Pain Medicine & Palliative Care: Pain Medicine
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Pain relief also can be achieved through approaches which stimulate nerve
pathways to produce analgesia. The best known and most widely prescribed
are acupuncture and transcutaneous electrical nerve stimulation (TENS).
These approaches stimulate the nerve pathways to reduce pain and facilitate
motor function.
Acupuncture
Acupuncture is the strategic insertion of fine needles into specific points
on the body's surface for the purpose of stimulating healing. It is part
of an ancient system of healthcare developed in China over 3000 years
ago. Acupuncture is based on the concept that energy (called chi)
flows through the body in certain patterns (meridians). The free flow
of these energies ensures good health. Change in the free flow of this
energy, such as stuckness, blockages, or imbalances, are believed to lead
to pain, congestion and eventually disease conditions in the body.
Recent research has elucidated some of the physiologic and biochemical
bases of acupuncture. Acupuncture stimulation has been shown to release
central nervous system endorphins and spinal cord dynorphins, explaining
part of its mechanism of action. It has also been shown to promote the
release of the chemical that activates the adrenal glands (adrenocorticotrophic
hormone or ACTH), affect chemicals that are known to be involved in mood
and pain perception (serotonin, GABA, catecholamines, dopamine, etc),
and influence one of the body's pain-generating messengers (substance
P). While its effects have traditionally been explained in terms of energy
flow dynamics (Qi or Chi), science has shown that acupuncture may work
at least partly by directly affecting the function of the nervous system.
Since the 1970's, acupuncture has been practiced in the United States
by licensed acupuncturists, physicians, dentists, and others. It has been
used to treat a wide variety of health conditions, as well as to maintain
an optimal state of health. Based on clinical experience, the World Health
Organization lists more than 40 conditions for which acupuncture might
be considered, including a variety of digestive, gynecological, neurological,
respiratory, and psychological conditions. In 1997, the National Institutes
of Health Consensus Development Conference, a panel of experts, reviewed
the scientific evidence on the effectiveness of acupuncture and concluded
that acupuncture was effective for postoperative dental pain, and helpful
as an additional treatment for headache, menstrual cramps, fibromyalgia,
myofascial pain, osteoarthritis, tennis elbow, low back pain, and carpal
tunnel syndrome.
More recent studies and reviews have supported the use of acupuncture
for migraine and tension headaches, chronic neck pain, and low back pain,
neck pain and soft-tissue injuries of the peripheral joints. According
to a recent National Institutes of Health study (2001), acupuncture is
most frequently used in both China and the U.S. for musculoskeletal pain
relief, with other common uses for pain including migraine and peripheral
nerve neuralgia.
In a 2001 review of nine surveys on the safety of acupuncture, it was
found that minor adverse events were common, but serious adverse events
were rare. The most commonly reported were needle pain, tiredness, nausea
or vomiting and slight bleeding, most often bruising. Feelings of faintness
were very rare. Pneumothorax, which is a complication that may occur if
a needle accidentally is placed into the chest cavity, is also very rare,
occurring only twice in nearly 250,000 treatments. There were no reported
cases of infection or transmission of disease through acupuncture.
Transcutaneous Electrical Nerve Stimulation
(TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) has been used successfully
to help control chronic pain in various conditions, including chronic
neuropathy, arthritis, postoperative pain, post-fracture recovery, low
back pain, postherpetic neuralgia, myofascial pain, and advanced painful
malignancies. Patients receiving TENS carry a small, box-shaped device
that transmits electrical impulses into the body through the electrodes
to interfere with pain signals. A buzzing, tingling or tapping sensation
is felt. (The device is an electrical unit that delivers different frequencies
and intensities of stimulation to the skin through electrodes.)
To increase the chance that TENS can help, the patient is given a TENS
device and then instructed to apply a variety of different types of stimulation
during a trial period. Patients vary a great deal in the type of TENS
that works.
TENS should not be used on inflamed or infected skin, in the presence
of a pacemaker, or if the patient is pregnant.
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