Alternative Pain Management - Essay Example

?Alternative Pain Management Project Proposal A. Problem identification International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Chen, 2004). Though symptoms of pain are difficult to define and categorize; they are equally difficult to ignore. Moreover, in some situations excruciating pain is borne without a twinge, while in others a mild pain can be unbearable (Wall, 2000). The way we deal with pain is an expression of individuality.” Patrick David Wall Understanding the mechanism of pain and devising strategies for pain management have been the goal of researchers for centuries. Philosophers, psychologists, biologists and pharmacologists have attempted to understand pain based on an interdisciplinary approach. With technological advances and centuries of research, have led to an in depth of comprehension of pain mechanisms and accordingly several theories have been put forward over the years to explain the mechanism of pain. While the classical theories stressed the physiological aspects of pain, the multidimensional theories included the physiological as well as psychological, cognitive and social aspects of pain (Gatchel et al., 2007). The pain pathway involves three neuron route that carry pain stimuli from periphery to cerebral cortex: the primary afferent neurons, the dorsal horn of spinal cord where primary afferent neurons synapse with second order neuron (SON); and finally the third order neurons (TON) that synapse with SON in thalamic nuclei. Each of these routes involve several alternative pathways. The receptors and the fibers associated with pain perception in peripheral receptor system are known as nociceptors which can be of different types depending on the nature of stimuli received. However there are also two more dimensions to pain perception besides nociception. The individual’s description or assessment of experiences that he labels as pain and the emotional reaction to the pain perception forms the second dimension. The third dimension encompasses the social aspects of pain (Gatchel et al., 2007). Professional aid for pain management becomes essential when it restricts or interferes with daily activities, or when self care techniques fail to provide relief. The ultimate treatment goal for pain is the alleviation of pain symptom and improvement of individual functional ability. Due to its complex nature, pain management is rendered a challenging and multifaceted task. In accordance care providers today incorporate and utilize varied techniques including patient education, medications, physical therapies, relaxation techniques, psychosocial counseling, surgical procedures, injection techniques, various alternative medicine modalities for effective and intensive pain management (Gatchel et al., 2007). Based on this premise the current project proposal aims to explore the available and prevalent alternative pain management techniques and their comparative efficacies. B. Solution description Mind/Body Medicine During the last three decades many researchers have begin to explore the interconnections between mind and body; and have attempted to understand the hitherto unexplored efficacy of most traditional systems of medicine such as Ayurveda and Tibetan medicine. This has led to the emergence of the new field of psychoneuroimmunology. Mid body techniques are based on three premises; relation of body and mind, ability of body to heal itself and role of care provider in restoring health. This field includes techniques such as psychotherapy, hypnotherapy, and guided imagery. Psychotherapy Psychotherapy approaches are based on the interdependence of stress and pain forming a vicious circle. They therefore provide relaxation therapies to develop a sense of control, change the mode of dealing with pain and decreasing levels of discomfort. Hypnosis, music or audioanalgesia and other relaxation techniques are also included in psychotherapy. A related intervention finding support is Cognitive Behavioral Therapy (CBT) (Dureja, 2006). Biofeedback Biofeedback employs electronic monitoring to provide patient immediate feedback regarding vital signs to enable him to make a deliberate attempt to gain control over his body (Dureja, 2006). Acupuncture Acupuncture originated in China and has been in use for thousands of years. The technique involves insertion of fine needles at specific points in the body that intend to rectify energy imbalances. Modern acupuncture techniques are based on identification of trigger points, segmental points and formula points and attempts have been made to provide explanations for the same on basis of neurophysiology and anatomy. This theory finds support in the fact that most acupuncture target points are located in the vicinity of neural structures; correlating them with the nervous system. Another mechanism of action of acupuncture is based on their stimulation of endorphins (Stener-Victorin et al., 2006). Chiropractics and massage Chiropractic treatment involves manual massage and manipulation of soft tissue and other joints and spine along with life style changes. The treatment is widely used for back pain, and pain due to other musculoskeletal disorders. Massage techniques are based on enhancing blood flow through specific regions of the body. Besides these, alternative treatments also include lifestyle changes, dietary modification, warm water treatment (Hydrotherapy), naturotherapy, herbal treatment, homeopathy, yoga and posture counseling. These alternative pain management strategies are in use since ages in different cultures and are becoming widely prevalent today (Gatchel et al., 2007). Transcutaneous