues of power to detect group differences, and most lacked credible controls for placebo and/or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions." [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/]

6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices

1. As with any treatment, it is important to consider safety before using complementary health products and practices. If you are considering a complementary health practice to help manage your chronic pain, talk with your health care providers first. [http://nccam.nih.gov/health/safety].

2. Reviews of research on acupuncture, massage, and spinal manipulation for chronic low-back pain have found evidence that these therapies may be beneficial.

3. According to reviewers who have assessed the research on complementary health practices and fibromyalgia, much of the research is still preliminary, and evidence of effectiveness for the various therapies used is limited. However, research has shown that tai chi may provide a benefit to patients with fibromyalgia.

4. Some research has shown that acupuncture may help to reduce pain and improve joint mobility, and a small number of studies on massage and tai chi for osteoarthritis symptoms suggest that both therapies may help to reduce pain and improve the ability to walk and move.

5. There is some evidence that spinal manipulation may help patients suffering from chronic tension-type or neck-related headaches.

6. In general, there is not enough scientific evidence to prove that any complementary health practices are effective for rheumatoid arthritis, and there are safety concerns about some practices.

Disclaimer - Information
These statements have not been approved by the U.S. Food and Drug Administration (FDA). This information is not intended to diagnose, treat, cure or prevent any disease.

The information provided using the Holistic Lifestyle Community Blog Web site is only intended to be general summary information to the public. It is not intended to take the place of either the written law or regulations. It is not Holistic Lifestyle Community Blog’s intention to provide specific advice, medical or otherwise, but rather to provide users with information to better understand and manage their life, environment, personal health and wellness, and their diagnosed disorders. Holistic Lifestyle Community Blog urges users to consult with a qualified health care professional for diagnosis and/or for answers to their personal medical questions. If you have a medical emergency call 9-1-1. The mention of any product, service, or therapy is not an endorsement by Holistic Lifestyle Community Blog. Any mention in the Holistic Lifestyle Community Blog of a specific brand name is not an endorsement of the product.

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