Other Therapies
It is often a good idea to try non-medication therapies in conjunction with medication. See your doctor for advice and for recommended practitioners.
Massage
Massage can help to relieve pain directly, by gently stimulating nerves in the skin, which then send signals into the spinal cord. These crowd out signals from pain fibres that are sending a pain message into the spinal cord. Thus this method is based on the gate theory of pain modification. Click here to read more about the gate theory.
Acupuncture
Acupuncture originated in China. A series of very fine needles are inserted into the skin at specific sites on the body - different parts of the body are meant to govern different health problems. The needles are usually left in for 10-30 minutes, but some practitioners only leave them in for a few seconds. The needles are twirled, warmed or electrically stimulated. Acupuncture is thought to work as a pain reliever by increasing the body's release of natural painkillers - endorphin and serotonin - in the pain pathways of both the spinal cord and the brain. This modifies the way pain signals are received. 1
Acupuncture needles are very thin, thinner than the needles used in normal injections.
Some pain specialists may advise acupuncture in addition to other approaches, if you are suffering from chronic pain that is not properly controlled by medication.
Biofeedback
Biofeedback is a technique that uses special machines to help you to consciously control involuntary responses such as heart rate, brain waves and muscle contractions. Sensors record involuntary responses that tend to increase under stress. You get feedback about these, through the machine, as a visual, auditory or tactile (touch) signal. You then try and control the responses. Your efforts are electronically monitored with graphs, or on a computer screen, which you can see 2. Through biofeedback, you will learn to relax your muscles and take deeper breaths, which helps you to relax. This can help to reduce pain.
Hypnosis
The word “hypnosis” is derived from the Greek word “hypnos” which means sleep. However, hypnosis is not exactly like sleep. When a patient is hypnotised, the mind is in a state of focused awareness, a trancelike state of deep relaxation in which the mind is open to suggestion. Hypnosis has been used to alleviate many different kinds of pain: pain from childbirth, dental work, burns, migraine headaches, cancer pain, arthritis and nerve pain.
The exact way hypnosis works is not fully understood. It may decrease the amount of pain signal that gets sent to the brain, or it may divert your attention from the pain. A third suggestion is that we may know that the pain is there, but not feel it. Through deep relaxation, hypnosis can stop us feeling it.
Yoga
The word yoga comes from the Sanskrit word 'yuga' - to join. It aims for the perfect union of body, mind and spirit, through a system of postures, breath control, sounds, meditation and other practices. Its main physical benefit is an increase in suppleness. Your muscles and tendons will be more flexible, which will decrease injury and painful stiffness. Many people take up yoga to reduce stress, rather than to be more flexible. Although there is little scientific evidence that it will reduce pain for you in this way, it may help and is unlikely to do any harm.
Osteopathy and chiropractic
Patients with backache are particularly likely to seek help from an osteopath or a chiropractor at some point, but these specialists will treat other parts of the body too.
Chiropractors treat bone, joint and muscle problems and the effects that they have on the nervous system. Chiropractors believe that interferences with the muscle, skeletal and nervous systems impair the body’s normal functions and lower its resistance to disease. They work on all the joints of the body, focusing on the spine, and use their hands to make specific adjustments that they claim improve the efficiency of the nervous system and release the body’s natural healing ability. Some chiropractors use water, light, massage, ultrasound, electric or heat therapy. They may also give you supports such as straps, tapes and braces. The chiropractic approach to healthcare is holistic, stressing the patient’s overall health and wellness. Chiropractors counsel patients about nutrition, exercise, changes in lifestyle and stress management, but do not prescribe drugs or perform surgery.
Osteopaths primarily work on joints and muscles with their hands. Treatment methods range from massage of muscles and connective tissues to manipulation and stretching of joints. The aim is to alleviate pain, restore freedom of motion and enhance the body's own healing power. Just like chiropractors, osteopaths also look at relevant psychological and social factors for a holistic approach. Osteopathy can be used to relieve chronic or acute problems including joint pain, upper and lower back pain, sciatica and arthritis.
Transcutaneous electrical nerve stimulation (TENS)
With transcutaneous electrical nerve stimulation (TENS), electrodes are attached to the surface of the skin and connected to a small portable battery powered unit. The electrodes are used to stimulate nerves in the skin and tissues just under the skin, with very small amounts of electricity. The gently stimulated nerves send signals into the spinal cord. These crowd out signals from pain fibres that are sending a pain message into the spinal cord. Thus, this method is based on the gate theory of pain modification. Click here to read more about the gate theory.
Success depends on the correct positioning of the electrodes and optimal adjustment of the electrical output. These differ from one person to another. It is difficult to predict whether or not you will benefit from TENS, and if you do benefit, the effect may not last more than a few weeks. TENS may be useful for patients with neuropathic pain (pain caused by nerve damage).
Spinal cord and brain stimulators
With a spinal cord stimulator, a thin wire is implanted near the spinal cord, and delivers a small electrical signal to the spinal cord. This signal crowds out signals from pain fibres that are sending a pain message into the spinal cord. Thus this method is based on the gate theory of pain modification. Click here to read more about the gate theory.
You may be asked to consider a similar technique that stimulates particular areas of your brain to reduce the pain sensation. 3
These methods work because they are done in a controlled way. Deep brain stimulation is now an accepted technique for the relief of a number of painful conditions refractory to conventional treatment, such as central post-stroke pain. Spinal stimulation tends to be reserved for neuropathic pain. 4
References
- What is acupuncture? The British Medical Acupuncture Society. accessed October 2005
- Biofeedback
- Nicholson BD. Evaluation and treatment of central pain syndromes. Neurology 2004;62 (suppl 2):S30-S36
- 4. Linderoth B, Simpson BA, Meyerson BA. Spinal cord and brain stimulation. Chapter 37. Wall and Melzack's Textbook of Pain 5th ed , ed: Mcmahon S, Koltzenburg M. Churchill Livingstone, 2005