Wednesday, April 7, 2010

Surprising Ways to Manage Chronic Pain

From massage to volunteering—pain management beyond the usual medications.

Mindfulness meditation
Though it might seem as though focusing on “being in the moment” without judgment would make pain worse, several studies now show that a form of meditation called “mindfulness”—which encourages people to do just that—can be a painkiller.
“Don’t reflect on the past and don’t anticipate the future: If you can do that, you are essentially being mindful without even the meditation component,” Zeidan says. His research found that college students given just three 20-minute training and meditation practice sessions actually raised their pain thresholds.
Before the study trials began, each person was tested to see how much electrical current applied to the forearm would be experienced as “high” and “low” pain. Afterward, it took much more current to cause similar levels of pain—but only in the group that was trained in meditation. “Meditation had a very comprehensive effect on altering the perception of pain,” Zeidan says. “We had to turn juice up to get them to feel pain even when they were not meditating.”

As with therapy, antidepressants are used to treat both pain and depression. But they don’t work only by relieving depression. Says Clauw, “Lots of patients get offended when they have pain and the doctor gives antidepressants.” Nonetheless, appropriate medications fight pain even if the patient isn’t depressed.
Not just any antidepressant will do, however. “Drugs that only increase serotonin don’t seem to be effective,” he says. Effective medications act on the neurotransmitter norepinephrine as well, including the older tricyclic antidepressants such as Elavil (amitriptyline) or so-called dual reuptake inhibitors such as Cymbalta (duloxetine).

Cognitive behavioral therapy
Though some think that using talk therapy for pain implies that the pain somehow isn’t “real,” in fact, the mind and body can’t be separated. Even pain from the most “physical” problems like cancer or injuries is literally “all in your head,” and the rest of what goes on there influences how bad it will be.
“If you’re in a bad mood, if you’re highly anxious, if you have fear and if you anticipate a painful stimulus—all of those things will increase your perception of pain,” says Fadel Zeidan, Ph.D., research fellow in neurobiology at Wake Forest University School of Medicine.
Another mental factor that makes pain worse is “catastrophizing.” This includes thinking, for example, that if one thing goes wrong, everything else will soon follow—and if pain is bad now, it will be bad forever. Clauw studied the effects of a Web site that teaches cognitive behavioral techniques to increase patients’ sense of control and to fight catastrophizing and other behaviors that worsen pain, showing that it was helpful in fibromyalgia. The content was licensed by the drug company Lilly and is now available for free at
Video: Moods & Pain

Clauw views exercise as the best drug we have for the chronic pain of fibromyalgia. “Exercise has been shown repeatedly in any chronic pain state to be an effective treatment,” he says.
His research found that exercise is especially potent for some people. “If you take asymptomatic healthy college students and deprive them of routine exercise, some people don’t feel different, but some, within a week, will develop pain, fatigue and memory problems.”
This group typically discovers early in life that activity is vital for them, but if they have a major injury or illness, they are more prone to develop chronic pain from immobility. While exercise can help anyone with pain, “Exercise and regular sleep are necessary to feel normal and not have pain in a subset of the population.”
Be sure not to overdo it, however, Clauw cautions. “Often people try to do too much too soon and that leads to an exacerbation of pain and then they believe that exercise is bad rather than good. In general, as with drugs, start low and go slow.”
Video: Treating Muscle Pain

Like massage, acupuncture is difficult to study because it’s hard to give a “fake” massage or “placebo” acupuncture. Says Clauw: “In ‘sham’ or placebo controlled trials in chronic pain, more studies have shown that acupuncture doesn’t work. But that doesn’t necessarily mean that it’s not effective—it might be that there really is no such thing as sham acupuncture. Acupuncture might somehow be effective in engendering a placebo response.” Whether that matters if someone feels significant pain relief is a question only the patient can answer. “The best evidence that it’s effective is that a lot people will pay out of pocket to use it,” he says.
Clauw himself conducted a fascinating imaging study of acupuncture, finding that while patients with fibromyalgia reported decreased pain with both fake and real acupuncture, fake acupuncture affected brain opioid receptors in a way that was more comparable to that seen with placebo. “Sham acupuncture may work via placebo effects and active acupuncture may work by more specific effects. That could help explain why trials don’t show much difference,” he says.
Some have claimed that electroacupuncture—which runs a small current through acupuncture needles—is more effective than needles alone, but Clauw says it’s even harder to parse out placebo effects here. “It may give a stronger placebo effect,” he says. For people in pain, however, that could be a good thing.
Video: The Body in Balance: Exploring Acupuncture

Connect and help others
Pain can make you feel hopeless and helpless—and feeling despondent can make pain worse. To escape this cycle, try to improve your sense of control over your life. Research finds that people with pain who see themselves as having greater power over their situation suffer much less.
"Don’t buy into an utterly passive ‘sick’ role," says Stephen Post, Ph.D., author of Why Good Things Happen to Good People. "Tell yourself, ‘I’m still an agent of purpose, goodness and moral creativity in the world.’”
There’s a growing body of research showing that giving gifts, volunteering and performing other acts of kindness and altruism not only feel good but also cut pain. For example, one small study of patients with chronic pain conducted by researchers at Boston College in 2002 found that those who trained and then volunteered to help others in pain cut their pain intensity almost in half after six months. There was also a significant reduction in pain-related disability.
“They get a greater sense of purpose. You see a reduction in depression levels as well, but what’s really interesting is this decrease in chronic pain,” says Post.
It’s important, however, that helping be voluntary, not forced. Research shows that people with overwhelming caregiving obligations—like spouses of Alzheimer’s patients—are actually more stressed than others. Uncontrollable stress can increase pain.
Video: Simple Life can make you Healthier and Happier

Massage (giving, not just getting)
Between 30 million and 50 million Americans suffer from serious, chronic pain—but while painkillers and other traditional treatments provide essential relief for many, they’re not always enough. Here are some unusual approaches and alternatives that may help.
Getting a massage can often relieve pain, but research shows that giving massages has profound physiological and psychological effects, too. In fact, massaging infants reduced stress hormones and doctor visits by elderly volunteers more than receiving massage did. Although this study, published in 1998 in the Journal of Applied Gerontology, did not directly measure pain, the reduction in stress hormones or doctor visits, the improvement in social functioning and decrease in anxiety and depression that were seen all suggest benefit.
Physical affection and touch are an important aspect of social support, which is important in relieving pain. Dr. Daniel Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, says, “If you touch someone, it doesn’t matter what disease they have, the patient will do better. Social support has been shown over and over again to be predictive of [good] outcomes across all diseases, not just pain.
“There’s not great evidence [supporting the use of massage in chronic pain] but I do think it’s useful, especially deep-tissue massage.”
Video: How to Give a Neck and Shoulder Massage

No comments:

Post a Comment

Other blog by ShIn

This blog talk about phones, share the lastest model's phone and it technology. ( Grand Opened )