The Seven Therapies Of A Pain Doctor...rest of article

From: Helen Dynda (olddad66@runestone.net)
Sun Jun 2 17:06:33 2002


Sorry but the Url for this article did not appear correctly on the Message Board; so I've decided to post the rest of this article here - but I will try once more to see if the Url will appear correctly:

The Seven Therapies Of A Pain Doctor

http://www.intelihealth.com/IH/ihtIH/WSIHW000/29816/23679/267028.html?d== dmtContent

The Seven Basic Tools Of Pain Management

Today's health professionals have numerous therapies at their disposal. Here are seven therapies frequently advised alone or in combination.

Anti-inflammatory drugs: These include such nonsteroidal anti-inflammatory drugs, or NSAIDs, as ibuprofen. Inflammation plays a major role. NSAIDs can have serious side effects such as stomach upset, ulcers or liver damage.

Antidepressants: Before the introduction of such antidepressants as Prozac, Paxil and Zoloft, collectively called selective serotonin reuptake inhibitors (SSRIs), there were tricyclic antidepressants, or TCAs. TCAs increase the body's own inhibitory (anti-pain) mechanisms to modulate pain. For unknown reasons, having nothing to do with their depression-lifting properties, tricyclics can be highly effective against headaches and neuropathic pain. Meanwhile, the SSRIs can be useful against the depression that accompanies pain.

Anticonvulsants: The anticonvulsants were developed to treat seizures . However, in some abnormal pain conditions, the nerve fibers become hypersensitive and start producing what amounts to mini-seizures, sending waves of pain racing to the brain. Anticonvulsants, especially the latest addition to this class, gabapentin, slow down nerve impulses.

Opiates: There is a huge stigma attached to the use of morphine and its derivatives on the part of both the public and physicians. This aversion is unfortunate because opiates are the only drugs that provide effective relief for many patients with pain. Studies have repeatedly shown that when prescription opiates are used under careful supervision, the risk of addiction for a patient with chronic pain is quite low, around 1 percent. Keeping the risk of addiction low requires careful evaluation of a patient before and after starting opiates. When used correctly, opiates should liberate, not stupefy, the patient. If the use of opiates increases a patient's mobility, mood and motivation to return to activities he or she had abandoned because of the pain, then the drugs should be continued. To avoid spikes in blood levels of opiates, patients often prefer time-release formulations, which decrease the chances of becoming overly sedated or high.

Behavioral Therapies: Because the mind-pain connection is so strong, psychological counseling is often a component of the pain management package. In particular, cognitive-behavioral therapy can help patients develop healthier and more productive thought patterns, emotions, and actions. Relaxation methods, including biofeedback, decrease anxiety and foster a more pain-free existence.

Nerve Block: Injections of local anesthetics into specific nerve bundles can suppress pain. The relief is usually temporary, but even the momentary respite helps patients to get actively involved in physical therapy and regain mobility.

Implantable Devices: When pain doesn't respond to the other six measures, certain devices can be implanted through the skin to provide relief. Patients report satisfaction with the implantable pump, which delivers a tiny dose of an opiate or other painkiller directly to the spinal cord where pain is processed.

Last updated May 31, 2001


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