Complementary Therapies for Chronic Pain

Complementary Therapies for Chronic Pain: What Does the Research Say? – RELIEF: PAIN Reserach News, Insights and Ideas 

When it comes to chronic pain, Western medical treatments are not optimal.

Invasive surgeries—such as removal of an injured spinal disc or spinal fusion—and nerve blocks bring some people relief, but many others are not helped or even get worse after the procedures, which carry considerable risks.

Drug treatments are mostly limited to narcotics such as morphine that can cause serious side effects and carry the potential for abuse and addiction, or over-the-counter medications like non-steroidal anti-inflammatory drugs (NSAIDs), which are not without risks either.

Considering these options, many patients have turned to complementary therapies to find relief. 

“All of us who are thinking about the management of chronic pain are aware that, alongside the use of pharmaceuticals, we need other strategies,” said Josephine Briggs, who heads the National Center for Complementary and Integrative Health (NCCIH)  

“The main reason people turn to complementary practices is overwhelmingly for pain,” said Briggs.

current findings suggest that some of the practices that seem to offer the best results for people with chronic pain include manual treatments, yoga, mindfulness and meditation.

Hands-on approach

Manual therapies encompass any manipulation of the body using the hands, including spinal or joint manipulation, by

  • a doctor of chiropractic (DC),
  • a doctor of osteopathic medicine (DO), or
  • a physical therapist (PT), as well as
  • massage by a licensed massage therapist.

“The unifying concept or proposed mechanism of action is to reduce and/or prevent stiff or dense, less-flexible tissue within and around joint structures,” Bove said. “Tissues are normally supposed to slide and glide. If they don’t, one result can be compressed or inflamed nerves.”

Every complementary treatment I’ve participated in or read about focuses on “relaxing”.  I resent the assumption that this is the proper approach for everyone, even a standard of sorts.

For those of us with connective tissue disorders, like with EDS, that kind of relaxation can allow joints to move out of alignment. Tension exists to hold them together.

After an incredibly pleasurable massage of my neck and shoulders, my troubles started when I got up and put my weight on all those “relaxed” joints. I initially felt pinches in my spine, hips, and shoulders, but those worked themselves out.

However, at 4am the morning after my massage, I woke with incredible head and neck pain, which worsened when lying down.  Putting any pressure on my head, especially in the back, immediately increased the pain, so all I could do is sleep sitting in a chair with the side of my head only lightly supported by a pillowed headrest.

The symptoms pointed to Cranial Hypertension resulting from Cervical Instability. So I learned the painful lesson that complete relaxation actually worsens my pain afterward.

Treatment might take the form of a spinal adjustment that is thought to restore normal movements, leading to reduced inflammation of an inflamed nerve.

Other treatments might involve massage of tight, “knotty” muscles with the intent of making them more pliable. “We think that manual therapies work to reduce pain by increasing motion between the tissues,” Bove said.

But treating pain and treating the underlying condition are two separate things, cautioned Bove, whatever the type of treatment.

“if we can identify and treat the condition itself, the underlying problem goes away, and the pain probably goes away too.”

How effective are manual therapies for pain? “We can’t answer that question for pain in general—we have to consider individual conditions,” said Bove.

Finally, someone intelligent states what should be obvious: only individual conditions can determine which treatments are optimal.

For instance, research suggests that spinal manipulation can relieve low back pain for some people. “But that does not mean it will help any given person,”

Ancient practices

“Yoga therapy adapts and applies yoga practices to help individuals or groups suffering from a specific condition,” including chronic pain. Just as with any treatment for pain, Kraftsow said, a yoga practice should be designed for the particular type of pain a person has, and it should consider the needs of the individual practitioner.

If used appropriately, yoga can benefit people with chronic pain. Studies have shown that after practicing a specially designed yoga asana sequence for several months, people with chronic low back pain experienced less pain, less functional disability and less depression than people who received standard care.

Another study showed that simple stretching exercises reduced pain as well as yoga, suggesting that yoga’s physical stretching and strengthening aspects might partly account for the improvements

But yoga also somehow influences the relationship between practitioners and their pain, which may confer additional benefits, particularly for people living with intractable chronic pain.

The current Yoga fad ignores the fact that holding the body in these unnatural positions can be harmful to those of us with structural problems, like EDS. My intense yoga practice for 5 years significantly ramped up my pain not just during and after practice, but permanently, by further stretching my ligaments.

“Yoga helps people to gain an understanding of themselves in relation to pain, and how to integrate that into their lives so they’re not overwhelmed by the pain and can be more in control of it.”

A study conducted at NCCIH and at McGill University in Montreal, Canada, examined the effects of long-term yoga practice on pain tolerance in healthy subjects.

