It may seem that with pain relief modern science has completely mastered: thirty seconds is enough for anesthesia in the dentist's chair, painless childbirth has long become a reality, and most of the available pain medications certainly have fewer side effects than their predecessor cocaine. But the existing methods are still not enough. Opioid analgesics continue to be used for severe pain and need a safe replacement. Many people suffer from chronic pain syndromes like fibromyalgia, and a solution has not yet been found. In addition to drug development, scientists and doctors are looking for non-pharmacological methods of pain relief - and they are used with varying success. We will tell you what can help in addition to pills, and sometimes instead of them.
You can often hear that it is not the symptoms that need to be treated, but the disease - but this statement is not always true. After an injury or intervention, pain can accompany a person in the recovery process, and this does not mean that it needs to be endured. It happens that it is no longer possible to cure a disease, but it is possible to improve the quality of life and alleviate suffering - then we are talking about palliative care. Finally, there are syndromes associated with chronic pain that are still poorly understood, such as fibromyalgia - interestingly, they are more common in women; perhaps that is why science has taken such diseases seriously just recently.
Chronic pain significantly affects physical health and productivity, quality of life, family relationships; it can be difficult to treat. Definitions vary, but most commonly referred to as chronic pain is pain that lasts at least three months or longer than it takes for tissue to heal after injury. In the United States, the annual medical costs associated with pain are estimated at $ 560–635 billion. The most common types of chronic pain in adults are back and neck pain, chronic tension headache, fibromyalgia, and osteoarthritis. In children, it is migraine, pain in the abdomen, back, arms and legs.
There are many studies of pain and non-drug methods of dealing with it - however, so far they do not give unequivocal conclusions. One review looks at fourteen studies on non-pharmacological treatment of pain during orthodontic treatment (those who have worn braces know how excruciating it can be). The conclusion of the review is disappointing: there is hope for low efficacy for laser therapy, for other methods (vibration therapy, chewing gum, cognitive-behavioral therapy) there is no evidence or their quality is very low. The same can be said for non-drug treatment of pain in multiple sclerosis: in those studies where pain or well-being indicators improved, there were methodological problems, so the reliability of the data is not yet clear.
Evaluating the effectiveness of treatment is not easy: chronic pain can recur, so the effect during or immediately after therapy may mean little. In a 2018 systematic review, the effect was tested one month after the end of therapy - its types included exercise, mindfulness practices, psychotherapy, acupuncture, and other methods. The results show that there is a point in non-drug methods - however, you cannot rely on them too much. For most interventions, the effect was weak, but still there. This includes exercise, psychotherapy, massage and yoga in the treatment of chronic low back pain, acupuncture, mindful stress reduction practices, and low-intensity laser exposure for neck pain. For fibromyalgia, cognitive-behavioral therapy and conscious muscle relaxation had little effect.
A 2017 study enrolled 100 patients with chronic back pain. In the first place in terms of the effectiveness of pain relief were drugs, and in second place were massage, acupuncture and the use of heat. Interestingly, the effect of non-drug methods was higher for everyone who worked on lifestyle, such as quitting smoking and drinking less alcohol. It is clear that pain is not easy to assess due to its subjectivity, different pain thresholds in different people and the possible placebo effect. People who have “improved” lifestyles are excited and may be oblivious to the mild pain that has plagued them before.
They are trying to apply non-medicinal methods even in newborn babies: swaddling, skin-to-skin contact with a parent, music therapy, massage, breastfeeding; children are also given a solution of glucose or sucrose - sugar can reduce pain by promoting dopamine production or indirectly through opioid receptors. Measuring pain levels in infants is difficult: the researchers focus on facial expressions or the duration of crying, but also take into account changes in heart rate or blood oxygen saturation. The results were not bad: swaddling, skin-to-skin contact, and hugging significantly reduced pain responses during interventions such as heel bleeding. Massage helped with colic and drawing blood from a vein, and music helped to calm down and sleep better. Vaccination was easier to tolerate when the infant was breastfed during the intervention. In children and adolescents, according to another review, relaxation and biofeedback techniques worked best.
What to do with all this information? Remember that non-drug methods sometimes work, and without placing too much hope in them, try as needed - after all, in most cases the risks are minimal or absent. For short-term painful procedures (be it injection, blood drawing or hair removal), it is usually recommended to take a deep breath at the moment when it is about to become painful. One small study found that simulating a cough can help relieve pain in this situation - why is unclear.
It is helpful to practice mindfulness to reduce longer-lasting pain, such as noticing muscle tension that can lead to a headache, and relaxing. Guided meditation exercises can help: the Headspace app has options ranging from a three-minute exercise to a month-long course that suggest “changing your relationship with physical pain by looking at it differently.” If you can't connect with your feelings, you can try biofeedback. Within the framework of this method, processes in the body (for example, measuring posture or breathing rhythm) are monitored on a computer screen - in general, the same awareness, only with visualization.
Physical activity can help with (or distract from) pain. In case of painful menstruation, in addition to exercise, it is recommended to warm to the abdomen or lower back, hot baths and orgasms - however, ibuprofen remains in the first place on the list. Those with frequent migraines are encouraged to sleep and eat, exercise regularly, and consciously reduce stress - with time management, work breaks, and breathing exercises for ten minutes a day.
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