What are the most effective treatments for chronic pain. How do drug therapies help manage pain symptoms. Which non-pharmaceutical approaches can provide pain relief. When are surgical interventions considered for chronic pain management. How can alternative therapies complement traditional pain treatments.

Understanding Chronic Pain and Treatment Approaches

Chronic pain is a complex condition that affects millions of people worldwide. It can stem from various causes and manifest in different ways, making its treatment a multifaceted challenge. This comprehensive guide explores 18 different treatment types designed to help manage chronic pain, offering insights into both traditional and alternative approaches.

Pharmacological Interventions for Pain Management

Medication often forms the first line of defense against chronic pain. But what are the most common drug therapies used, and how do they work?

Over-the-Counter Pain Relievers

For milder forms of pain, over-the-counter (OTC) medications can provide significant relief. These include:

• Acetaminophen (Tylenol): Effective for pain relief without anti-inflammatory properties
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Such as aspirin, ibuprofen, and naproxen, which reduce both pain and inflammation
• Topical pain relievers: Creams, lotions, or sprays applied directly to the skin

These OTC options are generally safe when used as directed, but it’s important to be aware of potential side effects, especially with long-term use.

Prescription Pain Medications

When OTC drugs prove insufficient, healthcare providers may prescribe stronger medications. These can include:

• Muscle relaxants
• Anti-anxiety drugs (e.g., diazepam)
• Antidepressants (e.g., duloxetine for musculoskeletal pain)
• Prescription NSAIDs (e.g., celecoxib)
• Opioid painkillers (e.g., codeine, fentanyl, oxycodone)

It’s crucial to note that prescription medications, especially opioids, carry risks of side effects and potential for dependency. Their use should be carefully monitored by a healthcare professional.

Interventional Pain Management Techniques

Beyond oral medications, there are several interventional techniques that can provide targeted pain relief. These approaches often involve direct application of medications or other therapies to specific areas of the body.

Steroid Injections

Steroid injections can be highly effective for reducing inflammation and pain in specific joints or areas of the body. How do they work? These injections deliver a potent anti-inflammatory medication directly to the site of pain, offering localized relief that can last for weeks or even months.

Nerve Blocks

Nerve blocks involve injecting a nerve-numbing substance to interrupt pain signals from a specific area of the body. This technique can be particularly useful for chronic pain conditions affecting specific regions or organs. However, it’s important to note that nerve blocks are not suitable for all types of pain and should be administered by a skilled professional.

Patient-Controlled Analgesia (PCA)

PCA allows patients to self-administer pre-measured doses of pain medication through a computerized pump. This method is often used in hospital settings for post-surgical pain or severe chronic pain conditions. The ability to control one’s own pain relief can provide a sense of empowerment and improve overall pain management.

Advanced Pain Management Strategies

For patients whose pain doesn’t respond to more conventional treatments, there are several advanced strategies that may offer relief.

Trigger Point Injections

Trigger point injections target specific knots of muscle that can cause pain. During this procedure, a healthcare professional injects a local anesthetic, sometimes including a steroid, into the trigger point. This can help deactivate the painful area and provide relief, particularly for conditions like fibromyalgia, tension headaches, and myofascial pain syndrome.

Botulinum Toxin Injections

Botulinum toxin, commonly known as Botox, is not just for cosmetic purposes. It can be an effective treatment for chronic pain, particularly chronic migraines. How does it work? The toxin blocks signals from nerves to muscles, potentially alleviating pain for up to three months after a series of injections.

Surgical Interventions for Chronic Pain

When conservative treatments fail to provide adequate relief, surgical interventions may be considered. These are typically reserved for severe cases where other treatments have been exhausted.

Intrathecal Drug Delivery Systems

Also known as pain pumps or spinal drug delivery systems, these implants deliver pain medication directly to the spinal cord. This targeted approach can provide effective pain relief with lower doses of medication, potentially reducing side effects associated with oral pain medications.

Spinal Cord Stimulators

Spinal cord stimulators are implantable devices that send low-level electrical signals to the spinal cord or specific nerves to block pain signals from reaching the brain. This can be particularly effective for certain types of chronic back pain or neuropathic pain.

Non-Pharmacological Approaches to Pain Management

While medications and interventional techniques play a crucial role in pain management, non-pharmacological approaches can be equally important in a comprehensive pain management plan.

Physical Therapy

Physical therapy is a cornerstone of many chronic pain management programs. It can help improve strength, flexibility, and overall function, potentially reducing pain and improving quality of life. A physical therapist can develop a customized exercise program and teach techniques for managing pain during daily activities.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can be particularly effective for managing chronic pain. It helps patients identify and change negative thought patterns and behaviors related to their pain, potentially improving pain perception and coping strategies.

Mindfulness and Meditation

Mindfulness techniques and meditation can help reduce stress and anxiety associated with chronic pain. These practices can also improve pain tolerance and overall well-being. Regular practice of mindfulness or meditation can lead to long-term changes in how the brain processes pain signals.

Alternative and Complementary Therapies for Pain Relief

Many individuals with chronic pain find relief through alternative and complementary therapies. While scientific evidence varies for these approaches, many patients report significant benefits.

Acupuncture

Acupuncture, an ancient Chinese healing practice, involves inserting thin needles into specific points on the body. How does it work for pain relief? While the exact mechanisms are not fully understood, acupuncture is thought to stimulate the release of natural pain-relieving compounds in the body and may help regulate the nervous system.

Massage Therapy

Massage can help relax tense muscles, improve circulation, and promote overall relaxation. For many chronic pain conditions, regular massage therapy can be an effective component of a pain management plan. Different types of massage may be more beneficial for specific conditions, so it’s important to work with a skilled therapist.

Chiropractic Care

Chiropractic treatments focus on the relationship between the body’s structure (primarily the spine) and its function. Chiropractors use hands-on spinal manipulation and other alternative treatments to enable the body to heal itself without surgery or medication. This can be particularly effective for certain types of back pain, neck pain, and headaches.

Lifestyle Modifications for Long-Term Pain Management

In addition to medical treatments and therapies, lifestyle modifications can play a crucial role in managing chronic pain and improving overall quality of life.

Exercise and Physical Activity

Regular exercise can help reduce pain, improve function, and enhance mood. What types of exercise are best for chronic pain? Low-impact activities such as swimming, cycling, or yoga can be particularly beneficial. It’s important to start slowly and gradually increase activity levels under the guidance of a healthcare professional.

Nutrition and Diet

A healthy diet can help manage inflammation, maintain a healthy weight, and support overall well-being. Some individuals find that certain foods exacerbate their pain, while others may have anti-inflammatory properties. Keeping a food diary can help identify potential triggers or beneficial foods.

Sleep Hygiene

Chronic pain can significantly disrupt sleep, and poor sleep can, in turn, exacerbate pain. Establishing good sleep hygiene practices, such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding screens before bedtime, can help improve sleep quality and potentially reduce pain.

Managing chronic pain is a complex and often challenging journey. While there is no one-size-fits-all solution, the wide range of treatment options available offers hope for improved pain management and quality of life. It’s important to work closely with healthcare providers to develop a comprehensive, personalized pain management plan that may include a combination of these approaches. Remember, what works best can vary from person to person, and it may take time to find the most effective combination of treatments for your specific situation.

18 Treatment Types to Help You Manage Chronic Pain

What Are the Treatments for Chronic Pain?

The treatments for chronic pain are as diverse as the causes. From over-the-counter and prescription drugs to mind/body techniques to acupuncture, there are a lot of approaches. But when it comes to treating chronic pain, no single technique is guaranteed to produce complete pain relief. Relief may be found by using a combination of treatment options.

Drug Therapy: Nonprescription and Prescription

Milder forms of pain may be relieved by over-the-counter medications such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Both acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, and additionally NSAIDs reduce inflammation (swelling and irritation). Topical pain relievers are also available, such as creams, lotions, or sprays that are applied to the skin in order to relieve pain and inflammation from sore muscles and arthritis.

If over-the-counter drugs do not provide relief, your doctor may prescribe stronger medications, such as muscle relaxants, anti-anxiety drugs (such as diazepam [Valium]), antidepressants (like duloxetine [Cymbalta] for musculoskeletal pain), prescription NSAIDs such as celecoxib (Celebrex), or a short course of stronger painkillers (such as codeine, fentanyl [Duragesic, Actiq], oxycodone and acetaminophen (Percocet, Roxicet, Tylox) or hydrocodone and acetaminophen (Lorcet, Lortab, and Vicodin). A limited number of steroid injections at the site of a joint problem can reduce swelling and inflammation. An epidural might be given for spinal stenosis or lower back pain.

In July 2015, the FDA asked that both prescription and over-the-counter NSAIDs strengthen their warning labels to indicate the potential risk of heart attacks and strokes. The risk increases with higher doses of the drugs. In addition, there is also the possibility of developing bleeding stomach ulcers.

Sometimes, a group of nerves that causes pain to a specific organ or body region can be blocked with local medication. The injection of this nerve-numbing substance is called a nerve block. Although many kinds of nerve blocks exist, this treatment cannot always be used. Often blocks are not possible, are too dangerous, or are not the best treatment for the problem. You doctor can advise you as to whether this treatment is appropriate for you.

Patient-controlled analgesia (PCA) is another method of pain control. By pushing a button on a computerized pump, the patient is able to self-administer a premeasured dose of pain medicine infused with opiods. The pump is connected to a small tube that allows medicine to be injected intravenously (into a vein), subcutaneously (just under the skin), or into the spinal area. This is often used in the hospital to treat pain in post-traumatic or post-surgical pain as well as terminal cancer pain..

Trigger Point Injections

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a healthcare professional, using a small needle, injects a local anesthetic that sometimes includes a steroid into a trigger point (sterile salt water is sometimes injected). With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.

Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment.

Onabotulinumtoxina (Botox) is a toxin that blocks signals from the nerves to the muscles. It can also be injected to alleviate chronic migraine headaches. The procedure involves multiple injections around the head and neck every 12 weeks and may alleviate pain for up to three months.

Surgical Implants

When standard medicines and physical therapy fail to offer adequate pain relief, you may be a candidate for a surgical implant to help you control pain. When they are used, which is rare, there are two main types of implants to control pain:

• Intrathecal Drug Delivery. Also called infusion pain pumps or spinal drug delivery systems. The surgeon makes a pocket under the skin that’s large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. The surgeon also inserts a catheter, which carries pain medicine from the pump to the intrathecal space around the spinal cord. The implants deliver medicines such as morphine or a muscle relaxant directly to the spinal cord, where pain signals travel. For this reason, intrathecal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain.
• Spinal Cord Stimulation Implants. In spinal cord stimulation, low-level electrical signals are transmitted to the spinal cord or to specific nerves to block pain signals from reaching the brain. This method being especially used for back and limb pain. In this procedure, a device that delivers the electrical signals is surgically implanted in the body. A remote control is used by the patient to turn the current off and on or to adjust the intensity of the signals. Some devices cause what’s described as a pleasant, tingling sensation while others do not.
  Two kinds of spinal cord stimulation systems are available. The unit that is more commonly used is fully implanted and has a pulse generator and a non-rechargeable battery. The other system includes an antenna, transmitter, and a receiver that relies upon radio frequency. The latter system’s antenna and transmitter are carried outside the body, while the receiver is implanted inside the body.

