Patients experience pain due to a number of reasons. Although the cause, intensity, and frequency of pain vary, all patients want the same – relief. In most cases, it is expected a doctor will prescribe a medication or recommend some over-the-counter painkillers to help patients manage their pain. However, non-pharmacological options can successfully relieve sensation and frequency of pain. We will discuss some non-pharmacologic options below that patients should be aware of.
Despite the fact that biofeedback became a popular non-pharmacological pain management method lately, it has been around for a long time. The concept of biofeedback has ancient antecedents in psychiatry and medicine, but it seems like a novel pain management approach because the term biofeedback was coined in 1969. Biofeedback has been found effective as an adjunct to traditional medical treatments for disorders such as hypertension, headache, chronic pain, and Raynaud’s disease. Evidence reveals that biofeedback is particularly effective in disorders that are chronic in nature and where specific management therapy is not available. This non-pharmacological approach is known to decrease the dose of the drug, the frequency of episodes, the severity of symptoms, and improves the overall quality of life. For instance, 66 patients admitted to general hospital in Taiwan for total knee arthroplasty were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice a day for five days concurrent with continuous passive movement (CPM) therapy, while the control group did not receive biofeedback training. Results showed that intervention group reported significantly less pain caused by CPM than the control group. These findings support the use of biofeedback relaxation as a non-pharmacological pain relief method.
The power of aromatherapy has been underestimated lately among doctors who are not a fan of a holistic approach, but it has great potential. A growing body of evidence confirms that aromatherapy can be effective in treating pain for a variety of medical conditions. The use of aromatherapy also increases patient satisfaction while decreasing patient anxiety and depression. What makes aromatherapy a viable option to try is the fact the costs are far less than those associated with standard pain management treatments that some patients cannot afford. This non-pharmacological manner of treating pain also works well with other treatment options such as massage.
Acupuncture has also been around for centuries, but it has found its way to remain respected in modern society and medicine too. A study from the Medical Journal of Australia found that the effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. For the purpose of the study, scientists evaluated 1964 patients between January 2010 and December 2011 who visited emergency departments in one of four tertiary hospitals in Melbourne. All patients experienced pain with pain score on a 10-point verbal numerical rating scale of at least 4. Acupuncture, either alone or with painkillers, was equivalent to drugs alone in providing pain relief.
Deep breathing belongs to the group of relaxation methods for pain relief. Taking slow, deep breaths allows patients to manage stress which is yet another factor that influences the severity of pain. Research shows promising results regarding deep breathing in pain management. The journal Pain Medicine published a study whose primary objective was to analyze the efficacy of deep and slow breathing (DSB) techniques in alleviating pain. For this purpose, scientists investigated two different DSB techniques:
Attentive DSB intervention – subjects were asked to breathe guided by a respiratory feedback task requiring a great deal of concentration and constant attention
Relaxing DSB intervention – participants relaxed during the breathing training
Besides DSB techniques, measurements included: skin conductance levels, indicating sympathetic tone; pain thresholds for both hot and cold stimuli; and moods states of subjects. Findings revealed that pain thresholds had a significant increase from relaxing DSB, but not from attentive DSB. The skin conductance levels indicating sympathetic activity decreased during relaxing DSB treatment, but not during attentive DSB. Both techniques significantly decreased negative moods. These results suggest that taking deep, slow breaths influences pain processing and modulates the perception of pain.
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Meditation also involves deep breathing, but at the same time, it allows patients to de-stress and divert their focus from pain. Benefits of this ancient practice are well-documented and it is one of the best non-pharmacological pain relief methods that doctors should consider recommending to their patients. One of the most recent studies on this subject found that mindfulness meditation reduces pain, but not in the same manner like opioids. In other words, meditation does not employ the endogenous opioid system in order to alleviate pain. Results of the study showed that the subjects’ pain ratings were reduced by 24% from the baseline measurement in the meditation group that received naloxone. When the body’s opioid receptors were chemically blocked, meditation still found a way to reduce pain by utilizing a different pathway.
Transcutaneous Electrical Nerve Stimulation (TENS) shows great potential for pain management. The analysis of current evidence on this pain relief approach published in the Pain Management journal found that both high- and low-frequency TENS activate opioid receptors, but different ones. Both applications provide analgesia, but high-frequency shows greater efficacy in patients who are already taking opioids. Application of TENS electrodes to acupoint sites increases analgesia, but the greatest effects are achieved when TENS is used during movement. When applied in adequate intensities, TENS successfully relieves postoperative pain, painful diabetic neuropathy, osteoarthritis, and some acute pain conditions. It shows potential in patients with spinal cord injury and fibromyalgia. This approach could also be effective in restoration of central pain modulation.
The successful management of pain does not always require the use of medications, particularly if we bear in mind that painkillers are over-prescribe during last few years. Various relaxation methods such as deep breathing, meditation, acupuncture, and aromatherapy can decrease the severity of pain and help patients manage their stress. Non-pharmacologic pain management tools could also involve TENS, biofeedback, and other approaches that doctors should strongly consider and discuss with their patients.