How Is Pain Treated?
is a chemical found in chili peppers that is also a primary
ingredient in pain-relieving creams (see Chili Peppers, Capsaicin, and Pain in
Chemonucleolysis is a treatment in which an enzyme, chymopapain, is
injected directly into a herniated lumbar disc (see Spine Basics in the
Appendix) in an effort to dissolve material around the disc, thus reducing
pressure and pain. The procedure's use is extremely limited, in part because
some patients may have a life-threatening allergic reaction to chymopapain.
Chiropractic refers to hand manipulation of the spine, usually for
relief of back pain, and is a treatment option that continues to grow in
popularity among many people who simply seek relief from back disorders. It has
never been without controversy, however. Chiropractic's usefulness as a
treatment for back pain is, for the most part, restricted to a select group of
individuals with uncomplicated acute low back pain who may derive relief from
the massage component of the therapy.
Cognitive-behavioral therapy involves a wide variety of coping skills
and relaxation methods to help prepare for and cope with pain. It is used for
postoperative pain, cancer pain, and the pain of childbirth.
Counseling can give a patient suffering from pain much needed
support, whether it is derived from family, group, or individual counseling.
Support groups can provide an important adjunct to drug or surgical treatment.
Psychological treatment can also help patients learn about the physiological
changes produced by pain.
may be effective for individuals
with arthritis. For many years scientists have wanted to develop a drug that
works as well as morphine but without its negative side effects. Nonsteroidal
anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1
and cyclooxygenase-2, both of which promote production of hormones called
, which in turn cause
inflammation, fever, and pain. The newer COX-2 inhibitors primarily block
cyclooxygenase-2 and are less likely to have the gastrointestinal side effects
sometimes produced by NSAIDs.
In 1999, the Food and Drug
Administration approved a COX-2 inhibitor-celecoxib-for use in cases of chronic
pain. The long-term effects of all COX-2 inhibitors are still being evaluated,
especially in light of new
suggesting that these drugs may increase the risk of heart attack and stroke.
Patients taking any
of the COX-2 inhibitors should review their drug treatment with their
Electrical stimulation, including transcutaneous electrical
stimulation (TENS), implanted electric nerve stimulation, and deep brain or
spinal cord stimulation, is the modern-day extension of age-old practices in
which the nerves of muscles are subjected to a variety of stimuli, including
heat or massage. Electrical stimulation, no matter what form, involves a major
surgical procedure and is not for everyone, nor is it 100 percent effective.
The following techniques each require specialized equipment and personnel
trained in the specific procedure being used:
TENS uses tiny electrical pulses, delivered through the skin to
nerve fibers, to cause changes in muscles, such as numbness or contractions.
This in turn produces temporary pain relief. There is also evidence that TENS
can activate subsets of peripheral nerve fibers that can block pain
transmission at the spinal cord level, in much the same way that shaking your
hand can reduce pain.
Peripheral nerve stimulation uses electrodes placed surgically on a
carefully selected area of the body. The patient is then able to deliver an
electrical current as needed to the affected area, using an antenna and
Spinal cord stimulation uses electrodes surgically inserted within
the epidural space of the spinal cord. The patient is able to deliver a pulse
of electricity to the spinal cord using a small box-like receiver and an
antenna taped to the skin.
Deep brain or intracerebral stimulation is considered an extreme
treatment and involves surgical stimulation of the brain, usually the thalamus.
It is used for a limited number of conditions, including severe pain, central
pain syndrome, cancer pain, phantom limb pain, and other neuropathic