TENS

Transcutaneous electrical nerve stimulation therapy, more commonly referred to as TENS, uses electrical stimulation to diminish pain. During the procedure, low-voltage electrical current is delivered through electrodes that are placed on the skin near the source of pain. The electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that “scramble” normal pain signals. TENS is not painful and may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not effective and cannot be recommended, says the American Academy of Neurology (AAN).

Bioelectric Therapy

Bioelectric therapy relieves pain by blocking pain messages to the brain. Bioelectric therapy also prompts the body to produce chemicals called endorphins (endorphins are also released by exercise) that decrease or eliminate painful sensations by blocking the message of pain from being delivered to the brain.

Bioelectric therapy can be used to treat many chronic and acute conditions causing pain, such as back pain, muscle pain, headaches and migraines, arthritis, TMJ disorder, diabetic neuropathy, and scleroderma.

Bioelectric therapy is effective in providing temporary pain control, but it should be used as part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may allow pain sufferers to reduce their dose of some pain relievers by up to 50%.

Physical Therapy

Physical therapy helps to relieve pain by using special techniques that improve movement and function impaired by an injury or disability. Along with employing stretching, strengthening, and pain-relieving techniques, a physical therapist may use, among other things, TENS to aid treatment.

Exercise

Although resting for short periods can alleviate pain, too much rest may actually increase pain and put you at greater risk of injury when you again attempt movement. Research has shown that regular exercise can diminish pain in the long term by improving muscle tone, strength, and flexibility. Exercise may also cause a release of endorphins, the body’s natural painkillers. Some exercises are easier for certain chronic pain sufferers to perform than others; try swimming, biking, walking, rowing, and yoga.

Psychological Treatment

When you are in pain, you may have feelings of anger, sadness, hopelessness, and/or despair. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships. In turn, depression and anxiety, lack of sleep, and feelings of stress can all make pain worse. Psychological treatment provides safe, nondrug methods that can treat your pain directly by reducing high levels of physiological stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the many problems associated with pain.

A large part of psychological treatment for pain is education, helping patients acquire skills to manage a very difficult problem.

Alternative Therapies

In the past decade, many people have found relief for their pain in mind-body therapies, acupuncture, and some nutritional supplements. Others use massage, chiropractic and osteopathic (bone) manipulation therapies, therapeutic touch, certain herbal therapies, and dietary approaches to alleviate pain. However, there is little if any scientific evidence supporting these therapies for pain relief.

Mind-Body Therapies

Mind-body therapies are treatments that are meant to help the mind’s ability to affect the functions and symptoms of the body. Mind-body therapies use various approaches including relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis. Relaxation techniques can help alleviate discomfort related to chronic pain.

Visualization may be another worthwhile pain-controlling technique. Try the following exercise: Close your eyes and try to call up a visual image of the pain, giving it shape, color, size, motion. Now try slowly altering this image, replacing it with a more harmonious, pleasing — and smaller — image.

Another approach is to keep a diary of your pain episodes and the causative and corrective factors surrounding them. Review your diary regularly to explore avenues of possible change. Strive to view pain as part of life, not all of it.

Electromyographic (EMG) biofeedback may alert you to the ways in which muscle tension is contributing to your pain and help you learn to control it. Hypnotherapy and self-hypnosis may help you block or transform pain through refocusing techniques. One self-hypnosis strategy, known as glove anesthesia, involves putting yourself in a trance, placing a hand over the painful area, imagining that the hand is relaxed, heavy, and numb, and envisioning these sensations as replacing other, painful feelings in the affected area.

Relaxation techniques such as meditation or yoga have been shown to reduce stress-related pain when they are practiced regularly. The gentle stretching of yoga is particularly good for strengthening muscles without putting additional strain on the body.

Acupuncture

Acupuncture is thought to decrease pain by increasing the release of endorphins, chemicals that block pain. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins that block the message of pain from being delivered to the brain.

Acupuncture may be useful as an accompanying treatment for many pain-related conditions, including headache, low back pain, menstrual cramps, carpal tunnel syndrome, tennis elbow, fibromyalgia, osteoarthritis (especially of the knee), and myofascial pain. Acupuncture also may be an acceptable alternative to or may be included as part of a comprehensive pain management program.

Chiropractic Treatment and Massage

Chiropractic treatment is the most common nonsurgical treatment for back pain. Improvements of people undergoing chiropractic manipulations were noted in some trials. However, the treatment’s effectiveness in treating chronic back and neck pain has not been supported by compelling evidence from the majority of clinical trials. Further studies are currently assessing the effectiveness of chiropractic care for pain management.

Osteopathic doctors, those with a “D.O.” after their names, are also trained in bone manipulation techniques similar to that of chiropractors.

Massage is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage can reduce stress and relieve tension by enhancing blood flow. This treatment also can reduce the presence of substances that may generate and sustain pain. Available data suggest that massage therapy, like chiropractic manipulations, holds considerable promise for managing back pain. However, it is not possible to draw final conclusions regarding the effectiveness of massage to treat pain because of the shortcomings of available studies.

Therapeutic Touch and Reiki Healing

Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so-called “energy-based” techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient.

In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health. Although several studies showed beneficial effects with no significant adverse side effects, the limitations of some of these studies make it difficult to draw definitive conclusions. Further studies are needed before these approaches for pain treatment can be recommended.

Nutritional Supplements

Dietary supplements, such as fish oils and SAMe, also show some evidence of benefit, although more research is needed.

Herbal Remedies

It has been difficult to draw conclusions about the effectiveness of herbs, though there are a few, such as white willow bark, devil’s claw, cat’s claw, ginger, and turmeric, that have some evidence supporting their use. If you decide to use herbal preparations to better manage your pain, tell your doctor: Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health.

Dietary Approaches to Treating Pain

Some people believe that changing dietary fat intake and/or eating plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation.

A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not methodologically strong. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis.

Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.

Things to Consider

Alternative therapies are not always benign. As mentioned, some herbal therapies can interact with other medications you may be taking. Always talk to your doctor before trying an alternative approach and be sure to tell all your doctors what alternative treatments you are using.

Other Options: Pain Clinics

Many people suffering from chronic pain are able to gain some measure of control over it by trying many of the above treatments on their own. But for some, no matter what treatment approach they try, they still suffer from debilitating pain. For them, pain clinics — special care centers devoted exclusively to dealing with intractable pain — may be the answer. Some pain clinics are associated with hospitals and others are private; in either case, both inpatient and outpatient treatment are usually available.

Pain clinics generally employ a multidisciplinary approach, involving physicians, psychologists, and physical therapists. The patient as well should take an active role in their own treatment. The aim in many cases is not only to alleviate pain but also to teach the chronic sufferer how to come to terms with pain and function in spite of it.

Various studies have shown as much as 50% improvement in pain reduction for chronic pain sufferers after visiting a pain clinic, and most people learn to cope better and can resume normal activities.

Non-Drug Pain Management: MedlinePlus

What is pain?

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen, chest, pelvis, or you may feel pain all over.

There are two types of pain:

• Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
• Chronic pain lasts for a long time, and can cause severe problems

What are pain relievers?

Pain relievers are medicines that reduce or relieve pain. There are many different pain medicines, and each one has advantages and risks. Some are over-the-counter (OTC) medicines. Others are stronger medicines, which are available by prescription. The most powerful prescription pain relievers are opioids. They are very effective, but people who take them are at risk of addiction and overdose.

Because of the side effects and risks of pain relievers, you may want to try non-drug treatments first. And if you do need to take medicines, also doing some non-drug treatments may allow you to take a lower dose.

What are some non-drug treatments for pain?

There are many non-drug treatments that can help with pain. It is important to check with your health care provider before trying any of them:

• Acupuncture involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
• Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.
• Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include
• Transcutaneous electrical stimulation (TENS)
• Implanted electric nerve stimulation
• Deep brain or spinal cord stimulation
• Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax, and relieve stress and pain.
• Meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings.
• Physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.
• Psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by
• Teaching them coping skills, to be able to better deal with the stress that pain can cause
• Addressing negative thoughts and emotions that can make pain worse
• Providing them with support
• Relaxation therapy can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.
• Surgery can sometimes be necessary to treat severe pain, especially when it is caused by back problems or serious musculoskeletal injuries. There are always risks to getting surgery, and it does not always work to treat pain. So it is important to go through all of the risks and benefits with your health care provider.

Pain Management: Know Your Treatment Options

Whether your pain is from arthritis, cancer treatments, fibromyalgia, or an old injury, you need to find a way to get your pain under control. What’s the best approach to do that?

The first step in pain management is scheduling an appointment with your doctor to determine the cause of your pain and learn which pain management approach is often the most effective for it. There are many different pain management options available: You can find the right treatment combination to get the relief you need.

Before you try to treat your pain, it’s important to understand how pain is defined.

“The International Association for the Study of Pain came up with a consensus statement,” says Judith Scheman, PhD, program director of the Chronic Pain Rehabilitation Program at the Cleveland Clinic in Ohio. “Pain is an unpleasant sensory and emotional experience. I think that’s extraordinarily important. When we focus only on the sensory aspect, we fail to appreciate the suffering component of the pain, which is important to recognize because pain is not what occurs at the periphery.”

Why Do People Experience Pain Differently?

Pain is real and it’s physical — there’s no mistaking that. But pain is measured and specific to one person based on that person’s perception of the pain, and that’s why everyone’s pain is different.

“What the brain perceives is indisputably modifiable by emotions,” notes Scheman. That means that people who are fearful of pain, depressed, or anxious may experience pain differently, and perhaps more severely, than someone who has pain but isn’t experiencing those other emotions.

Pain Management: Treating Mind and Body

Scheman stresses the importance of approaching pain both physically and emotionally and addressing “people as entire human beings.” So while chronic pain medication can be effective and important for pain management for many people, it isn’t the only tool available when it comes to pain treatment, and it shouldn’t be the only tool that’s used.

Medications. “There are a lot of medications that are prescribed for pain,” says Scheman, although she notes that opioids (narcotics) and benzodiazepines may not be the best options. Those treatments “have their own problems, and there are no good studies on using opioids for long periods of time for the treatment of chronic pain.”

Types of chronic pain medication used include:

Therapy. Therapy can be aimed at both the mind and the body. Says Scheman, “I try to look at any of these therapies as not being purely physical or purely psychological — we are always a mixture of both of those things. “

• Physical therapy is a very important part of any pain management program. Pain can be worsened by exercise that isn’t done correctly (or interpreted incorrectly as pain rather than overuse), and a physical therapist can tailor the right exercise regimen for you. Proper exercise slowly builds your tolerance and reduces your pain — you won’t end up overdoing it and giving up because it hurts.
• Cognitive-behavioral therapy allows people to “learn and have a better understanding of what the pain is from, and what they can do about it,” says Scheman. This therapy is really about understanding the role of pain in your life and what it actually means for you, add Scheman.

