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Brain-safe ways to ease chronic Pain: when medical approaches fail, alternative treatments may help reduce pain safely.

Pain results from a complex interaction of biological, sensory, emotional, and cognitive factors unique to each individual, and finding successful treatments is equally complex. Pain medications, usually the first choice for easing physical discomfort, are often only mildly helpful, if at all, and they tend to wear off over time. For many individuals with chronic pain, alternative treatments may be less expensive, and just as effective--or more effective--than traditional medical treatments. Alternative therapies such as acupuncture, massage, yoga, and hypnosis, among others, often relieve pain in people for whom medications are less than satisfactory.

"In cases where standard medical treatment doesn't work, it makes sense to explore with your doctor the possibility of using an alternative therapy," says neurologist and neurobiologist David Borsook, MD, PhD, co-director of The Center for Pain and the Brain at MGH and Bostons McLean and Children's Hospitals. "Pain treatment involves addressing multiple bodily systems and rebalancing a persons pain and reward circuits. Drugs, life-style changes, alternative approaches--it's not really important what makes a person better, as long as a treatment or combination of treatments works safely and with few side effects."

Try a Variety of Options

If you experience chronic pain, Dr. Borsook suggests working with your doctor to try a variety of pain-reducing strategies in the search for therapies that help ease your discomfort. Of course, avoid or halt any treatment that is associated with undesirable side effects or unwanted interactions with your medications. Some other tips:

* Start slowly and gradually build up treatment levels while you determine whether a treatment is helpful.

* When trying any new treatment, use it consistendy to maximize effects.

* Give any new therapy time. Pain treatments may take months to work.

Although it's not always clear precisely how alternative treatments are able to reduce pain, research by Dr. Borsook and his colleagues offers intriguing clues. Working with children who suffered from a chronic pain condition called complex regional pain syndrome, the researchers discovered that combining various intensive psychological and physical treatment approaches not only resulted in a lessening of pain, but also led to brain changes visible on brain scans. After treatment, the children showed signs of increased gray matter volume and connectivity among brain regions involved in sensation, emotion, cognition, and pain modulation, bringing them closer to brain characteristics seen in a control group of healthy children, according to a report published March 22, 2016 in Brain Structure & Function.

"Pain can be likened to an orchestra in disarray," Dr. Borsook explains. "The various instruments (pain circuits) are not coordinated--they're operating chaotically. What we're trying to do with pain control is to use any means available to get the musical instruments to work together. Any process that helps alleviate your pain--for example, combining exercise with low-dose medication or counseling for depression--should be used."

Alternative Approaches

Although complementary treatments may not work in all cases and scientific data on some therapies may not be extensive, the principal therapies have minimal side effects and are safe for most people. Among the most promising alternative therapies are:

* Mind-body methods: Harnessing the pwer of the mind to address bodily pain may help some people achieve significant pain reduction. Mind-body practices include techniques such as guided imagery (in which pleasing mental images are used as a distraction from pain and a means of promoting relaxation), meditation, progressive muscle relaxation, and yoga. These methods are thought to reduce pain by stimulating the brains production of endorphins, chemicals produced by the body that act as natural painkillers.

* Psychological methods: Seeing a mental health professional about anxiety and mood disorders such as depression can help reduce levels of perceived pain. It may also help people with chronic pain to learn about lifestyle changes, relaxation techniques, stress reduction, and other strategies for coping with pain.

* Physical methods: Massage, physical therapy, and other forms of physical manipulation can be very effective in reducing pain in some individuals. These methods involve manipulating joints, muscles, and other soft tissues of the body for benefits such as improved circulation and flexibility, restored mobility, reduced stress, and relaxation.

* Non-Western methods: Acupuncture and acupressure, ancient Chinese forms of medicine, can be very effective in relieving pain from conditions such as arthritis, headaches and aches in muscles and connective tissues. Acupuncture therapy consists of inserting slender needles through the skin, muscles and connective tissues at any of nearly 1,000 points along energy channels (meridians) to remove blockages and achieve energy balance. Acupressure works by applying pressure to these same energy points. Both procedures, which are essentially pain-free, are thought to cause the release of natural painkillers. Tai chi, an ancient Chinese system of meditative movements, has been found to reduce the pain of arthritis.

* Hypnosis: People who undergo hypnosis are induced to enter a state of deep relaxation called a "trance," during which awareness of external noises and activity is diminished. In this state, the hypnotized person is open to suggestions from a health practitioner that may lead to changes in thoughts, perceptions, behavior or sensations. Imaging studies have shown that the technique can reduce activity in brain regions responsible for pain perception.

WHAT YOU CAN DO

You can use strategies on your own, without the help of providers of traditional or alternative treatments, to improve chronic pain. These include taking steps to improve your:

* Sleep: Insufficient sleep has been found to increase sensitivity to pain. Practice good sleep hygiene by establishing a quiet, dark, and comfortable sleep environment, keeping a regular sleep schedule, avoiding caffeine and exercise at least four hours before bedtime, and getting at least seven hours of sleep at night

* Physical activity: Exercise lowers stress levels and elevates mood, which can result in pain reduction. It also increases flexibility, aerobic conditioning, and muscle strength--all of which may make managing pain easier. Check with your doctor about what types and levels of exercise are appropriate for you, and try to work out on a regular basis.

* Weight: Extra pounds can cause pain by increasing inflammation, and putting stress on your muscles, tendons, joints, and bones, and increases risk for painful medical conditions that are associated with obesity.

* Diet: An anti-inflammatory diet that emphasizes consumption of fruits and vegetables (especially cruciferous vegetables such as broccoli, cabbage, and Brussels sprouts), whole grains, fish, chicken, and some dairy products, and limits consumption of red meats, simple sugars, and processed foods can help fight pain.
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Publication:Mind, Mood & Memory
Geographic Code:1USA
Date:Feb 1, 2017
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