Acupuncture to Treat Pain

Acupuncture can be effective at treating both acute and chronic pain. Certain points on the body are stimulated with a needle. Stimulation of particular acupuncture points, or groups of points, can relieve pain in specific parts of the body.

There are different types of acupuncture methods, ranging from the traditional Chinese procedure to a more modernized, Western approach that involves laser acupuncture. Acupuncture is a safe way of relieving pain, although its effectiveness for relieving cancer pain in particular is unknown.

Diathermy and Cryotherapy to Treat Pain

Diathermy is the use of a high-frequency current to generate heat in some part of the body and generate blood flow. The use of diathermy as a pain management technique includes the use of heating pads and hydrotherapy (such as a hot bath).

Cryotherapy is the use of cold to treat pain (such as applying an ice pack).

Therapeutic Exercise and Massage to Treat Pain

Exercise such as yoga, stretching, and other forms of gently moving the body have proven to be important ways to relieve pain. Massage can also be a way to manage pain.

Behavioral Methods of Pain Control

Hypnosis is a method of distracting the patient so that they can focus their attention away from their pain. Its effectiveness varies widely and depends on the skills of the hypnotherapist to constructively engage a person's imagination.

Biofeedback is a method of providing information to a patient about their own physiology so that they can learn to control it. It is not clear what makes biofeedback effective when it works, and it is not known how widely used or effective it is in cancer pain therapy.

Relaxation and guided imagery techniques involve getting the patient to relax by talking to them and guiding them through images. Usually the patients listen to tapes, which allows them to do it when they want and where they want. Like hypnosis, it is based on distracting the patient so that their attention is focused away from the pain. All of these behavioral methods are usually used to treat chronic pain in combination with drug therapy.

Some studies have shown that people who practice them increase the chances that the patient's pain will be relieved. Effectiveness varies widely, from person to person.

Opioid Dependence, Addiction & Tolerance

There are several terms used to describe the effect that opioids can have on people. These include physical dependence, addiction, pseudo-addiction, and tolerance. What do these terms mean?

Physical Dependence

Physical dependence is a pharmocological effect that results from long-term opioid usage. A person is physically dependent on a drug when decreasing the dose, or removing the drug entirely, causes withdrawal. Physical dependence is often confused with addiction, but it is a different phenomenon. Dependence is the body having a physical reaction, whether the person is addicted or not.

Addiction

Opioid use can lead to addiction, a psychological and behavioral disorder. Symptoms of addiction include loss of control over drug usage, compulsive drug usage (using the drug to achieve a certain psychic effect), and continued drug use despite the harm it may be causing to the person.

Pseudo-addiction

Sometimes when a patient is being inadequately treated with analgesic therapy, that is they are feeling unrelieved pain, their behavior might look like the behavior of an addict. A patient might be overly concerned about drug availability, or they may increase the dose without receiving authorization. In a patient who is taking drugs but is still experiencing pain, these are not addictive behaviors. They are pseudo-addictive, because the patient really does need more medication. Open and honest communication, and assertiveness on the part of the patient, is the best strategy to avoid undertreatment and pseudo-addiction.

Tolerance

Like physical dependence, tolerance is often confused with addiction. Tolerance is the need for increasing amounts of opioids to achieve the same pain relief. Many cancer patients develop tolerance for opioids, and increasing their dosage is important, even at the risk of side effects. Often, however, increased pain indicates a progression of the cancer, not tolerance. When a patient who is being treated with opioids begins to feel more pain, and they are not at end-stage cancer with little chance of cure, it may be necessary to determine through appropriate diagnostic tests if in fact that cancer is progressing. Whether due to tolerance or development of the disease, increased pain needs to be treated by targeting either the cancer or the pain.

Side Effects of Opioids

Common side effects of opioid usage include gastrointestinal disturbance (constipation, nausea, and vomiting) and central nervous system disorders (delirium, sedation, confusion, respiratory depression, urinary retention, sudden muscle cramping). If the patient is taking any other medication, there may be assorted adverse effects. Although adverse reactions resulting from opioid usage are rare, they do happen, and it important to give your physician a complete list of all medications that you are taking, from prescription to over-the-counter to alternative forms of therapy (e.g.,herbal or shark cartilage). The side effects of opioid usage can be relieved with various over-the-counter and prescription medicines.

Why Pain is Under-treated

Opioid drugs are an important type of pain relief medicine, and the fact that they can be addictive likely plays a major role in why physicians are often reluctant to prescribe them. Other factors that may play a role in the under-treatment of pain include a physician's lack of knowledge about pain medication and a failure to inquire about or assess a patient's pain.

Open and honest communication is essential in avoiding the under-treatment of pain. If you do not feel that your physician is listening, be assertive and persistent. You may choose to seek another opinion. Talk about it with your family as well, so that they can advise your medical team about your pain, should you be unable or too weak to demand better relief.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Jul 1999

Last Modified: 03 Sep 2015