Other pain management options. A variety of approaches and modalities can help you deal with both the physical and emotional parts of pain:

• TENS (transcutaneous electrical nerve stimulation) therapy
• Meditation
• Relaxation techniques
• Visual imagery, as simple as picturing a peaceful scene, for example
• Biofeedback, which teaches control over muscle tension, temperature, heart rate and more
• Heat and cold therapy
• Manipulation and massage

The bottom line: Seek help for your pain as soon as it becomes a problem in your life. “We aren’t guaranteed lives without pain,” says Scheman. But when chronic pain starts to destroy your ability to function in the world, then it’s a problem that needs to be addressed.

Management of Pain without Medications

Management of Pain Without Medications

What is non-pharmacological pain management?

Non-pharmacological pain management is the management of pain without medications. This method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain. Methods of non-pharmacological pain include:

Education and psychological conditioning

Not knowing what to expect with cancer treatment is very stressful. However, if you are prepared and can anticipate what will happen, your stress level will be much lower.

To decrease your anxiety about cancer treatment, consider the following:

• Ask for an explanation of each step of a procedure in detail, utilizing simple pictures or diagrams when available.
• Meet with the person who will be performing the procedure and write down answers to questions.
• Tour the room where the procedure will take place.
• Ask what you can expect as an outcome of the treatment.

Hypnosis

With hypnosis, a psychologist or doctor guides you into an altered state of consciousness. This helps you to focus or narrow your attention to reduce discomfort.

Methods for hypnosis include:

• Imagery: Guiding you through imaginary mental images of sights, sounds, tastes, smells, and feelings can help shift attention away from the pain.
• Distraction: Distraction is usually used to help children, especially babies. Using colorful, moving objects or singing songs, telling stories, or looking at books or videos can distract preschoolers. Older children and adults find watching TV or listening to music helpful. Use distraction appropriately, and not in place of an explanation of what to expect.
• Relaxation/guided imagery: Guiding you through relaxation exercises such as deep breathing and stretching can often reduce discomfort

Other non-pharmacological pain management may utilize alternative therapies such as comfort therapy, physical and occupational therapy, psychosocial therapy/counseling, and neurostimulation to better manage and reduce pain. Examples of these non-pharmacological pain management techniques include the following:

Comfort therapy

Comfort therapy may involve the following:

• Companionship
• Exercise
• Heat/cold application
• Lotions/massage therapy
• Meditation
• Music, art, or drama therapy
• Pastoral counseling
• Positioning

Physical and occupational therapy

Physical and occupational therapy may involve the following:

• Aquatherapy
• Tone and strengthening
• Desensitization

Psychosocial therapy/counseling

Psychosocial therapy/counseling may involve the following:

• Individual counseling
• Family counseling
• Group counseling

Neurostimulation

Neurostimulation may involve the following:

What Is It, Causes, Symptoms & Treatment

Overview

What is chronic pain?

Chronic pain is pain that lasts for over three months. The pain can be there all the time, or it may come and go. It can happen anywhere in your body.

Chronic pain can interfere with your daily activities, such as working, having a social life and taking care of yourself or others. It can lead to depression, anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle that’s difficult to break.

What’s the difference between chronic pain and other pain?

Chronic pain differs from another type of pain called acute pain. Acute pain happens when you get hurt, such as experiencing a simple cut to your skin or a broken bone. It doesn’t last long, and it goes away after your body heals from whatever caused the pain. In contrast, chronic pain continues long after you recover from an injury or illness. Sometimes it even happens for no obvious reason.

Where do people have chronic pain?

Chronic pain can come in many different forms and appear across your body. Common types of chronic pain include:

How common is chronic pain?

Chronic pain is a very common condition, and one of the most common reasons why someone seeks medical care. Approximately 25% of adults in the United States experience chronic pain.

Symptoms and Causes

What causes chronic pain?

Sometimes chronic pain has an obvious cause. You may have a long-lasting illness such as arthritis or cancer that can cause ongoing pain.

Injuries and diseases can also cause changes to your body that leave you more sensitive to pain. These changes can stay in place even after you’ve healed from the original injury or disease. Something like a sprain, a broken bone or a brief infection can leave you with chronic pain.

Some people also have chronic pain that’s not tied to an injury or physical illness. Healthcare providers call this response psychogenic pain or psychosomatic pain. It’s caused by psychological factors such as stress, anxiety and depression. Many scientists believe this connection comes from low levels of endorphins in the blood. Endorphins are natural chemicals that trigger positive feelings.

It’s possible to have several causes of pain overlap. You could have two different diseases, for example. Or you could have something like migraines and psychogenic pain together.

What does chronic pain feel like?

People with chronic pain describe their pain in many different ways, such as:

• Aching.
• Burning.
• Shooting.
• Squeezing.
• Stiffness.
• Stinging.
• Throbbing.

Chronic pain often leads to other symptoms and conditions, including:

Diagnosis and Tests

How is chronic pain diagnosed?

Pain is considered to be chronic if it lasts or comes and goes (recurs) for more than three months. Pain is usually a symptom, so your healthcare provider needs to determine what’s causing your pain, if possible. Pain is subjective — only the person experiencing it can identify and describe it — so it can be difficult for providers to determine the cause.

If you have long-lasting pain, see your healthcare provider. Your provider will want to know:

• Where your pain is.
• How intense it is, on a scale of 0 to 10.
• How often it occurs.
• How much it’s affecting your life and work.
• What makes it worse or better.
• Whether you have a lot of stress or anxiety in your life.
• Whether you’ve had any illnesses or surgeries.

What tests are used to diagnose chronic pain?

Your healthcare provider may physically examine your body and order tests to look for the cause of the pain. They may have you undergo the following tests:

• Blood tests.
• Electromyography to test muscle activity.
• Imaging tests, such as X-rays and MRI.
• Nerve conduction studies to see if your nerves are reacting properly.
• Reflex and balance tests.
• Spinal fluid tests.
• Urine tests.

Management and Treatment

How is chronic pain treated?

To relieve chronic pain, healthcare providers first try to identify and treat the cause. But sometimes they can’t find the source. If so, they turn to treating, or managing, the pain.

Healthcare providers treat chronic pain in many different ways. The approach depends on many factors, including:

• The type of pain you have.
• The cause of your pain, if known.
• Your age and overall health.

The best treatment plans use a variety of strategies, including medications, lifestyle changes and therapies.

If you have chronic pain and depression and/or anxiety, it’s important to seek treatment for your mental health condition(s) as well. Having depression or anxiety can make your chronic pain worse. For example, if you have depression, the fatigue, sleep changes and decreased activity it may cause can make your chronic pain worse.

What medications can treat chronic pain?

Your healthcare provider may recommend certain medications to relieve chronic pain, including:

• Anticonvulsants (medications that prevent seizures) for nerve pain.
• Antidepressants such as tricyclic antidepressants.
• Corticosteroid.
• Muscle relaxers.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
• Topical products (applied to the skin) that contain pain relievers or ingredients that create soothing heat or cold.
• Opioids (narcotics). Opioids can be addictive, and you can build up a tolerance to them over time. Because of this, healthcare providers usually try other pain treatment options before prescribing opioids.
• Sedatives to help with anxiety or insomnia.
• Medical marijuana.

Other medical treatments your healthcare provider may have you try include:

• Transcutaneous electrical nerve stimulation (TENS): This procedure delivers small shocks through patches on your skin. The electrical impulses can relieve pain.
• Nerve blocks: For this treatment, your healthcare provider injects an anesthetic near the site of your pain to reduce feeling in the area. Nerve blocks can also sometimes provide diagnostic information and locate the source of your pain.
• Epidural steroid injections: This procedure is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the space around your spinal nerves known as the epidural space to treat chronic pain caused by irritation and inflammation of spinal nerve roots.

Are there side effects or complications of medical treatment for chronic pain?

Every medication has a potential for side effects — some are more serious than others. Be sure to discuss the possible side effects of your chronic pain medications with your healthcare provider.

Complications from medical treatments for chronic pain can include:

• Acute liver failure from acetaminophen treatment.
• Opioid addiction and/or overdose.
• Mood changes, confusion and respiratory issues from nerve pain medications.
• Spinal cord damage or infection from spinal cord stimulators.

Can lifestyle changes help with chronic pain?

Four major lifestyle factors can affect your chronic pain and help minimize it. Healthcare providers sometimes call them the four pillars of chronic pain. They include:

• Stress: Stress can play a major role in chronic pain, so it’s important to try to reduce your stress as much as possible. Everyone has different techniques for managing their stress, but some techniques include meditation, mindfulness and deep breathing. Try different options until you find what works best for you.
• Exercise: Participating in low-intensity exercises, such as walking or light swimming, for 30 minutes every day may help reduce your pain. Exercise can also be a stress reliever for some people, which is important to manage when you have chronic pain.
• Diet: It’s important to eat a healthy diet to boost your overall health. Your healthcare provider may suggest trying an anti-inflammatory diet by eliminating foods that cause inflammation, such as red meat and refined carbohydrates.
• Sleep: Getting enough quality sleep is important for your overall health. A lack of sleep can cause you to gain weight, which could make your chronic pain worse. Getting quality sleep is also important for stress management.

Be sure to discuss these four lifestyle pillars with your healthcare provider to determine how each applies to your type of chronic pain and how you can incorporate changes into your day-to-day life.

Can therapy help with chronic pain?

Certain therapies may help you manage chronic pain, including:

• Cognitive-behavioral therapy (CBT): This counseling method helps you think differently about pain and teaches you ways to cope.
• Counseling: Talk therapy can help you manage chronic pain, especially psychogenic pain.
• Occupational therapy: Occupational therapy teaches you how to do everyday tasks differently to lessen pain or avoid injury.
• Physical therapy: Physical therapy involves exercises that stretch and strengthen your body, which can help reduce your pain.

What alternative treatments are available for chronic pain?

Alternative treatments that have been shown to relieve chronic pain over time include:

• Acupuncture, which uses small needs placed in the body.
• Aromatherapy, which uses aromatic plants and essential oils.
• Biofeedback, which teaches you how to tweak the way your body works, influencing such things as heart rate, breathing and muscle tension.
• Hypnotherapy, or hypnosis.
• Mindfulness training, which teaches you how to calm yourself.
• Music, art or pet therapy.
• Reiki or Healing Touch™, with a therapist using touch to change energy fields in your body.
• Relaxation techniques, such as massage, meditation and guided imagery.

Is there a cure for chronic pain?

Currently, there is no cure for chronic pain, other than to identify and treat its cause. For example, treating arthritis can sometimes stop joint pain.

Many people with chronic pain don’t know its cause and can’t find a cure. They use a combination of medications, therapies and lifestyle changes to lessen pain.

Prevention

What are the risk factors for chronic pain?

Since many conditions or injuries can cause chronic pain, there are several risk factors for experiencing it. Some risk factors include:

• Your genetics: Some chronic pain causes, like migraines, run in the family (are genetic).
• Having obesity: Having obesity can worsen certain health conditions that cause pain, such as arthritis since there’s extra pressure on your joints.
• Your age: Older people are more likely to experience chronic pain from arthritis and neuropathy.
• Having a previous injury: If you’ve had a traumatic injury, you’re more likely to develop chronic pain in the future.
• Having a labor-intensive job: If you have a physically strenuous job, you’re at greater risk for developing chronic pain.
• Experiencing stress: Studies have shown that chronic pain is connected to both frequent stress and post-traumatic stress disorder.
• Smoking: If you smoke, you’re at greater risk for developing medical conditions that lead to a need for chronic pain treatment.

