What is Chronic Pain?
While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).
Is there any treatment?
Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.
What is the prognosis?
Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.
What research is being done?
Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers believe activates endorphin systems. Other experiments with acupuncture have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.
What we do at Natural Medicine
Pain Management: Alternative Therapy
The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been sufficiently scientifically documented or identified as safe and effective for a specific condition. Alternative therapy encompasses a variety of disciplines including acupuncture, guided imagery, chiropractic treatment, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others.
In the past decade, strong evidence has been accumulated regarding the benefits of mind-body therapies, acupuncture, and some nutritional supplements for treating pain. Other alternative therapies such as massage, chiropractic therapies, therapeutic touch, certain herbal therapies, and dietary approaches have the potential to alleviate pain in some cases. However, the evidence supporting these therapies is less concrete.
Mind-Body Therapies
Mind-body therapies are treatments that are meant to help the mind’s ability to affect the functions and symptoms of the body. Mind-body therapies use various approaches including relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis. Relaxation techniques can help alleviate discomfort related to chronic pain.
Acupuncture
Although the World Health Organization currently recognizes more than 30 diseases or conditions that can be helped by acupuncture treatment, one of the main uses of acupuncture is for pain relief.
Sixteenth century Chinese doctors believed that illness was due to an imbalance of energy in the body. In acupuncture, disposable, stainless steel needles are used to stimulate the body's 14 major meridians, or energy-carrying channels, to resist or overcome illnesses and conditions by correcting these imbalances.
Acupuncture is also thought to decrease pain by increasing the release of chemicals that block pain, called endorphins. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like chemicals produced in our own bodies during times of pain or stress). Endorphins, along with other neurotransmitters (body chemicals that modify nerve impulses), block the message of pain from being delivered up to the brain
Acupuncture may be useful as an accompanying treatment for many pain-related conditions, including: headache, low back pain, menstrual cramps, carpal tunnel syndrome, tennis elbow, fibromyalgia, osteoarthritis and myofascial pain. Acupuncture also may be an acceptable alternative to or may be included as part of a comprehensive pain management program.
Chiropractic Treatment and Massage
Chiropractic treatment is the most common non-surgical treatment for back pain. Improvements of people undergoing chiropractic manipulations were noted in some trials. However, the treatments effectiveness in treating back and neck pain has not been supported by compelling evidence from the majority of clinical trials. Further studies are currently assessing the effectiveness of chiropractic care for pain management.
Massage is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage can reduce stress and relieve tension by enhancing blood flow. This treatment also can reduce the presence of substances that may generate and sustain pain. Available data suggest that massage therapy, like chiropractic manipulations, holds considerable promise for managing back pain.
Therapeutic Touch and Reiki Healing
Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so called "energy-based" techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient.
In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health. Although beneficial effects with no significant adverse side effects were reported in several studies, the limitations of some of these studies make it difficult to draw definitive conclusions. Further studies are needed before the evidence-based recommendation for using these approaches for pain treatment can be made.
Dietary Approaches to Treating Pain
Some people believe that changing dietary fat intake and/or consuming plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation.
A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not randomized and was without a control group. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis.
Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.
Nutritional Supplements
There is solid evidence indicating that glucosamine sulfate and chondroitin sulfate are effective for knee osteoarthritis. These natural compounds were found to decrease pain and increase mobility of the knee and were well tolerated and safe.
Other dietary supplements, such as fish oils, also show some evidence of benefit, although more research is needed.
Herbal Remedies
It has been difficult to draw conclusions about the effectiveness of herbs. If you decide to use herbal preparations to better manage your pain, it is of critical importance to share this information with your doctor. Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health.
Things to Consider
Alternative therapies are not always benign. As mentioned, some herbal therapies can interact with other medications you may be taking. Always talk to your doctor before trying an alternative approach and be sure to tell all your doctors what alternative treatments you are using.
Research on Massage Therapy
A July 2001 survey conducted by the American Massage Therapy Association found that the number of adults receiving massages from a massage therapist more than doubled since 1997.
Most healthcare providers are recognizing massage therapy as a legitimate aid for lower back pain and an effective adjunct to lower back treatments. Fifty-four percent of healthcare providers say they will encourage their patients to pursue massage therapy in addition to medical treatment.
