Pain Health Article

Surgery

Because surgery is itself a cause of pain, few surgical treatments to relieve pain were available prior to the discovery of safe general anesthetics in the mid-nineteenth century. For most of human history, doctors were limited to procedures that could be completed within two to three minutes because the patients could not bear the pain of the operation. Ancient Egyptian doctors gave their patients wine mixed with opium, while early European doctors made their patients drunk with brandy, tied them to the benches that served as operating tables, or put pressure on a nerve or artery to numb a specific part of the body.

Modern surgeons, however, can perform a variety of procedures to relieve either acute or chronic pain, depending on its cause. These procedures include:

• removal of diseased or dead tissue to prevent infection
• removal of cancerous tissue to prevent the spread of the cancer and relieve pressure on nearby healthy organs and tissues
• correction or reconstruction of malformed or damaged bones
• insertion of artificial joints or other body parts to replace damaged structures
• organ transplantation
• insertion of pacemakers and other electrical devices that improve the functioning of damaged organs or help to control pain directly
• cutting or destroying damaged nerves to control neuropathic pain

PSYCHOTHERAPY Psychotherapy may be helpful to patients with chronic pain syndromes by exploring the connections between anger, depression, or anxiety and physical pain sensations. One type of psychotherapy that has been shown to be effective is cognitive restructuring, an approach that teaches people to "reframe" the problems in their lives—that is, to change their conscious attitudes and responses to these stressors. Some psychotherapists teach relaxation techniques, biofeedback, or other approaches to stress management as well as cognitive restructuring.

Another type of psychotherapy that is effective in treating some patients with chronic pain is hypnosis. Although there is some disagreement among researchers as to whether hypnosis works by distracting the patient's attention from painful sensations or whether it works by stimulating the release of endorphins (chemicals produced by the body that are released in response to stress or injury and act as natural analgesics), it has been approved by the American Medical Association since 1958 as a treatment for pain. Some therapists offer instruction in self-hypnosis to patients with chronic pain.

COMPLEMENTARY AND ALTERNATIVE (CAM) APPROACHES CAM therapies that are used in pain management include:

• Acupuncture. Studies funded by the National Center for Complementary and Alternative Medicine (NCCAM) since 1998 have found that acupuncture is an effective treatment for chronic pain in many patients. It is thought that acupuncture works by stimulating the release of endorphins, the body's natural painkillers.
• Exercise. Physical exercise stimulates the body to produce endorphins.
• Yoga. Practiced under a doctor's supervision, yoga helps to maintain flexibility and range of motion in joints and muscles. The breathing exercises that are part of a yoga practice also relax the body.
• Prayer and meditation. The act of prayer by itself helps many people to relax. In addition, prayer and meditation are ways to refocus one's attention and keep pain from becoming the center of one's life.
• Naturopathy. Naturopaths include dietary advice and nutritional therapy in their treatment, which is effective for some patients suffering from chronic pain syndromes.
• Hydrotherapy. Warm whirlpool baths ease muscular and joint pain.
• Music therapy. Music therapy may involve listening to music, making music, or both. Some researchers think that music works to relieve pain by temporarily blocking the "gates" of pain in the dorsal horn of the spinal cord, while others believe that music stimulates the release of endorphins.