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Chronic pain affects nearly 90 million Americans. It usually begins with a sports injury, car accident or health condition like migraines, diabetes, arthritis and cancer. Chronic pain is different from the acute pain of stubbing your toe and often feels like burning, shooting, or shocking sensations. The good news is that today’s pain specialists have sophisticated new treatments — from medications to advanced technologies — to provide chronic pain relief.
Chronic pain can be classified as nociceptive or neuropathic pain. In some cases (nociceptive pain) the body’s nervous system is working properly, relaying signals to the brain that there is an injury. But in neuropathic pain the nervous system is not functioning properly. There is no obvious source of pain but the body continues to tell the brain that injury is present. Treatment is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions. The concept behind most interventional procedures for pain control is that there is a specific structure in the body with nerves of sensation that is generating the pain. Repair or replacement of the damaged structure may be all that is needed to bring relief. For neuropathic pain, specialists have multiple tools at their disposal – painkillers, injections, physical therapy, massage, heat therapy and use an individualized approach to attack symptoms from multiple angles.
Treatment
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Heat
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Infrared heat
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Transmits the heat directly to the body through vibration of the water molecules present. Vasodilation– an increase in the diameter of the blood vessels, results in increased permeability allowing substances (oxygen , etc.) to pass more easily
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Heat sensation
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Capsaicin- works by reducing transmission of a pain-relaying chemical called substance P to the brain
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Radiofrequency ablation
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Pain relief lasts for a relatively long period, from three to six months.
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Massage
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Influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.
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Exercise/ Physical Therapy
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Reduces pain perception, Strong muscles help support and protect, Stretching exercises lengthen shortened muscles which can pull and cause pain.
(amount and form of exercise recommended for each individual will vary depending on area affected, amount of inflammation, how stable the joints are)
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Percutaneous Electrical Nerve Stimulation (PENS)
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Theorized that electrical stimulation of the nerve fibers close to a segment of the spinal cord blocks the pain signals from reaching the brain or that electrical stimulation reduces inflammation, swelling and relaxes muscle fibers by releasing endorphins in the brain which act like analgesics
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Linear polarized near-infrared light
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Suggested that PL-irradiation produces almost the same effect on shoulder joint range of motion as light exercise.
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Radiofrequency ablation
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Electrical current produced by a radio wave is used to heat-and-destroy a small area of nerve tissue
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Accupuncture/ Sham acupuncture
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evidence supports the claim that opioid peptides are released during acupuncture
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Nutritional Modification
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Certain foods (aspartame, methanol) contribute to nervous system damage, others modulate inflammation (omega fatty acids)
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Modern knowledge of chemical pain signals — how the nervous system, including the spinal cord, interacts with the brain to create the sensation of pain– has led to methods for blocking or ‘confusing’ these signals.
The brain can powerfully shape pain and we are just learning how to exploit its power. Scientists are investigating the use of antidepressants, biofeedback and relaxation techniques. Wake Forest University School of Medicine researchers conducted a study that suggests that decreasing the expectation of pain can reduce both the pain-related brain activity and perception of pain intensity (Koyama). Patients elsewhere have been taught to control body functions such as muscle tension, breathing, and heart rate — all of which help to reduce anxiety and stress reactions. They can be taught to unlearn the pain response.
There is help available for chronic pain. Seek treatment early when there is a better chance for success.
References
Binder, I.. Aktuelle Urol. 2008 May;39(3):205-14. The complexity of chronic pelvic pain exemplified by the condition currently called interstitial cystitis. Part 1: Background and basic principles.
Usha, Clin Drug Investig. 2004;24(6):353-63. Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis
Muneshige H. J Rehabil Res Dev. 2006 Jul-Aug;43(4):565-72. Antinociceptive effect of linear polarized 0.6 to 1.6 microm irradiation of lumbar sympathetic ganglia in chronic constriction injury rats.
Demura, Shinichi Clinical Journal of Sport Medicine:Volume 16(4)July 2006pp 293-297
Haake M. Arch Intern Med. 2007 Sep 24;167(17):1892-8. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.
Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. “The subjective experience of pain: Where expectations become reality.” Proceedings of the National Academy of Sciences, September 6, 2005, Vol.102, pp.12950-12955.
http://www.empireblue.com/wellchoice/medicalpolicies/guidelines/gl_pw_a053534.htm accessed Mar 9, 2009
Martin Hoffman, MD. Medical College of Wisconsin. Department of Physical Medicine and Rehabilitation. Exercise: a Natural Reliever for Chronic Low Back Pain http://www.mcw.edu
Little, P. Br J Sports Med. 2008 Dec;42(12):965-8. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.
http://www.blatmanpainclinic.com/blat_articles_12.htm
Haake, M. Archives of Internal Medicine, Sept. 24, 2007; vol 167: pp 1892-1899. Heinz G. Endres, MD, Eric Manheimer, MS, research associate, Center for Integrative Medicine, University of Maryland School of Medicine, College Park.