Alternative/complementary methods

In addition to medication, there are several techniques that can be useful in managing pain. These techniques can be used in conjunction with medication or, in some cases, can be used alone to effectively manage pain. Several alternative methods of pain control for cancer pain have been sanctioned by the National Institutes of Health ref. 1995 NIH Technology Assessment Conference, sponsored jointly by the Office of Alternative Medicine and the Office of Medical Applications of Research. These include cognitive/behavioral techniques such as relaxation, distraction, and visualization and mind/body techniques such as hypnosis and biofeedback. Although there is limited scientific data to support some of these methods, the risks associated with using them are minimal. Moreover, many of these methods can be used any place or any time and some of them don't cost anything. Therefore, many of these techniques are worth trying because they might help give you more control of your pain.

Cognitive/behavioral techniques such as relaxation, distraction, and visualization have been shown to reduce and control pain. Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and make other pain relief methods work better. Relaxation can include quiet breathing, deep breathing, or progressive relaxation. Progressive relaxation is a technique used to reduce cancer pain in specific areas of the body. This technique entails lying down and successively clenching and releasing individual muscle groups, eventually focusing on those involved with the pain.

Distraction (i.e., focusing your attention on something else) can be a powerful way of temporarily relieving even the most intense pain. Patients report that when concentrating on something else--music, television, talking to family or friends -- pain is diminished. This can work especially well while waiting for pain medications to take effect. The use of a portable radio or CD player (with earphones) during painful procedures is especially helpful for some people.

Visualization involves the use of a personal symbol to imagine the transformation of pain; for example, you might imagine the pain as a red hot fire and then visualize the pain diminishing as the fire is put out by water. Audiotapes are widely available to teach imagery and visualization skills. Meditation, in which a person focuses on his or her own breathing or the repetition of a word, phrase, or prayer, is another useful cognitive/behavioral method.

Physiatric techniques include a variety of methods including electrical stimulation (such as PENS and TENS), skin stimulation, therapeutic exercise, and the use of orthoses and assistive devices. Percutaneous electrical nerve-stimulation (PENS) combines acupuncture with electrical stimulation of the nerves to achieve pain control. Transcutaneous electrical nerve stimulation (TENS) relieves pain by sending small electrical impulses through electrodes placed on the skin to underlying nerve fibers. Skin stimulation is the use of pressure, friction, temperature change, or chemical substances such as menthol to excite the nerve endings in the skin. When the skin is stimulated so that pressure, warmth, or cold is felt, the pain sensation is lessened or blocked. Therapeutic exercise, even exercise as minimal as range-of-motion exercise, can improve function and lessen pain. A physical therapist can prescribe an exercise program that may include stretching, strengthening, and conditioning. Several devices are available that may improve function and relieve pain such as wraps, pressure stockings, or pneumatic pump devices. Orthotic devices can immobilize and support painful or weakened areas of the body. Examples of orthotic devices include a splint on a painful limb or a collar for patients with neck or back pain.

Massage is another technique that can be very useful in managing pain. Massage increases blood circulation and relieves tension. Massage can be performed by anyone, from a trained massage therapist to a caregiver who is willing to give a simple massage. There are several devices on the market that enable you to add vibration and/or heat to a massage. One of the most gratifying aspects of massage is the simple fact that it involves one person touching and caring for another person.

Biofeedback techniques, which use special machines to help patients learn how to control certain body functions such as heart rate, blood pressure, and muscle tension, can help you reduce anxiety and help you cope with your pain. Personal, portable biofeedback equipment is available for home use .

Hypnosis can change how you perceive pain and reduce your anxiety. Under hypnosis, a patient enters a state of deep relaxation and then is given simple suggestions to experience the pain in a different way. Several studies have supported the effectiveness of hypnosis and imagery ; hypnosis is effective in reducing dependence on opioids during bone marrow transplant procedures