Can chronic pain be prevented?

Unfortunately, nothing has been proven to prevent chronic pain in general. You may be able to prevent certain conditions that lead to chronic pain. For example, you can quit smoking to lower your risk of lung cancer.

Outlook / Prognosis

What is the prognosis (outlook) for people with chronic pain?

Chronic pain usually doesn’t go away, but you can manage it with a combination of strategies that work for you. Current chronic pain treatments can reduce a person’s pain score by about 30%.

Researchers continue to study pain disorders. Advances in neuroscience and a better understanding of the human body should lead to more effective treatments.

If you have chronic pain and depression and/or anxiety, it’s important to seek treatment for your mental health. Untreated depression and anxiety can make your pain worse and further lower your quality of life.

What are the complications of chronic pain?

Complications of chronic pain can include:

• Decreased quality of life.
• Depression.
• Anxiety.
• Substance abuse disorders.
• Worsening of existing chronic disease.
• An increased risk of suicidal ideation and/or suicide.

The complications of chronic pain are serious. Because of this, it’s essential to seek medical care if you’re experiencing chronic pain. There are many options for pain treatment and management. While it may take a while to find the right combination of therapies that work for you, it’s worth undertaking.

If you’re experiencing thoughts of suicide, contact the National Suicide Prevention Lifeline at 800-273-8255. Someone will be available to talk with you 24 hours a day.

Living With

How can I cope with chronic pain?

Besides taking medications, getting therapy and making lifestyle changes, take good care of yourself. The following actions can help you cope with your chronic pain and improve your overall health:

• Avoid smoking.
• Don’t try to do too much. Create a daily schedule that includes a few priorities and time for rest and self-care.
• Eat a healthy diet.
• Exercise regularly.
• Get enough sleep.
• Manage your stress.
• Join a support group for chronic pain to learn from other people with similar conditions.
• Limit alcohol, which can cause more problems with sleep and pain.
• Try to think positively.

What questions should I ask my doctor?

If you have chronic pain, it may be helpful to ask your healthcare provider the following questions:

• What’s causing my pain?
• Will it go away? If no, why not?
• What kinds of medications can I take? What are their side effects?
• Should I try physical or psychological therapy?
• Is it safe to exercise?
• What else can I do to relieve my chronic pain?
• Should I call you if it gets worse?

A note from Cleveland Clinic

Chronic pain lasts months or years and can interfere with your ability to work, enjoy activities and take care of yourself or others. If you have chronic pain, please talk to a healthcare provider or pain specialist. There are ways to manage your pain to help you toward a more comfortable life.

Pain Relief Through Physical Therapy

Nov 16, 2016 12:00 AM

Author:
Libby Mitchell

We think of physical therapy when we think of recovering from an injury or a surgery. Broken leg? You’ll need physical therapy. Knee replacement? See you in PT. However, physical therapy can be effective in treating a condition more than 3 million Americans live with every day: chronic pain.

“It is a much better option than pain killers in many circumstances, particularly with longstanding musculoskeletal conditions,” says Tamara Dangerfield, MPT, a physical therapist with University of Utah Health. “Movement-based therapies become more and more effective for pain control the more they are practiced, and the side effects include improved mood, blood pressure, weight control, bone density, endurance, strength, and sleep.”

Pain relief through physical therapy is based in the knowledge that all forces in the body affect each other. When a nerve is pinched it can be due to compression from the muscle or fascia. Reducing that strain and restoring fluid movement will help alleviate the pain. It works similarly for other types of pain. “Many people do not realize that the nerves and blood vessels that attach to all structures in the body, including organs as well as musculoskeletal structures, travel through muscle and fascia tissue,” says Dangerfield. “We work to restore the balance of coordination, flexibility, and strength so that movement, blood and nerve flow are not hindered.”

Unlike other methods of reducing pain, physical therapy aims not to stop pain quickly and temporarily, but over time and for the long term. This is why it is a perfect for patients who want to avoid taking opioid painkillers—which often are offered as a solution. “Opioids are only effective at treating these types of pain for short periods of time and in long-term situations become less and less effective with huge risks and side effects,” says Dangerfield. “Taking a pill may seem like a great option for people when they hurt and just want the pain to go away, but we have seen huge detrimental effects on people who have come to rely solely on opioids for pain control.”

Physical therapy encompasses a variety of treatments, which means patients who do not respond to one method may find relief in another. Treatments run the gamut from massage to join manipulation to dry needling and electrical stimulation. “Just because something doesn’t work the first time or even if it worsens pain, that does not mean that a person has failed physical therapy,” says Dangerfield. “There are infinite possibilities to modify a person’s program to keep it comfortable and keep making progress.”

Pain Relief Machines – a Full Guide for Chronic Pain Treatment

Chronic pain is becoming more and more widespread, due to different factors such as environmental factors and aging populations.

Chronic pain is pain that lingers for months and even years. When pain lasts for 3 to 6 months or more, it’s defined as chronic pain. Symptoms range from a dull ache to shooting pain. Suffering chronic pain means hurting every day, and this can take a toll on every person.

Chronic pain management techniques

Treatments for chronic pain depend on the severity of the pain, the underlying cause, and the location of the pain.

Efficient chronic pain treatment techniques can be divided into general categories including self-care, exercises, various therapies, medications, and the interventional techniques. It’s not necessary to choose only one treatment option, and a combination of different treatments may prove to be the best option.

The pain relief technologies described below fall into the self-care category that is so crucial in chronic pain management. There are other forms of self-care, starting with the most basic one: rest. Exercises are another form of self-care that can both alleviate symptoms and keep you healthy. Chronic pain management therapies include physical therapy, cognitive behavioral therapy (CBT), relaxation techniques and others. Prescription and nonprescription drugs can help in chronic pain treatment when needed, and interventional techniques such as injections and surgery are recommended in severe cases only.

Pain Relief Technologies

Here’s a guide to 5 major pain relief technologies offered today for chronic pain treatment. All 5 chronic pain relief technologies are 100% drug-free, non-invasive and non-surgical solutions to apply daily using portable, practical devices. These noninvasive pain management devices usually use electrodes in the form of pads to connect to the skin or of conductive gel. All 5 technologies are available for use in the comfort of your home and sometimes on-the-go, for self-care and pain management. It is always advised to read instructions and warnings carefully and consult before use, especially if you have any medical conditions.

(1) E-Stim

What is e-stim?

Electrical stimulation, often referred to as E-stim, is a technology that sends mild electrical pulses through the skin to target nerves or muscles. These electrical pulses help stimulate nerves with the purpose of relieving pain, possibly because they block the transmission of pain signals from nerves to the spinal cord and the brain.

Uses and benefits of e-stim devices

Electrical stimulation technology has been used for pain management for decades, and it has been found to have potential benefits in the management of various painful conditions causing nerve and muscoloskeletal pain.

The electrical pulses also stimulate injured muscles for purposes other than pain relief. When targeted muscles are stimulated, they contract repeatedly, and this may be helpful in enhancing muscle recovery and strength.

Electrical stimulators are small electronic devices used externally by the patient. In electronic pain relief devices, electrical pulses are delivered through wires that connect the e-stim unit to electrodes placed on the skin and from there into the body. The impulses can vary in intensity, frequency and duration, depending on the treated area, the device, and the patient’s tolerance.

The two main types of e-stim are transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS). There are also other types of e-stim for noninvasive chronic pain relief that may be beneficial depending on your condition.
We focus on TENS, as the TENS technology is aimed at chronic pain treatment.

E-sim FAQ

What does e-stim treat?

E-stim may be appropriate for the following pain relief:

• Acute pain
• Chronic pain
• Back pain
• Joint pain
• Sports injuries
• Arthritis
• Post-surgical pain
• Muscle injury from trauma or disease
• Nerve inflammation
• Fibromyalgia

What to expect during e-stim therapy?

• Electrodes are placed around the site of pain
• Electrical current begins to transmit pulses, starting on low setting and increased gradually
• You will feel the electrical pulses as “pins and needles” or tingling on site
• Muscles may twitch or contract in response to the electrical stimulation
• E-stim therapy sessions usually lasts 5 to 15 minutes

What are the risks of e-stim?

E-stim is generally safe, but it does involve risk to heart health. E-stim is not recommended and may even be dangerous for people with a pacemaker or other implantable heart device. It is also not recommended for pregnant women or people with epilepsy.

Skin irritation may occur where the electrodes are placed. Also, e-stim electrodes should not be placed over the eyes and on the front of the neck or directly over the spinal column. In addition, they should not be placed in situations such as broken skin or over a tumor.

(2) TENS devices

What is TENS?

TENS, Transcutaneous electrical nerve stimulation, is a treatment that administers mild electrical current to the skin to create nerve stimulation and trigger pain relief response. The electric current is produced by a TENS pain relief machine and delivered to the body through electrode pads attached to the skin around or near the area to be treated for pain. The electrical impulses reduce the body’s ability to transmit pain signals, and they also stimulate the body to produce endorphins that act like natural pain relievers.

TENS machine uses

TENS devices may help with the following symptoms of chronic pain: chronic back pain, chronic neck pain, and chronic joint pain.

They may also alleviate the pain that results from various conditions such as period pain, sports injuries, post-surgical pain, arthritis, endometriosis, and other conditions.

While the use of TENS has proved effective in clinical studies, there is a lack of conclusive scientific studies and clinical trials, and there is controversy over which conditions the TENS device should be used to treat. A few studies have shown objective evidence that TENS may modulate or suppress pain signals in the brain. This may be dependent on several factors, such as the painful body part.

As they stimulate nerves, most TENS devices can modulate intensity, frequency, and duration to administer an appropriate level of pain relief depending on the painful area, the device, and the patient’s tolerance.

Intensity: The TENS technology requires an adequate intensity of stimulation to achieve pain relief. The intensity can be set by the user.

Frequency: Frequency refers to the number of electrical pulses per second. TENS is usually applied at high-frequency (more than 50 Hz) for acute pain, and at low-frequency (up to 10 Hz) for chronic pain.

Duration: The duration is the amount of time that the electric current enters the skin.

There seem to be more positive results for chronic pain treatment when complying with clinical advice of intensity of sensations, frequency, and duration of treatment.

Duration of pain relief

Pain relief experienced during the use of TENS device and after can vary. Some TENS device users experience relief only when the device is on, while others continue to experience pain relief for up to 24 hours after using the device.

TENS machine for back pain

To treat back pain with TENS machine, the placement of the electrodes is crucial. Electrodes should be placed on the skin over an area of pain in the back. Doing this should result in electrical impulses that travel along nerve fibers and create a tingling sensation. This should not hurt. Pain relief is usually experienced during use, and in some cases may still be felt after it.

Before using TENS machine for back pain consult with your doctor and make sure it’s right for you. This is especially true for people with pacemaker, heart problem, epilepsy or pregnant women.