“Not only did they tolerate pain longer,” said study author Marta Ceko, now at University of Colorado Boulder, “but they seemed to engage different mechanisms of dealing with the pain.” The yoga practitioners used strategies like observing their pain, rather than avoiding it. “The yogis seemed to be more mindful about their pain,” said Ceko.

In many chronic pain syndromes, the brain no longer processes pain normally, so any observations and studies of “healthy” individuals tells us nothing about chronic pain patients.

To find the neural basis of the change in yoga practitioners’ reaction to pain, the researchers also used magnetic resonance imaging (MRI) to see inside subjects’ brains.

When they analyzed the images, the researchers found that yoga practice correlated with changes in a brain area called the insula, which is crucial to how people sense their internal environment and form a sense of “self.”

Mind over matter

Mindfulness is another modern complementary practice for pain that originated from an ancient Eastern philosophy. In 1979, Jon Kabat-Zinn at the University of Massachusetts in Worcester, Massachusetts, US, adapted Buddhist meditation practices into a secularized treatment plan specially designed for healthcare clinics in the Western world; he called it Mindfulness-Based Stress Reduction (MBSR).

“Mindfulness meditation is a practice designed to cultivate the cognitive state of mindfulness, which is premised on nonjudgmental awareness of the present moment,”

Over the past 35 years, thousands of studies have investigated the effects of mindfulness on physical and mental health. For pain, however, the results are mixed

a recent analysis of eleven studies showed little evidence that mindfulness treatments improved pain in people with a variety of pain conditions, perhaps in part because of the quality of the studies. “A lot of the research is not extremely well done,” Zeidan said.

Zeidan tested subjects’ pain ratings in response to a hot plate placed on their leg before and after mindfulness training. “Our studies show that three to four days of meditation training can significantly reduce pain,” Zeidan said.

Similar to the yoga study, Zeidan also performed brain imaging on the subjects and found that they engaged a unique subset of brain areas associated with meditation-related pain relief

What’s in a name?

NCCIH is dedicated to the study of treatments that were once commonly called “alternative.”

(See CDC-preferred pain therapies often don’t work)

“But the term ‘alternative medicine’ came to be used for approaches with little basis in scientific evidence, and that were used instead of conventional care,” Briggs said.

Today, approaches including manual therapies, yoga and mindfulness are more commonly called “complementary” because they are usually applied together with medical treatments.

So, changing the term from “alternative medicine” to “complementary medicine” suddenly makes these therapies appropriate? Has the name change retroactively affected all the studies that found these treatments mostly ineffective?

The term “integrative health” refers to a growing movement in healthcare to treat patients more holistically—as a person, rather than an illness—and to coordinate conventional and complementary treatments.

That shift was reflected in the recent name change of NCCIH, which was formerly called the National Center for Complementary and Alternative Medicine (NCCAM).

The government apparently believes these name changes will change the facts.

At the NCCIH, researchers are also investigating another non-medical treatment for pain so mainstream that few people would consider it “alternative” in any sense: exercise.

Exercise has become the panacea for all pain, according to the anti-opioid folks. Yet, plain “exercise” can make some pain syndromes much worse (I aggravated my pain from EDS with excessive exercise in my younger years).

I do, however, believe that the body needs movement for health. Humans were not designed to stay still, as do so many of us with unbearable pain upon movement. Still, movement is needed to stimulate our bodily systems, like heartbeat and respiration, and even mood.

Still, we must adapt our movements to our pain’s cause and expression, and not just start running around without restraint, as I did in my youth.

When people are in pain, exercise might seem like the wrong idea. After all, said Briggs, sometimes pain is a warning that something is wrong in the body, signaling to people to rest and recover. “But often it’s not. Many chronic pain states do not have a simple underlying medical cause.”

But while it might seem counterintuitive, exercise provides a range of health benefits for people with chronic pain, provided that the regimen does not worsen the underlying cause of pain (see a review article here)

Much remains to be learned about whether—and how—complementary treatments can help people living with chronic pain.

Studies of treatments tailored to specific pain conditions will surely help in the quest to find winning prescriptions for complementary and integrative care for pain.

But in the meantime, one thing is clear about complementary therapies when appropriately applied: they have low risk.

“Nothing bad will happen to you—there are no side effects as with pain drugs,” Ceko said.

Our brains have their own pain-fighting mechanisms, she said. “Being able to engage those systems with something that doesn’t require pills would be amazing.”  

This sort of “mental technique” of pain control is presented as though it were within the reach of the average pain patient, yet actually requires years of dedicated practice.

To claim its effectiveness for pain patients ignores the required commitment of so much time and energy. If it was as easy as they make it seem, we would all be using it already.

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