John Scott asked:


Talking only about pain from a benign and not a malignant source, the standard medical approach today expands beyond the use of a simple painkiller such as tramadol and includes a number of other options. The most common is the addition of an antidepressant both for musculoskeletal and neuropathic pain. In the choice of drug, the emphasis tends to be on the tricyclic antidepressants because of their sedative properties – which incidentally helps people to sleep even when the pain levels are quite high. For neuropathic pain, it may also be appropriate to add an anticonvulsant. More generally, it is only human to be afraid that movement will cause pain. People readily accept the idea that pain is a warning signal. They fear that if they try to work through the pain, they will actually further injure themselves. In this, a combination of psychological and physical therapies can produce excellent outcomes, allowing people to learn how to manage their pain without becoming overly dependent on medications. But it also points to another highly relevant factor. Many people dislike taking medications, particularly painkillers which do not always have the best reputation. This emphasizes the importance of physical therapy, particularly of massage and manipulation. If the pain arises from the joints or the spine, physiotherapy can significantly reduce the intensity of the pain, improve mobility and relieve stress. In this, the relationship between the patient and the physiotherapist is vital. Once trust is established, the therapist can move the patient through the flinch response to appreciate that not all movement results in pain. Since there is also a chance for people to talk through their problems, the human interaction, if properly managed, can also improve mood. As an alternative to physiotherapy, some people have been turning to acupuncture – a proven treatment in traditional Chinese medicine for the relief of pain. Western trained physicians are sceptical and there is little research evidence to prove its safety and effectiveness. But, with the right person delivering the treatment to a patient who has faith in its effectiveness, it is reported highly effective. Modern technology is also moving into the field and an increasing number of patients now rely on Transcutaneous Electrical Nerve Stimulation (TENS) – a modern variation on the traditional use of electricity to “cure” muscular disorders. A TENS unit is battery driven and has one or more electric signal generators. Electrodes are placed on the skin and the generators deliver bursts of stimuli across the surface of the skin. Patients are able to vary the strength of the current, the pulse rates and amplitude. They experiment to discover the settings that produce the best results for them. Because the equipment is highly portable, it can be used anywhere. This convenience factor has increased the popularity of the device. Even though many dismiss acupuncture and the use of a machine such a TENS as producing nothing more than a placebo effect, an increasing number of people now rely on this form of treatment and sceptics should not be too quick to deny their apparent effectiveness. After all, if the “talk” of behavioral therapists can produce measurable improvements, why should a TCM specialist or technologist not be able to do the same thing.



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