A study on massage and back pain conducted at the Touch Research Institute at the University of Miami in 2001 found that: “Massage lessened lower back pain, depression and anxiety, and improved sleep. The massage therapy group also showed improved range of motion and their serotonin and dopamine levels were higher.” (International Journal of Neuroscience, 106, 131-145.)
Anma Massage
Anma, which is commonly referred to as healing with hands originated in China more than 5,000 years ago and is rooted in the principles of ancient Oriental Medicine. From China, warrior monks spread Anma through Korea and on to Japan where the technique was perfected and formerly called Nihon Kaifuku Anma.
Today, Anma is widely regarded as a type of Japanese massage therapy, and it is used in some forms of Japanese martial arts. Variations of Anma have led to the emergence of other related massage therapies such as Shiatsu, Tuina, and Swedish massage. Shiatsu is considered a component of Anma and was formally recognized as a distinct therapy in 1964.
Anma in Energy Medicine
The word Anma means to push and pull, which describes the basic Anma technique of kneading the skin. In addition, Anma means to spread peace by rubbing or to calm the body using the hands. By using healing arts such as stretching and squeezing directly on small areas of the skin, Anma stimulates key points on the skin’s surface called Tsubo, which are similar to acupoints. When the Tsubo points are stimulated they release the muscular and nervous system tension that leads to circulatory blockages.
Muscular tension and nerve irritation are caused by excess production and build-up of lactic acid resulting from trauma, fatigue, physical and psychological stress, chemical imbalances, and poor circulation. By releasing tensions in the body, the musculoskeletal and nervous systems are able to relax, and blood and energy (Kiketsu) are able to flow freely. The cells of the immune system become more efficient due to the free flow of lymphatic fluid. In the process of inducing free circulation of the body’s fluids, toxins are released, and symptoms caused by toxins such as headache, back pain, and constipation are reduced.
Anma Massage Procedure
Anma is a pure form of deep tissue massage in which no essential or carrier oils are used. Anma can be performed directly over clothing although some practitioners uncover only the specific area of the body they’re working on. Clients may either remain seated or lie on a massage table or floor while receiving their Anma massage. The kneading and percussion techniques used in Anma are distinct and not found in other styles of massage. The manipulations in Anma involve 9 different categories or sections of the body, each of which results in different effects that contribute to health. In Anma massage, all of these sections are addressed regardless of the specific complaint, making this procedure a complete body massage. Because Anma offers spiritual as well as physical benefits, the massage therapists health is also optimized during an Anma massage
Benefits of Anma
As a therapy, Anma is primarily used to treat painful conditions that result from blockages of chi energy within the acupressure meridian system. Specifically, Anma is used to prevent and reduce symptoms in various conditions, including sports injuries, headaches, respiratory disorders, blood pressure abnormalities, constipation, gastrointestinal irritation, menstrual irregularity, fatigue and insomnia. In addition, Anma is especially effective in improving breathing, particularly in cases where respiration is shallow. Because Anma is known to restore health, it is often referred to as a restoration therapy.
In a recent study, Japanese researchers studied 15 healthy female volunteers aged 50-59 years with chronic neck stiffness. The study group received 40-minute Anma therapy sessions, followed by a 3 day interval of no therapy, and followed by therapy consisting of 40-minute rest sessions. Subjects were assessed with Visual Analogue Scale (VAS) for muscle stiffness in the neck and shoulder, anxiety scores salivary cortisol levels, and immunoglobulin A levels before and after their treatment interventions. Results showed that Anma significantly reduced pain scores using the VAS and anxiety scores. Immunoglobulin A increased significantly across both groups, showing improvement in immune function. The researchers concluded that Anma therapy reduced muscle stiffness in the neck and shoulder and also anxiety levels (Donoyama et al 2010).
Precautions
Anma should not be used in patients with fever or who have contagious illnesses or skin infection. Patients who recently had surgery should also wait until healing is underway before using Anma. Used after injury or trauma, Anma is most effective when used within 24-48 hours of the injury and preferably before any pain medications have been administered. Anma is available at many spas that offer Asian massage therapies. It should only be performed by massage therapists with special training.
Resources:
Donoyama N, T Munakata, and M Shibasaki. 2010. Effects of Anma therapy (traditional Japanese massage) on body and mind. Journal of Bodyworks and Movement Therapy. Jan; 14(1): 55-64.
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