Top Ten Reviews


Pain Management

 

Pain Management Introduction

Pain Management is a complex physical and psychological experience that may, or may not, reflect injury or tissue damage. In fact, the paradox of pain is that it may often exist without recent injury or tissue damage.

  1. Acute pain is usually a sign of actual or potential injury or trauma. It is often associated with anxiety or sympathetic nervous system hyperactivity, lasting a short time, generally between one to six months, according to different definitions.
  2. Chronic pain lasts longer than this period. Chronic pain is usually paralleled to the duration of the many physiological healing processes of acute tissue damage.

Other symptoms commonly become associated with the chronic stage of pain, including; anxiety, depression, insomnia, weight loss, appetite disturbance, constipation, and decreased libido.

Pain can have a somatogenic or organic cause, involving a physiological mechanism. Pain may also be psychogenic, caused by certain psychological issues. Unfortunately, doctors too often ascribe chronic pain to a psychological causes when organic pathology is not apparent; the correct description in this case, however, should be idiopathic pain (i.e. pain of unknown origin).

Pain Management Signs & Symptoms

Because pain is predominantly a subjective experience, the best reflection of the existence and severity of the condition is within the list of words commonly used to describe pain. These words, compiled by psychological researchers Melzack and Torgerson, are classified into three separate catagories [4]:

  • Sensory Pain: throbbing, pounding, shooting, pricking, sharp, stabbing, pinching, pressing, gnawing, crushing, burning, searing, stinging, smarting, wrenching, etc.
  • Affective or Emotional Pain: sore, tender, sickening, blinding, etc.
  • Evaluative Pain: excruciating, intense, unbearable, etc.

Conventional Pain Relief Treatment

Conventional treatments in areas of chronic pain relief, have been primarily through pharmaceutical medications. Among the most popular are non-opioid analgesics. These include popular over-the-counter products, like acetaminophen and non-steroidal anti-inflammatory drugs (NSAID’s), such as ibuprofen, naproxen and aspirin. All are used for the treatment of mild to moderate pain. Excessive doses can cause toxic effects on the liver and kidney. Another classification of medicinals used are of the opioid, or narcotic, variety. These opioid agents bind to opioid receptors in the central nervous system and can control either acute pain after injury or surgery, or chronic and severe pains, such as those resulting from cancer and other diseases.

For acute pain relief, morphine is usually delivered intravenously or intramuscularly. Other opioids include codeine, and the synthetic agents methadone and oxycodone. Opioids may be administered in the elderly with extreme precaution, infants, and those with kidney, respiratory, or liver diseases. In all cases, however, dosage is guided by frequent monitoring of pain levels, respiratory rate, and blood pressure. Adverse reactions, or side effects, of morphine and other opioids may manifest as constipation, nausea, or respiratory depression. Physical dependence can also be a danger [5].

Non-drug alternatives for pain relief in conventional medicine can range from non-invasive approaches like physical therapy; including manual therapy, therapeutic exercise and modalities like ultrasound, to spinal surgery and the implanting of electrical stimulators.

Acupuncture Pain Relief Therapy

Acupuncture has provided analgesia for acute and chronic pain for thousands of years in China. Past clinical and experimental studies show an estimated 70 percent level of pain relief in comparison to placebo [6, 7]. Objective evidence of this analgesic effect has also been provided by EEG evoked-potential studies [8].

Different types of electrical stimulation devices have been used successfully for pain relief. In particular, transcutaneous electrical nerve simulation (TENS) has become increasingly popular for home-based therapy. This method of therapy utilizes pads attached over the area of pain, or clips attached to the ear lobe (for central nervous system control), and a small control unit attached to the belt [9].

Psychological strategies for pain management include both cognitive and behavioral skills and include; focusing and relaxation training, and preparatory information, used to develop control in conditions like chronic low back pain, irritable bowel syndrome, cancer, migraine headaches and rheumatic conditions [10]. Hypnosis has also been successful in inducing a deep relaxation state, which directs focus to relieve a specific area of pain [11].

Supplements for Pain Relief

Botanical agents have traditionally been used to provide pain relief throughout the world for thousands of years. Today these same natural sources still provide us with safer alternatives to pharmaceutical drugs.

Capsaicin

Capsaicin, the active ingredient of cayenne or red pepper, has been a successful topically applied (0.025% or 0.075% in a cream base) Pain Relief cream for a number of chronic conditions. Research supports its effectiveness in reducing the pain of post-herpetic neuralgia (the chronic pain persisting after the healing of shingles lesions), trigeminal neuralgia (facial pain), post-mastectomy pain, pain due to chemotherapy or radiation, diabetic neuropathy, cluster headaches, and arthritis [12].

Kava

Kava, an herb known for its sedative effect, was also demonstrated to have analgesic effect, although through a mechanism different from opiate and non-steroidal anti-inflammatory drugs [13].