Benefits of TENS device

TENS devices are painless and noninvasive. Pain relief is the major benefit of TENS pain relief devices, which may enable users to reduce their intake of pain medications and improve their quality of life.

Easy-to-use and portable, they can offer pain relief almost anytime, anywhere.

Safety and side effects
TENS units are generally safe and have no side effects. However, the electric pulses produced by the TENS device may cause an uncomfortable sensation on the skin. Some people may also experience skin irritation from the adhesive pads and may find that hypoallergenic pads are better for them.
There are several locations where TENS should not be used, especially over the eyes and on the front of the neck. It should also not be placed directly over the spinal column, or through the chest (positioning the electrodes in anterior and posterior locations). Also, normally TENS devices should not be used internally, on broken skin, or over a tumor.

Specific groups of people should avoid TENS treatment as a result of having a special medical condition unless advised by a doctor:

• People with heart problems
• People with a cardiac pacemaker or implantable cardioverter-defibrillators (ICDs)
• People with epilepsy
• Pregnant women

TENS devices

Different companies specialize in TENS devices. Quell device, for example, is a wearable TENS device. Quell is designed to treat chronic pain. It uses electrical pulses and claims to be 3 times more powerful than typical TENS devices. It is designed to stay on your body day and night, even in your sleep, usually running one hour on, one hour off as long as you wear it.

Another example is Nursal TENS unit electronic pain relief massager, with different massage modes and levels of strength, for chronic pain relief. HealthmateForever is FDA-cleared and offers different versions of electrotherapy for topical pain management.

TENS FAQ

What does TENS treat?

TENS may be appropriate for the following pain relief:

• Chronic pain
• Back pain
• Neck pain
• Joint pain
• Sports injuries
• Arthritis
• Post-surgical pain
• Period pain
• Nerve inflammation
• Fibromyalgia

What to expect during TENS therapy?

For home use devices, prepare the device according to instructions.

• Place electrodes around the site of pain
• Turn the unit on
• Electrical current begins to transmit pulses. Start on a low setting and change intensity to be strong but comfortable
• You should feel the electrical pulses as “pins and needles” or tingling on site
• Muscles may twitch or contract in response to the electrical stimulation
• Session length varies depending on the device. For example, HealthmateForever units suggest 30 minutes therapy sessions, 2-3 times daily for acute pain relief of more for chronic pain relief.

What are the risks of TENS?

TENS technology is generally safe, but it does involve risk to heart health. TENS is not recommended and may even be dangerous for people with a pacemaker or other implantable heart device. It is also not recommended for pregnant women or people with epilepsy.

Skin irritation may occur where the electrodes are placed.

(3) RF Devices

What is RF?

RF, radiofrequency, involves the application of alternating pulses of electrical current produced by a radio wave in the suggested frequency range of 20 kHz to 300 GHz (different sources specify different range). This is a low-energy, high-frequency alternating current that heats up a small area of nerve tissue, decreasing pain signals from that area.

In medical settings, RF procedures are described as the application of RF electrical signals to neural tissue with RF electrodes inserted into the tissue and RF administered directly to the roots of the nerves which are responsible for sending pain signals, sometimes involving needles that penetrate into the body to reach specific nerve cells. This is an invasive procedure, usually done with X-ray to monitor the location and verify that the needle is located safely before radiofrequency currenct can be applied.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) is a minimally invasive medical procedure to ablate nerves in order to essentially stop the transmission of pain signals to the brain. It is usually performed in an outpatient setting, by a specialist using anesthetics. It is effective in many cases, offering pain relief.

Continuous RF (CRF)

In CRF, alternating RF current is applied to a target nerve using a needle electrode. The goal is to apply the current for sufficient time to cause coagulation, or a thermal lesion, less painful, although the mechanism for its effectiveness is unclear. Diagnosis is very important since pulsed RF seems to be ineffective in some conditions.

Non-invasive RF

Home devices are noninvasive and RF is administered by a device placed on the skin with the help of conductive gel.

Read more on What is Radiofrequency Pain Treatment?

Uses of RF device

RF devices may help with the following symptoms of chronic pain: chronic back pain, chronic neck pain, and chronic Joint pain from arthritis.

Radiofrequency (RF) energy, in the form of radiating waves or electrical currents, has been used in medical treatments for many decades. However, peer-reviewed publications regarding the efficacy and mechanisms of RF are now starting to appear. There are a number of medical applications of RF, such as diathermy, a therapeutic treatment most commonly prescribed for muscle and joint conditions, and even magnetic resonance imaging (MRI).

Benefits of RF device

Pain relief is the major benefit of RF chronic pain devices, alongside healing acceleration and muscle relaxation. This often enables users to reduce their intake of pain medications and improves their quality of life.

Best pain relief devices using RF technology that used to be available only in medical settings, are now portable and can be used almost anytime, anywhere.

Safety and side effects
RF pain relief devices are generally safe and have no side effects. Applying RF to the body often does not involve any pain or muscular contraction. However, it’s important to be careful not to get superficial burns called RF burns.
In addition, be careful if you have a cardiac pacemaker or other active implants.

RF Devices

RF technology for pain management, which was not previously available for home use, is now part of new devices for chronic pain relief.
Solio Alfa Plus uses bi-polar radiofrequency deep penetration technology that reaches the muscles and joints and increases blood circulation to cure the pain. It is the first pain management device that treats pain using RF+IR+LLLT technologies for maximum benefits. In fact, Solio Alfa Plus is the only FDA-cleared home-use device featuring the patented synergy of 3 energy sources to gain pain relief and help the body heal itself.

Radiofrequency FAQ

What does RF treat?

RF is used to treat many conditions, such as the following:

• Chronic pain
• Low back pain (such as from lumber facet joints, the sacroiliac joint, the intervertebral discs)
• Neck pain
• Joint pain (such as thoracic)
• Knee pain
• Trigeminal neuralgia
• Complex regional pain syndrome
• Chronic post-surgical pain
• Cancer pain

What to expect during RF therapy?

For home use devices, prepare the device according to instructions.

• Plug the device into electrical outlet and turn it on
• Apply slider gel to the treatment area
• Place device on site of pain
• Warmth is emitted from the device if used in RF mode
• Session length varies depending on the device. Solio Alfa Plus requires 15-20 minutes per sessions.

What are the risks of RF pain relief devices?

There are no known risks associated with noninvasive RF pain relief devices for home use.

(4) IR Devices

What is IR?

IR, infrared light therapy, is a treatment that uses certain wavelengths of light delivered to the skin to trigger pain relief response to sites of the body. Infrared light cannot be seen by the eye, yet it penetrates into the body to offer pain relief. Unlike ultraviolet light which may be harmful, infrared light is the heat that we feel when exposed to the sun, and it helps cells regenerate or repair themselves. IR light is produced by a pain relief machine.

Uses of IR device

IR devices may help with the following symptoms of chronic pain: chronic back pain, chronic neck pain, chronic joint pain from arthritis, temporomandibular joint pain (TMJ), and chronic tendonitis.

Infrared light therapy is applied in the treatment of various health conditions, including trauma, muscle pain, joint inflammation, carpal tunnel syndrome, sciatica, diabetic neuropathy, injuries, wounds, and post-surgical incisions.

Benefits of IR device

IR is a natural, non-invasive, and painless technology that offers various health benefits, from pain relief to reduced inflammation.
Infrared light penetrates into the skin and improves the circulation of oxygen-rich blood in the body, promoting faster healing of deep tissues and relieving pain.

Safety and side effects
Infrared therapy is a safe and effective pain relief technology, without adverse side effects. As a matter of fact, infrared light is safe and is used even for infants.

IR Devices

IR devices are offered for home use. Best home use devices offer clinically effective light therapy delivered consistently to maximize pain relief.

The LumiWave® Infrared Light Therapy Device was FDA cleared for temporary relief of minor muscle pain and spasms and minor joint pain and stiffness, such as resulting from strains and sprains, as well as the first clearance for the treatment of arthritis for an infrared therapy device.

Solio Alfa Plus pain relief device uses also Infra-Red (IR) and red spectrum for treating skin pain and stiffness, in synergy with RF energy and LLLT energy. Infrared has invisible wavelengths that we feel as heat and can penetrate into the body, while similar red light is part of the visible spectrum.

Another company to use red spectrum is Joovy. Joovy is a manufacturer of personal, in-home red-light therapy devices, which come in different sizes, setup options, and wavelengths. Joovy offers models for specific areas in the body as well as larger models that are full body.

Some clinical studies demonstrate the pain relieving benefits of red-light therapy. But remember, wavelength and intensity are incredibly important. Make sure you choose a device with the correct wavelength and optimal amount of power.

IR FAQ

What does IR treat?

IR may be appropriate for the following pain relief:

• Chronic pain
• Chronic back pain
• Chronic neck pain
• Chronic joint pain
• Arthritis
• Post-surgical incisions
• Trauma pain
• Muscle pain
• Sciatica
• Carpal tunnel syndrome

What to expect during IR therapy?

IR and red-light therapy are treatments in which you expose your skin to a device or a laser. For home use devices, prepare the device according to instructions.

• Plug in
• Place unit over site of pain
• Select treatment mode (this may refer to intensity of treatment and/or the types of light therapy applied)
• Session length varies depending on the device.

What are the risks of IR devices?

IR is generally safe, with no known risks and side effects.

(5) LLLT Devices

What is LLLT?

LLLT, Low-Level Laser Therapy, is a treatment that administers low power laser or light-emitting diodes (LEDs) beams of light to the surface of the body to relieve pain, as well as stimulate and enhance cell function.

LLLT is known in many names, including:

• Cold laser therapy
• Low-power laser therapy (LPLT)
• Soft laser therapy
• Soft laser biostimulation
• Low-intensity laser therapy
• Therapeutic laser
• Photobiomodulation
• Monochromatic infrared light therapy (MIRE) technology

Uses of LLLT device

Light affects cellular function, and this is used at specific wavelengths and the right intensity in LLLT pain management medical devices.

There is no consensus over LLLT validity, but there are studies that suggest it may be effective in relieving pain for different conditions, including low back pain, chronic neck pain, acute neck pain and more.

LLLT devices may help with the following symptoms of chronic pain:

• Nonspecific chronic back pain
• Neck pain
• Musculoskeletal pain

LLLT may also be helpful for pain relief for muscle pain, injuries and joints, and useful in the short-term treatment of pain caused by various conditions such as chronic joints conditions like osteoarthritis and tendinopathy. These devices were said to be useful in the treatment of other musculoskeletal conditions, such as carpal tunnel syndrome, rheumatoid arthritis and fibromyalgia. Other applications such as post-operative pain may also be used.

Benefits of LLLT device
LLLT devices may help with pain management, but there is no clinical support regarding their long-term outcomes.

Safety and side effects
The wavelengths used by LLLT devices are within the normal visible spectrum of light, but with no harmful UV rays.
The range of wavelengths, also known as the “therapeutic window” of light therapy, needs to be effective but not too powerful. Therefore, it is advised to use a high-quality therapy device that delivers optimal power with proven wavelengths.

Nevertheless, LLLT should be avoided on the eyes and thyroid and consulted before use if you have any medical conditions.