Electrical Nerve Stimulation (TENS) TENS involves electrical stimulation of dorsal columns of spinal cord using high frequency low intensity current (0-40mA at 40-150MHz). Two electrodes each are placed over the dermatomes of T11-L1 and S2-S4, over intact skin. While the low intensity signals are known to initiate release of endorphins, the high frequency shut spinal neuronal gate. The cumulative impact of the two is to block the pain stimuli, thereby reducing pain sensation (Bedwell et al., 2011). C. Research support Psychotherapy has found support in various spheres, however scientific evidences for the same are lacking. CBT has however been tested as a part of multimodal pain management strategies and found to be effective for migraines, cancer pain, rheumatoid arthritis and osteoarthritis. Biofeedback technique has been found to be effective in cases of migraines, temporomandibular disorders, pain associated with irritable bowel syndrome etc (Dureja, 2006). TENS have been found to reduce labor pain and effective for other acute pain as well (Simkin, 2004). Acupuncture has been found to be effective for treatment of labor pain, headache, low back pain, tennis elbow, osteoarthritis. However adequate scientific evidences supporting the same are lacking. Chiropractics have been intensively evaluated as a pain relief technique and have found support. Massage, lifestyle changes, dietary modification, hydrotherapy, naturotherapy, herbal treatment, homeopathy, yoga and acupressure are techniques that are rapidly gaining support but controlled trials to evaluate their efficacy are lacking. The biggest advantage of these techniques has been stated to be that they lack major drawbacks and side-effects, which is true in most cases especially with respect to immediate effects. However, long term impacts of these interventions need to be studied before they can be recommended. E. Evaluation plan Evaluation data collection The project involves a systematic review of randomized controlled trials studying the alternative methods of pain management. The search strategy would involve the use of keywords alternative, complementary, pain management, psychotherapy, acupressure and acupuncture, relaxation techniques, TENS and other related terms for known alternative treatments. The search would be conducted using Google scholar, PubMed, Wiley online library, Science Direct, Springer etc for original research article or systematic reviews published in peer reviewed journals. To ensure study of latest concepts articles published in or after 2000 will only be considered for the study. Further selection of the studies would be based on the criteria of their being original research articles using randomized controlled trials, clinical trials, case studies or systematic reviews. Selection of the reviews would be based on the AMSTAR (assessment of multiple systematic reviews) measurement tool. Outcome measures The outcome measures for evaluating the efficacy of the treatment strategies include levels of pain intensity, satisfaction with pain relief and sense of control as described by the subjects. The outcome criteria related to safety of intervention includes negative impact or adverse side effect; Apgar scores in case of labor pain, and incidences of requirement of additional interventions. Any intervention has to be within the affordable limit of the patient. The opinion of the subjects with reference to the cost affectivity and affordability of the intervention would be other important criteria for outcome evaluation. F. Decision making Consideration of physiological, psychological and social aspects of pain is essential for effective management of pain. Advantages of alternative treatments and their common characteristics despite their diverse nature include their being holistic, integrative, naturalistic, stressing interpersonal relation (especially between the care provider and the patient) and spiritual. Though convetional medicines too are based on similar principles; complementary medicines unlike the conventional are still to find scientific basis. Thus ethical issues need to be considered before taking decisions regarding the usefulness and applicability of alternative strategies. Further, a care provider or clinician cannot present generalizations stating the better efficacy of one over another. In fact an integrative and multimodal approach based on the fundamental cause of pain, its nature and severity, individual’s perceptions and needs should be designed and implemented. One cannot depend on either of alternative or conventional interventions exclusively, while completing ignoring the other. References 1 Bedwell, C., Dowswell, T., Neilson, J. P., & Lavender, T. (2011). The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence. Midwifery , e141-8. 2 Chen, H., Lamer, T. J., Rho, R. H., Marshall, K. A., Sitzman, B. T., Ghazi, S. M., et al. (2004). Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc , 1533-45. 3 Dureja, G. P. (2006). Chronic pain management: (non pharmacological technique). Indian J. Anaesth. , 397-407. 4 Gatchel, R. J., & Peng, Y. e. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin , 581-24. 5 Simkin, P., & Bolding, A. (2004). Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering. The Journal of Midwifery & Women’s Health , 489-504. 6 Stener-Victorin, E., Fujisawa, S., & Kurosawa, M. (2006). Ovarian blood flow responses to electroacupuncture stimulation depend on estrous cycle and frequency of stimulation in anesthetized rates. Journal of applied physiology , 84-91. 7 Wall, P. D. (2000). Pain: the science of suffering. New York: Columbia University Press. Read More