Subject: Re: Chronic Pain Relief & Releases of Endorphins

From: [email-masked] (0000-Admin(0000))
Date: 6 Nov 1994 01:07:53 GMT

I know alot about chronic pain therapies, for I've done a search for one
of my friends with severe u/e chronic pain.

I would refer you to two texts on chronic pain, one by Arnoff and the
other by Bonica. Bonica's text is far more comprehensive.

The following are the therapies I know of that were appropriate for my
client:

low dose anti-depressents (both tricyclics and tetracyclics): some
	researchers believe they work because they're serotonergic; others
	have shown that most chronic pain pts are atypically depressed &
	that's why they work.

TENS unit: electrical stimulation of nerves. Two theries: gate control and
	the unit masks the pain by inflicting pain somewhere else.

steroid phonopheresis/iontopheresis: drive steroids (anti-inflamatory
	agents) into affected areas using ultrasould or electricity.
	Not appropriate for pts with medication sensitivities/allergies.

massage: reduces inflamation

accupuncture: helps some patients. If it works, pt will know after first
	session.

Hypnosis, meditation, relaxation: seems to help. tension in area affected
	by injury makes things work.

ice: reduces inflamation and dulls pain

capsacian cream: OTC (a brand name: Zostrix) applied topically to where
	pt feels pain.

cognitive-behavorial psychotherapy: was not appropriate for my client because
	she hates shrinks in general and shrinks that browbeat her in
	particular. Helps pts deal with depression & secondary gain issues.
	(my client was unusual: she has a healthy MMPI, a normal BDI, a
	normal IBQ-illness behavior questionare, and a McGill pain
	questionare consistant with her physical diagnosis. Her coping
	strategies are good. There is absolutely no reason to condition her.)

work hardening: appropriate for some pts

exercise: all chronic pain pts should exercise: does seem to help reduce
	pain. My client runs.

opiates: only appropriate for cancer patients. Otherwise should not be
	prescribed for chronic pain patients.

NSAIDS (asperin, tylenol): painkiller that s/b used with chronic pain pts.
	Does not work for my client.

ultrasound: reduces inflamation, but can cause loss of bone mass.

nerve gliding and other stretching exercises: see PT/OT for appropriate ones.

lifestyle modification: very important. Must be done alongside other modalities.
	(particularly cognitive-behavorial psychotherapy)

ablative neurosurgery

TENS unit implant

heat/whirlpool

couples/family psychotherapy: help restructure pts life and help family
	deal with the eventuality of chronic pain. Some families really
	baby pt: not requiring pt to do household chores or let pt use
	pain as an excuise not to do an unpleasent task or face a
	confrontation with someone.

assertiveness training: Wasn't appropriate for my client.

This list may not be complete. I would strongly advise people to stay away
>from  any sort of therapy/therapist who endorses the New Age philosphy or seems
too 'spiritual'. Every one I've met of this ilk was a rip-off. Avoid
homeopathy: it's a fancy and expensive way to dispense placebos.

Hope that helps.

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From: [email-masked] (Camilla Cracchiolo)
Date: Sun, 6 Nov 1994 20:12:09 GMT

Basically good summary about chronic pain management.  I'd like to point
out, however, that there is controversy about narcotics.  I don't think
they should be the first line of treatment, but I also think there
are times besides cancer when they're indicated and that they should
be used more than they are.  People with chronic pain that doesn't
respond to the other therapies listed are made to jump through amazing
hoops, have to put up with humiliation and being called addicts and
often months or years of pain before someone finally admits they
need narcotics.  This is absurd and is cruel.

I also edited the newsgroups line.  The number of groups was ridiculous.

--

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 Camilla Cracchiolo, RN     [email-masked]    Los Angeles, CA

     Shrine of the Cybernetic Madonna BBS      213-766-1356
              "The BBS for the information addict!"
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