LLLT devices
Different companies specialize in LLLT devices.

Solio Alfa Plus utilizes LLLT light energy to treat muscle spasms and work with deeper RF energy to treat pain at its source.

B-cure uses LLLT to treat the pain and its source, helping with chronic pain relief even when used for a few minutes, twice a day. According to B-cure, it has “clinically proven efficacy for treating pain”, as well as other conditions such as inflammation and sports injuries.

LLLT FAQ

What does LLLT treat?

LLLT may be appropriate for the following pain relief:

• Chronic pain
• Low back pain
• Neck pain
• Joint pain
• Sports injuries

LLLT may also be useful in short-term pain relief for:

• Musculoskeletal conditions such as rheumatoid arthritis
• Post-surgical pain
• Chronic joints conditions

What to expect during LLLT therapy?

For home use devices, prepare the device according to instructions.

• Place the unit on site of pain
• Turn the unit on
• Session length varies depending on the device.

What are the risks of LLLT devices?

LLLT is safe, with no known risks. However, it should be avoided on the eyes and thyroid.

* * *

Chronic pain is more prevalent in some areas of the body than others. Now that we know more about in-home pain relief technologies, let’s take a look at two especially common areas of chronic pain, back pain, and knee pain, where chronic pain relief devices are often used successfully.

(1) Chronic back pain relief devices

Lower back pain is one of the main causes of pain and disability in everyday life. Most instances of back pain subside after a few days, but many others suffer chronic back pain, defined as pain that lasts for 3-6 months or more.

Signs for back pain can include pain that worsens with activities such as walking and bending, and improves with reclining. Pain symptoms can include shooting pain, muscle ache, and pain that radiates down the leg.

Common causes for lower back pain include nerve injury, muscle injury, injury to ligaments and tendons, or injury to spinal vertebrae. These can be the result of various causes such as wear and tear, long hours of seating, the sciatic nerve and many more.

Different chronic pain relief treatments are available for chronic low back pain, depending on the cause and intensity of the pain. There are medications and
injections, physical therapy, stretching, massages, and chronic pain relief devices.

Home-use devices offer significant pain relief benefits for chronic back pain, such as the following 4 leading devices:

1. Quell TENS device. In a study conducted by Quell in 2016, results show the fixed-site TENS (FS-TENS) is an effective option for treating chronic low back pain and lower extremity pain.
2. Nursal TENS device. This electronic pain relief device claims to benefit people with back pain thanks to its relaxation and tension release properties.
3. LumiWave IR pain relief device. LumiWave helps with back pain relief in cases of muscle strain and disk degeneration.
4. Solio Alfa Plus. Solio is an FDA cleared home-use device, the first pain management device that treats pain using Radio Frequency (RF) + Infrared (IR) technologies and Low-Level Laser Therapy (LLLT). The synergy of three different energy sources works to eliminate pain by treating its source, increasing circulation and accelerating the healing process. The optimal healing environment also helps to reduce inflammation, muscle aches, and stiffness.

(2) Chronic knee pain relief devices

Knee pain is one of the most common types of pain, and affects people of all ages.
Chronic knee pain can be the result of different knee problems. Knee injuries may cause tears in ligaments or cartilage. Medical conditions, including arthritis, meniscus, tendonitis, osteoporosis, and rheumatoid arthritis, can also cause chronic knee pain. Symptoms may vary and include swelling, stiffness, weakness, instability, and others.
Knee pain can be treated with rest, knee braces, and physical therapy. However, sometimes surgery is needed. Knee pain can also be alleviated with chronic pain relief devices.
Home-use devices offer significant pain relief benefits, such as the following 4 leading devices:

1. B-Cure laser therapy. The laser’s restorative power is provided by laser technology. B-Cure Laser is an effective mode of treatment that helps treat inflammation, reduce swelling, and provide laser pain relief.
2. Tendlite® red light therapy device. Tendlite is used for pain relief for muscles and joints such as knees, but also fingers, ankles, and shoulders.
3. Healthmateforever YK15AB TENS unit. Specifically designed mode buttons make pain management quick and easy. Apply 8 pads at the same time, and help your knee with a safe and effective solution to pain relief.
4. Solio Alfa Plus. This pain relief device was developed in order to reduce chronic pain, including chronic knee pain. It uses specific wavelengths and bipolar RF to stimulate the body’s healing mechanisms and increase blood circulation, drawing oxygen and nutrients to the afflicted area. The deep heating creates an optimal healing environment that accelerates tissue regeneration and reduces inflammation, muscle aches, stiffness, and pain.

Home use pain relief devices also help with other body parts, such as foot pain relief devices, and neck pain relief devices.

Solio Alfa Plus and its features: Bipolar RF and IR heat energies, skin temperature sensor and LED light energy

Conclusion

Chronic pain can interfere with your life. It can make you less active, damage your quality of sleep, and increase the risk of emotional difficulty and depression. Don’t just accept pain. Choose to alleviate it using one of the many options available today.
Solio Alfa Plus is a new device for chronic pain treatment, offering new pain relief technology for a wider variety of needs through the patented synergy of 3 energy sources, each directed at a different depth within the body, therefore generating more healing and pain relief processes.

Solio Alfa’s benefits:

• FDA-cleared for pain relief
• 100% natural – no drugs, no surgery
• Non-invasive and painless
• Safe and No side effects
• Easy-to-use
• Portable
• Suitable for all ages

Back pain therapy

Many people know what back pain is. In most cases, back pain is of a non-specific nature and is associated, for example, with a violation of the tone of the back muscles. Such pains regress against the background of physical therapy or other gymnastics. However, there are also specific back pains, the cause of which is the irritation of the nervous structures by various substrates (protrusion, herniated disc, cicatricial, post-inflammatory changes, etc.). To effectively combat, to prevent the transition of pain to the chronic stage, it is necessary to carry out treatment with maximum focus on the cause of the pain.

How do pulling pains in the arms or legs occur?

The spine consists of vertebral bodies, which are connected to each other by intervertebral discs, intervertebral (“facet, facet”) joints, ligaments and muscles. In the event of an overload of the facet joints, bone deformities may occur, accompanied by “inflammatory changes” in the surrounding tissues, compensatory growth and “ossification” of them later. In the case of irritation of nearby spinal nerves, pain is typical and is “reflected” in the arms or legs.Similarly, pain occurs with a herniated disc. The intervertebral disc functions as a buffer between the vertebral bodies. In the middle, the intervertebral disc consists of a nucleus pulposus surrounded by a ring of fibrous plates (fibrous cartilage). As a result of the aging processes, which begins in people, including healthy ones in their young years, microdamages and breaks can appear in the plastics of the annulus fibrosus, where the nucleus pulposus in turn is displaced. Because of this, irritation occurs, pressure on the membranes of the spinal cord or spinal nerves, and spreading pains appear.The pressure on the nerve quickly leads to an inflammatory irritation response and pain.

What is CT – controlled periradicular therapy?

CT-guided periradicular therapy works as follows. With an accuracy of a millimeter, anti-inflammatory, decongestant medicines in a mixture with local anesthetic agents are brought to the “cause” of pain (protrusion, disc herniation, area of ​​inflammation, scarring), which leads to relief of pain, removal of edema, and reduction of inflammation.

How is the procedure performed?

The procedure takes place in the computed tomography room. In the position of the patient on the side (abdomen), the injection site is marked on the PC monitor, a decision is made at what angle and to what depth the needle should enter. After preliminary anesthesia of the needle insertion site, a thin special needle is installed and a small amount of contrast agent is injected. The position of the needle and the spread of the contrast medium is monitored by performing a computed tomography.In case of incorrect position of the needle, as well as the spread of the contrast medium in the wrong direction, computed tomography allows the doctor to correct these moments absolutely safely. After reaching the goal, a mixture of medicines is supplied.

Benefits of treatment

Periradicular therapy combines the highest efficiency with the greatest safety. The optimal placement of the needle and the introduction of a mixture of medications directly to the cause of the pain is monitored by a specialist using computed tomography, inadvertent trauma to adjacent structures is prevented.In most cases, complete relief of pain syndrome occurs within 20 to 30 minutes. The procedure takes 15 – 20 minutes and if the treatment is performed on an outpatient basis, the patient can leave the CDC in 40 minutes.

Treatment of pain associated with operations

This patient guide is based on the Estonian treatment guide “Perioperative management of acute pain”, approved in 2016. Treatment guidelines were compiled from a literature review based on scientifically proven evidence.The aim of the patient guide is to help patients manage postoperative pain and to provide answers to questions related to acute pain. Knowledge of pain management options helps patients actively participate in treatment. The importance of the topics covered in the patient guide, as well as the accessibility of its text, were assessed by patients with acute postoperative pain. The patient guide explains the following topics: what is acute postoperative pain, why is it important to treat acute pain, and how to evaluate it.Different chapters describe options for treating acute postoperative pain. The reader will receive answers to the following questions: why the use of oral drugs is preferred for pain management, whether different pain relievers can be taken together, and what else can be done in addition to drugs to relieve pain. It also provides guidance on how to manage postoperative pain at home. The topics covered in the patient guide can be read in more detail on the web pages at the end of the guide (see.Annex 1).

What is acute postoperative pain?

Pain is a subjective and unpleasant sensation that affects consciousness and impairs well-being. Acute pain is short-term, it most often has a well-defined area, a certain time of onset, as well as subjective and objective physical signs: heart rate and breathing become more frequent and blood pressure rises.Severe pain interferes with sleep and creates feelings of fear and anxiety. Acute postoperative pain occurs due to a surgical procedure or surgery. The severity of pain depends both on the severity of the operation and the size of the surgical wound, and on the pain threshold of a person. People feel and react to pain in different ways. Pain can also be influenced by the patient’s early pain experience, age, gender, cultural background, and psychological factors. In the case of children, pain can also be influenced by their parents’ attitude towards pain.

Why treat acute postoperative pain?

Postoperative pain does not need to be tolerated, as pain may increase the incidence of postoperative complications: recovery from surgery will be slower and therefore may increase the length of hospital stay. If the pain is not treated, chronic postoperative pain is more likely to occur. Effective treatment of postoperative pain relieves heart and lung function, reduces the risk of venous thrombosis, and helps normalize digestion.

How is the intensity of pain assessed?

Assessing the severity of pain after surgery is a routine part of patient follow-up work. Pain is assessed regularly, and the frequency of the assessment depends on the patient’s condition and the severity of the operation. Since the sensation of pain is individual and subjective, only you yourself will be able to assess the strength of the pain experienced. The nurse will assess your pain regularly, both before and after taking pain relievers, both during rest and while moving. Based on the information received, it will be possible to draw up a pain treatment scheme that suits you personally.

Different pain scales are used to assess pain. For example, the scale for the numerical rating is used in adults. It is used to assess the severity of pain on a ten-point scale, where zero means there is no pain, and 10 means the most severe pain you can imagine. The patient is asked to rate the pain experienced in the past 24 hours using three different methods.
Rate:

1. force of existing pain,
2. the weakest feeling of pain and
3. the most intense feeling of pain.

