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Treating pain is important. Unrelieved pain can cause anxiety, depression, feelings for helplessness, as well as disruptions in daily activities, appetite, and sleep.

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Stimulatory Approaches
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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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