Ginger

The analgesic effect of ginger in experimental mammalian studies, suggest that it may operate like capsaicin in inhibiting the release of the neurotransmitter Substance P [14]. In studies on rheumatoid arthritis and migraine headache, ginger had marked anti-inflammatory effect, with 75% of arthritis patients and 100 % of patient with muscular discomfort experiencing relief in pain or swelling [15].

Curcumin (Turmeric)

Curcumin, the active ingredient of turmeric, has been used in the Ayurvedic medical tradition of India for topical pain relief, also operating like capsaicin to deplete the nerve endings of Substance P [16].

Angelica

The Chinese herb angelica (known in Chinese as tang-kuei), through its pain-relieving and muscle-relaxing acitivity, has demonstrated an analgesic action 1.7 times that of aspirin [17]. Historically, angelica has treated such conditions as uterine cramps, trauma, headaches, and arthritis [18].

Corydalis

The Chinese herb yan hu su, or corydalis, has traditionally been used like the opiates morphine and codeine for neurological pain relief. It has also been used for the pain associated with headaches, low back, abdomen, arthritis, and dysmenorrhea [19].

White Willow Bark

The active ingredient of white willow bark is salicin, from which aspirin (acetylsalicylic acid) is formed. White willow bark has been a traditional native American herbal agent, used for controlling painful conditions like osteoarthritis [20].

D-phenylalanine

The amino acid D-phenylalanine, through its promotion of the endorphin pathway, has demonstrated positive effects in relieving post-surgical lower back pain, osteoarthritis, whiplash, rheumatoid arthritis, fibrositis and migraine headaches [21].

L-tryptophan

L-tryptophan, another amino acid, has raised pain tolerance threshold in numerous experimental and clinical studies of acute and chronic pain conditions [22].

References

1 The Merck Manual, 17th edition, Beers M and Berkow R.,ed. 1999: 1363.

2 Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-979.

3 Melzack R., Casey KC. Sensory, motivational and central control of pain. In Kenshalo DL, ed. The skin senses. Springfield IL: CC Thomas. 1968: 423-443.

4 Melzack R. and Torgerson WS. On the language of pain. Anesthesiology 34. 1971: 50-59.

5 The Merck Manual, 17th edition. Beers M and Berkow R, ed. 1999:1364-70.

6 Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain. 1983: 16: 111-127.

7 Reichmanis M, Becker RO. Relief of experimentally-induced pain by stimulation at acupuncture loci, a review. Comp Med East West. 1973; 5: 281-288.

8 Chapman CR, Kitaeff R, et al. Evoked potential assessment of acupunctural analgesia. Pain. 1980; 9: 183-7.

9 Shealy CN, Maurer D. Transcutaneous nerve stimulation for control of pain. Surg Neurol. 1974; 2: 45-57.

10 Kitaeff R. Non-pharmacological control of pain. Textbook of natural medicine, vol I, second edition: 501-2

11 Chaves JF. Recent advances in the applications of hypnosis to pain mangement. Am Soc Clin Hypnosis. 1994; 34: 117-129.

12 Murray M and Pizzorno J. Textbook of natural medicine, vol I, second edition. Pizzorno J. and Murray M ed. 1999: 630-1.

13 Jamieson DD, Duffield PH. The antinociceptive action of kava components in mice. Clin Exp Pharmacol Physiol 1990; 17: 494-508.

14 Onagi T., Minami M., Kumishi Y, Staoh M. Capsaicin-like effect of (6)-shagoal on substance P-containing primary afferents of rats. A possible mechanism of its analgesic action. Neuropharmacol. 1992; 31: 1165-1169.



15 Murray M, Pizzorno J. Textbook of natural medicine, vol I, second edition. Pizzorno J. and Murray M. ed. 1999:1028-9.



16 Patacchini R., Maggi CA and Meli A. Capsaicin-like activity of some natual pungent substances on peripheral nerve endings of visceral primary afferents. Arch Pharmacol 1990, 342: 72-7.



17 Tanaka S., Kuno Y, Tabata M., Konoshima M. Effects of “toki” (angelica acutiloba Kitagawa) extracts on writhing and capillary permeability in mice:analgesic and anti-inflammatory effects. Yakugaku Zasch 1071; 91: 1098-1104.



18 Murray M., Pizzorno J. Textbook of naturopathic medicine, vol I, second edition. Pizzorno J. and Murray, M. ed. 1999: 591.



19 Yeung H. Handbook of Chinese herbs and formulas, vol. I. Institute of Chinese medicine. 1983: 566.



20 Mills SY, Jacoby RK, Chackfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br. J. Rheum 1996; 35: 874-8.



21 Ehrenpreis S et al. Naloxone reversible analgesia in mice produced by D-phenylalanine and hydrocinnamic acid, inhibitors of carboxypeptidase A. Adv Pain Res & Therapy, vol 3. 1978.



22 Werbach M. Nutritional influences on illness. Keats. 1988: 344-5.



23 Maclean W. The clinical manual of Chinese herbal patent medicines. Pangolin.2000: 268.

24 Locke A. and Geddes N. The complete guide to homeopathy. Darling Kindesley. 1995: 154-7.