The arithmetic mean of the scores received will show the strength of the patient’s feeling of pain during the last 24 hours. Sometimes you are asked to choose words that would describe your pain. These words can be:

• no pain
• minor pain
• moderate pain
• severe pain
• very severe pain
• unbearable pain

Figure 1.

Numeric Pain Rating Scale Sometimes the face scale (FPS-R) is used to assess pain (see Figure 1).Figure 2) or the so-called face scale. This scale can be used, for example, in older children. The child will need to explain the face scale so that he can use it to assess his pain. The child will need to explain the scale as follows: “This face (point to the leftmost face) shows that there is no pain at all. Other faces (point to each face from left to right) show that the pain is getting worse and worse. The face on the far right shows that he is in great pain. ” After the explanation, the child can be asked which face shows how much it hurts now?

According to the person chosen by the child, the assessor will be able to give the indicated pain a score of 0, 2, 4, 6, 8 or 10 points, counting from right to left: 0 = not painful at all.10 = very painful. You cannot use the words “sad” or “joyful” in your assessment. It is imperative to clarify that we are talking only about how the child feels, and not about the external expression of the face.

Figure 2. Facial scale for assessing pain intensity ( FPS-R )

The above scales are used not only to assess pain in older children, but also for patients with mild to moderate mental disorder. For young children, infants and patients with severe mental disorders, a behavior scale is used, in which the nurse assesses the severity of pain. Patient vital signs, such as heart rate, blood pressure, blood oxygen, and behavior (facial expression, anxiety, sleep), are taken into account for these pain severity scales.

How to treat pain after surgery?

In the treatment of postoperative pain, different medications are used with different routes of administration.In addition, the use of alternative methods is allowed, which can be used in case of mild to moderate pain.

In order to prescribe a suitable pain treatment, it is important to know which medications (including pain relievers) you have already used, if you are allergic to medications and if you have any side effects. When prescribing a medicine, modern principles from the medical field are taken into account regarding the operation performed to you and painkillers.

The choice of a suitable pain reliever, the dose of the medication and the duration of treatment depends on both the severity of the pain (mild, moderate or severe pain), the type of pain (whether there was, for example, wound pain or nervous pain), the person himself (elderly, child, pregnant and dr.), as well as from concomitant diseases.

To achieve the best effect of pain relievers, take medication regularly (at regular intervals). Pain relievers of different effects are often combined.

Groups of painkillers

Medicines are used as pain relievers, which are divided according to the type of mechanism of action into three main groups:

1. Simple pain relievers. For example, paracetamol, ibuprofen, and diclofenac.
2. Opioids. Medicines in this group are divided into weak opioids, such as tramadol, codeine, and strong opioids, such as morphine.
3. Supportive medicines. They are used, for example, to treat nervous pain.

Paracetamol

Paracetamol is often the first choice for mild to moderate pain. Paracetamol differs from other pain relievers (for example, from ibuprofen and diclofenac) primarily in that it does not have an irritating effect on the mucous membrane of the digestive tract.Side effects are rare when taking paracetamol. The most severe possible side effect is liver damage, which is rare and occurs most often due to drug overdose. Paracetamol should be used with caution in liver and kidney failure, chronic malnutrition, or alcoholism. The child should be prescribed paracetamol according to his age and weight.

If medications are additionally used (for example, the so-called teas for influenza), which include paracetamol in combination with an anesthetic, you need to ensure that the amount of paracetamol taken per day does not exceed the permitted daily dose (for adults, 4 grams per day).

Nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, ketoprofen, dexketoprofen, naproxen, etc.)

If the analgesic effect of paracetamol is too weak (an hour after taking paracetamol, the pain intensity is still more than five points), then in case of mild or moderate pain, for example, ibuprofen, ketoprofen, naproxen, diclofenac or other drugs from the same group should be taken according to the instructions for use the medicine listed on the medicine information sheet.

These drugs have analgesic, antipyretic and anti-inflammatory effects, but their use is contraindicated in case of gastrointestinal ulcers. These medicines should be used with caution by patients who have cardiovascular diseases. The risk of side effects in the digestive tract is greater in older people and in those who take large amounts of NSAIDs. The occurrence of side effects in the digestive tract does not depend on the method of taking the medications – medicinal suppositories with NSAIDs and injectable forms of drugs are also not suitable for patients with ulcers in the digestive tract.The strength of the harmful effect on the digestive tract differs for different drugs of the NSAID group. Ibuprofen is believed to be the least harmful to the digestive tract.

Depending on what concomitant diseases you have, some pain relievers belonging to this group may be more suitable for you than others, and this must be taken into account when prescribing treatment. For children, ibuprofen is most often used, it is prescribed according to the age and weight of the child.

Opioids or narcotic pain relievers (codeine, tramadol, morphine, fentanyl, oxycodone, pethidine, etc.)

In the case of severe pain, opioids are used in addition to the aforementioned groups of drugs. Common side effects of opioid use are nausea and vomiting. The nausea-inducing effect of opioids is weakened by long-term use. Constipation is another common side effect.

Supportive medicines such as gabapentin, pregabalin.

Supportive drugs are drugs that were not originally developed as pain relievers, but were later discovered to be useful in relieving certain types of pain. For example, gabapentin and pregabalin were originally used to treat epilepsy. These medications are often used to treat chronic nerve pain. They are also effective in treating postoperative pain, reducing pain and the need for other pain relievers.

After surgery, pain relievers can be taken:

• Oral
• by injection into a vein or muscle
• via epidural catheter
• with medicated candle

Oral pain relievers are preferred after surgery.Oral medication is as effective as injected medication without pain or injection-related complications such as hemorrhage, inflammation of the injection site. Pain medications taken by mouth are suitable for all types of pain relief, but you must be able to eat and drink.

Vein injection

If you cannot take the pills by mouth because of the operation, the nurse will inject your medicine through a cannula into a vein.The pain relieving effect will come within a few minutes. Once you start eating and drinking, you can return to your pill medication again.

After a major and painful operation, pain relievers can be taken using a special pain pump, with which you yourself can adjust the dose of the pain reliever (opioids) in the vein. This is called Patient Controlled Pain Relief or PCA (short for Patient Controlled Analgesia).

For taking painkillers, use a special pump that will allow you to receive painkillers as soon as you feel the need. The doctor will calculate the appropriate dose of the medicine for you and enter it into the pump’s memory. If you feel pain, press the button and the pump will inject the appropriate amount of medication through the cannula into the vein. There is no danger of medication overdose as the pain pump is programmed according to your needs.

The pump button must be pressed by yourself, you must not let anyone else do it.If the dose of the medication calculated for you is not sufficient and does not relieve pain, inform your nurse or doctor, who will adjust the dose of the medication given according to the severity of the pain. The PCA pump is also used for children if the child’s age allows it to be used and is able to understand how the pump works.

Figure 3. PCA pump

Muscle drug administration

The administration of painkillers by injections is tried to be avoided, since, due to heterogeneous absorption, the effect of anesthesia may be less than the expected effect.In addition, the injection can be painful.

Drug administration with medicinal suppositories

Sometimes, if it is impossible to take painkillers by mouth for some reason, medications can also be taken through the rectum. Medicated suppositories are often used to relieve pain in young children.

Medication via epidural catheter

Using local anesthesia, if necessary, the anesthesiologist will place a thin plastic tube (epidural catheter) in the epidural space surrounding the spinal canal before the operation, if necessary.The epidural space is located in the spinal canal, where the roots of the nerves that transmit the feeling of pain pass. The medicine injected there affects the roots of the nerves and thus prevents the spread of the pain pulse. Therefore, the introduction of drugs into the epidural space is one of the most effective methods of pain relief.

Opioids and local anesthetics – a mixture for local anesthesia – are continuously injected into the epidural catheter through an automatic syringe throughout the day. The analgesic effect begins no later than 20 minutes after the start of the medication.

Figure 4. Inserting an epidural cutter

Epidural pain relief can cause:

• Nausea and vomiting – these are relieved by anti-nausea medication
• Weakness and numbness of the legs – they go away on their own
• Urinary disorders – if necessary, a catheter is placed in the bladder
• Decreased blood pressure – blood pressure monitored regularly
• Head or back pain – notify your nurse or healthcare professional.If a headache occurs after surgery while undergoing home treatment, contact your doctor immediately.

Nerve plexus block

Nerve plexus blocks are used most often for anesthetizing the extremities. Blockages are done both with a single injection and with the use of a catheter, which is placed next to the nerve plexus, and is needed for the constant administration of medication (local anesthesia).Medications are injected through the plexus catheter either with a single injection or with an automatic syringe.

The effect of alternative pain treatment methods on postoperative pain is small, therefore you should not use such methods separately, but only together with pain relievers. Alternative methods reduce anxiety and feelings of tension throughout the hospital stay. Most methods, such as music therapy or distraction, are safe and can be used without special training or additional tools.If the pain is mild or moderate, then in addition to pain relievers, you can use the methods from the list below. For more information on the different methods, ask your ward nurse.

Cold compress

Cold leads to constriction of blood vessels and bleeding in the damaged area slows down. If you have no contraindications, you can use a cold compress to reduce swelling and pain in the operation area. As a cold compress, you can use special gel packs sold in pharmacies, any packaging from the freezer is also suitable.Wrap the cold bag in a towel and then place it over the damaged area and fix the compress if necessary. The towel will protect fabrics from possible local exposure to cold. Keep the cold compress in place for 20-30 minutes in a row, then pause for 10-15 minutes and repeat the procedure if necessary.

Transcutaneous electrical nerve stimulation or TENS

TENS, or transdermal electrical nerve stimulation, is a pain management method in which electrical impulses are used to relieve postoperative pain.

Physiotherapy

Physiotherapy is recommended to be added to the postoperative treatment regimen, as it reduces the risk of complications and facilitates the recovery of the body after surgery. Physiotherapy is carried out by a specialist. He will explain to you why you need to start moving as quickly as possible after the operation, teach you how to take the most comfortable and relaxed posture after the operation, how to prop your body with pillows or the operating area with a bandage.In addition, he will teach you breathing techniques, as well as movement exercises.

Music therapy

Listening to music reduces anxiety, slightly reduces the severity of postoperative pain, and the stress response associated with pain is less common with music. Therefore, the need for opioids is also reduced.

If you enjoy listening to music and it relaxes and calms you, then we recommend that you take your favorite music with you to the hospital with you.You just need to remember that your favorite music may not be liked by other patients, so we recommend that you use headphones when listening to music.

Psychological Methods

This includes various relaxation techniques, daily self-activity training, distraction, and positive visualization techniques.

Using a variety of psychological methods throughout your hospital stay can help reduce feelings of tension and anxiety.With the help of them, you will more easily cope with the situation that has arisen. Both the severity of the pain and the need for pain relievers will decrease to a small extent.

For distraction, you can solve crosswords, put puzzles, play electronic games, etc. You can also use relaxation techniques to relax specific muscles or to reduce general feelings of anxiety and tension.

In the case of children, it is also important to use different psychological techniques to reduce feelings of anxiety and pain, and to do this throughout the entire hospital stay.The child becomes more calm if he is already explained to him what awaits him before admission to the hospital.

