Chronic Pain Management

Many health care professionals are now recognising that pain is complex and multidimensional. Patients with chronic pain require a careful evaluation and a treatment strategy that may incorporate a variety of distinct modalities. 

Among the modalities that now are being explored as treatments for chronic pain are numerous approaches that usually are considered out of mainstream medicine-the so-called complementary and alternative medical treatments. Many specialists in pain management view the integration of traditional treatment approaches and a wide range of complementary and alternative medicine approaches as the ideal goal for many types of chronic pain. "Integrative Pain Therapy" is a term that has been used to describe this effort to link these traditional and non-traditional approaches. 

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Hypnosis

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Hypnosis is a highly relaxed, trance-like state in which the conscious or rational part of the brain is temporarily tuned out through a focus on relaxation and non-attention to distracting thoughts. During hypnosis, changes like those found in meditation can occur, such as a slowing of the pulse and respiration, and an increase in alpha brain waves. The person may become more open to specific suggestions and therapeutic goals such as pain reduction. In the post-suggestion phase, the continued use of the new behaviour after the hypnosis session is reinforced. 

Medical hypnosis has been shown to be helpful in reducing both acute and chronic pain (Holyroid, 1996). A National Institutes of Health panel found hypnosis to be effective in alleviating the pain associated with cancer (NIH, 1996). A 1997 review of the literature on hypnosis in pain control, which evaluated all controlled scientific studies comparing hypnosis to other psychological interventions for pain, showed hypnosis to be equally or more effective in reducing suffering and possibly even reducing pain sensation (Holyroid, 1996). Other studies have shown effectiveness of hypnosis for pain associated with burns, cancer, and rheumatoid arthritis (DePalma, 1997) (Sellick, 1998) and pain and anxiety reduction related to surgery (Lang, 2000). Clinical evidence supports the use of hypnosis in reducing pain in a wide variety of acute and chronic pain conditions for a substantial number of patients.

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Imagery

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Imagery is the use of imagined pictures, sounds, or sensations for generalized relaxation or for specific therapeutic goals, such as the reduction of pain. These images can be initiated by the patient or guided by a practitioner. The sessions in which imagery is used can be individual or group. 

More than half the studies of imagery for pain–postoperative pain, cancer pain, chronic low back pain, burns, and migraine headache–report significant relief from the procedure (Eller, 1999). In a review of laboratory research on coping strategies for pain control, imagery was the most effective in relieving pain (Eller, 1999). Many of these studies, however, evaluate imagery together with other interventions such as hypnosis, cognitive-behavioural therapy and relaxation techniques. Nonetheless, the limited evidence suggests the usefulness of guided imagery in reducing the sensory and emotional components of pain. The Agency for Health Care Policy and Research recommends the use of imagery for reduction of pain intensity and distress for cancer pain and for the management of mild to severe acute pain (AHCPR, 1992).

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Relaxation Therapies

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Relaxation therapies include a range of techniques such as autogenic training, various forms of meditation, progressive muscle relaxation, deep breathing, and paced respiration. The goal of these therapeutic approaches is overall relaxation and stress reduction. Practice can produce a set of physiologic changes that result in slowed respiration, lowered pulse and blood pressure, an increase in alpha wave brain activity, and possibly even reduction in the body's inflammatory response mechanism (Lutgendorf, 2000). This can have a positive impact on health and improve symptoms in many acute and chronic illnesses and conditions, including pain.

Relaxation training may decrease pain, depression and disability (Barkin, 1996). According to the 1996 National Institutes of Health report on the treatment of chronic pain and insomnia, there is strong evidence for the effectiveness of relaxation techniques in reducing chronic pain in a variety of medical conditions. Effects may include reduced pain and muscle tension, reduced anxiety and insomnia, and increased activity level (Good 1996, Carroll, 1998; Mandle, 1996). 

Meditation is a specific type of relaxation intervention that also can have an effect on pain. Results suggest that meditation can result in a higher tolerance to pain; decreased anxiety, stress and depression; increased activity levels; decreased use of pain-related medications; and increased levels of self-esteem (Mills, 1981; Kabat-Zinn, 1985; Harmon, 1999). The meditative technique based on increased awareness and staying in the moment, called mindfulness meditation, has been successfully used in treatment programs to reduce pain and improve mood in patients with chronic pain from a variety of conditions, including facial pain, coronary and non-coronary chest pain, gastrointestinal pain, low back, neck and shoulder pain and headache (Kabat-Zinn, 1982).

 

An excerpt from the "Healing Chronic Pain" web site www.healingchronicpain.org

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