Play is an effective method of distracting attention for a child: both during the postoperative period and during procedures. Games in which the child will be an active participant (for example, electronic games) are more effective than the usual distraction.

Listening to your favorite music is particularly good at reducing pain and anxiety in older children.For newborns, physical contact is important (being on the breast of mom or dad), the benefits for reducing pain during procedures and after surgery will be from massage, and from breastfeeding, and from sucking the nipple.

When you are discharged from the hospital, you will be given recommendations on how to treat pain at home: what painkillers you may need, how much and how often you will need to take them. They will also tell you about possible side effects and what to do if they occur.Pain relievers for home use may not necessarily be the same as those you received at the hospital.

Ask your doctor where you can go if you have a problem. Make sure your doctor is aware of which medications have previously caused you problems. This will help avoid possible complications associated with medications.

Houses:

• Take pain relievers regularly as directed by your doctor. You can always check information about the prescribed prescriptions, including the regimen for taking the medicine prescribed by your doctor, in the prescription center of the state portal (www.eesti.ee → Services → Citizen → Health and healthcare → Prescriptions).

• Get enough rest. If you have trouble sleeping, tell your doctor.

• While sleeping or doing deep breathing exercises, prop your body with pillows.

• To reduce pain, you can use alternative methods approved by your doctor: cold or warm compresses, listening to music, massage, substitution therapy (being in a position that relieves pain, supporting the body with pillows, etc.)

• If you have to use opioids at home to treat acute postoperative pain, then driving will be prohibited, and you will not be able to use devices / mechanisms that require special attention.

• If the pain relievers prescribed by your doctor do not relieve your pain (the pain is still greater than five on a scale of ten), then contact your doctor or family doctor.

In Estonian and Russian:
www.regionaalhaigla.ee/et/valuravi
www.valu.ee
Website of the Estonian Association of Anesthesiologists
video: Amanda goes to surgery

In English:
www.mayoclinic.org/pain-medications/art-20046452
www.preop.com.au/postop.htm
www.cuh.org.uk/sites/default /files/publications/PIN1304_TENS_pain_service_v4.pdf
patient.info/health www.painaustralia.org.au/healthcare-professionals/patient-resources.html

Used literature

Allred KD, Byers JF, Sole ML. The effect of music on postoperative pain and anxiety. Pain Manag Nurs Off J Am Soc Pain Manag Nurses. 2010 Mar; 11 (1): 15-25.

Crowe L, Chang A, Fraser JA, Gaskill D, Nash R, Wallace K. Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain. Int J Evid Based Healthc. 2008 Dec; 6 (4): 396-430.

Engwall M, Duppils GS. Music as a nursing int ervention for postoperative pain: a systematic review.J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses Am Soc PeriAnesthesia Nurses. 2009 Dec; 24 (6): 370–83

Johansson K, Nuutila L, Virtanen H, Katajisto J, Salanterä S. Preoperative education for orthopedic patients: systematic review. J Adv Nurs. 2005 Apr; 50 (2): 212-23

Macintyre PE, David A Scott, Stephan A Schug, editors. Acute Pain Management: Scientific Evidence (3rd edition) 2010.

Vaajoki A, Pietilä A-M, Kankkunen P, Vehviläinen-Julkunen K. Effects of listening to music on pain intensity and pain distress after surgery: an intervention.J Clin Nurs. 2012 Mar; 21 (5-6): 708-17.

Wood S. Postoperative pain 2: patient education, assessment and management. Nurs Times. 2010 Nov 23; 106 (46): 14-6.

IASP Taxonomy. (2012). International Association of the Study of Pain.
www.iasppain.org/Education/Content. aspx? ItemNumber = 1698 & navItemNumber = 576 # Paintolerancelevel

Manual therapy of the spine: prices, reviews

Manual therapy of the spine is a complex of techniques for influencing the spinal column and muscles of the back with hands.It is used for various diseases of the musculoskeletal system and allows you to eliminate pinched nerves, improve the mobility of the vertebrae, improve the blood supply to tissues, and accelerate the removal of inflammation. Do not confuse manual therapy with massage – in the latter case, the specialist acts only on the muscles, and the manual therapist works with the muscles and vertebrae, intervertebral discs, joints, bones, ligaments.

Functional principle

Manual massage of the spine is based on ancient healing techniques that came to us from the East.These include the following:

• techniques for working with soft tissues: skin, muscles, subcutaneous fat;
• work with joints;
• manipulations with tissues that come from the field of osteopathy;
• body-oriented therapy: relaxation techniques, release of clamps;
• impact on the cervical spine;
• visceral therapy: work with putting the internal organs in place.

The therapy can be combined with some methods of treatment: medication, surgical (after tissue healing). It is not recommended to accompany manual therapy with a number of methods involving thermal effects – mud therapy, paraffin-ozokerite applications, physiotherapy.

90,050 Objectives and Outcomes 90,051

The main tasks of manual therapy are to restore normal muscle tone, relieve pain, improve the mobility of the vertebrae and tissues.Using this approach, you can achieve the following results:

• slow down age-related changes by increasing the range of motion;
• strengthen the muscle corset;
• improve posture;
• reduce deformities of the spinal column;
• eliminate pinched nerves and blood vessels.

In one session of manual therapy of the spine, pain symptoms can be reduced.It restores blood supply to tissues and relieves headaches and muscle pain. Removal of muscle spasm allows you to return the correct anatomy to the musculoskeletal system, which means that you can cope with the consequences of hernias and osteochondrosis. The return of normal posture leads to the normalization of the position of internal organs, an improvement in the general state of health and well-being.

Features of the conduct

Manual therapy involves the use of hands as the only instrument of influence.There are several basic techniques:

• manipulation: these are short, medium-intensity jerky movements, with the help of which the specialist restores the mobility of the joints and vertebrae;
• mobilization: movements that return mobility to the joints, improve blood flow, gently stretch the spine, stop swelling by normalizing lymph flow;
• soft: the technique is designed to normalize muscle tone, relieve pain, eliminate pathologies of the ligaments, make them more elastic and mobile.It does not provide for sudden movements.

There are other techniques: craniosacral therapy, shiatsu massage, lymphatic drainage, kinesiological techniques, etc. In each clinical case, a specialist selects a set of techniques, taking into account the disease, symptoms, and the patient’s condition.

The frequency of the sessions is determined by the state of health, the tasks set. Usually up to 2 procedures per week are performed, but for some diseases it is advisable to visit a chiropractor more often.The number of sessions required also varies, in one case, three is enough, in another, a course of up to 15 will be required.

The duration of one session is 10-30 minutes.

For whom manual therapy of the spine is indicated

The main indications for manual massage of the spine are as follows:

• back pain, including muscle pain, associated with osteochondrosis;
• discomfort in the neck-collar zone;
• headaches and dizziness;
• pain associated with previous trauma;
• deformities and curvature of the spine – kyphosis, lordosis, scoliosis;
• contractures, limitation of mobility, decreased volume of movement;
• protrusion, hernia;
• pinched nerves;
• spasms, violations of the tone of the muscles of the back, neck.

You can consult a chiropractor not only in the presence of painful symptoms, but also for preventive purposes. People who practice a sedentary lifestyle are at risk for the development of diseases of the musculoskeletal system. Driving or at a computer monitor can lead to impaired blood supply, congestion, inflammatory and degenerative processes in the spine and adjacent tissues.

Disorders in the cervical spine are a common cause of headaches.With the help of manual therapy, you can get rid of the root cause, as well as cope with the so-called tension pain. People leading a sedentary lifestyle may suffer from vertebral blockade, limitation of the cervical spine. As a result, the muscles become toned, there is a pain in the neck, and subsequently frequent headaches. Wrong position of the body during sleep (high pillow), sudden movements of the head can provoke deterioration.

The price for a manual therapy session includes an initial examination and diagnostics.The doctor identifies problem areas, determines which parts of the spine are functioning incorrectly. Clarification of the focus of the problem allows for effective therapy. It is important to understand that most often an x-ray or an MRI diagnosis is required. Only after a comprehensive assessment will the specialist develop a course of treatment to normalize the condition.

Protrusion of the intervertebral disc

Manual therapy for protrusion of intervertebral discs will help to achieve the following results:

• removal of excess muscle tone.The protrusion of the disc into the spinal canal leads to compression of the nerve roots, reflex spasm of the adjacent muscles. Relaxation of the muscles can significantly reduce pain;
• stimulation of metabolism in cartilage tissue. Improving blood supply to tissues and lymph flow allows you to normalize metabolic processes around the diseased disc, accelerate recovery;
• soft stretching of ligaments and tendons. Allows you to increase the mobility of the spine, including by increasing the elasticity of soft tissues;
• reduction of protrusion.If the protrusion has arisen recently, the methods of manual therapy allow you to gently set the tissue.

The complex of techniques, the impact force are selected on an individual basis. Twisting, pressure with hands on tissues, work with the ribs, allowing to increase the distance between the vertebrae, etc. can be involved. The specialist also chooses the position of the patient’s body individually – lying on his back or on his side. Protrusions in the cervical spine are rare. With them, the doctor acts especially carefully, paying attention to soft stretching.

Scoliosis

The main tasks of manual therapy for scoliosis are to improve the mobility of the spine, its flexibility, stimulate muscles with reduced tone, and remove functional blocks. Thorough diagnosis includes determining the angles of curvature; it is important to provide the doctor with accurate information about the degree of the disease, concomitant diseases.

A session of manual therapy of the spine includes gentle stretching, work with painful zones, areas of curvature along the entire length of the spinal column.Particular attention is paid to the extreme vertebrae, after which the specialist moves to the center. The doctor will definitely give recommendations for homework in order to consolidate the results obtained. Usually the course consists of ten sessions, for preventive purposes it is enough to undergo treatment twice a year.

Kyphosis and lordosis

With an average degree of curvature of the spine, the doctor acts on it in such a way as to “put” the vertebrae, intervertebral discs, muscles, ligaments in place.Typically, the course of treatment involves several sessions every other day. It is possible that pain may appear after exposure, but in this case, this is a normal symptom. It is associated with the gradual movement of tissues seeking to take the correct position. After the course of treatment, noticeable improvements in posture, relief of pain and unpleasant symptoms are noted.

Pinching of the sciatic nerve

Acute pain accompanying pinching makes it impossible to walk normally.A protective reaction of the surrounding tissues is muscle spasm. Manual therapy can help to quickly relieve the condition, reduce muscle spasm and pain, and restore normal range of motion. With its help, it is possible to relieve swelling, return normal functions to the ligaments and muscles. A gentle hand effect is used in elderly patients, pregnant women.

Osteochondrosis is a degenerative-dystrophic disease, in which it is important to have a complex effect on the body. First of all, it is important to return the spine to its normal shape, as well as to stimulate metabolic processes.The doctor can use the following techniques and techniques:

• quick movements to restore joint mobility;
• relaxing effects to relieve muscle spasms and reduce the severity of pain;
• careful traction to normalize the mobility of the spine, improve blood supply, lymph flow, metabolic processes.

You can achieve tangible improvement after the first session.At the end of the course, pain, dizziness, tinnitus disappear, the normal range of motion in the neck and shoulders is restored.

The price of manual massage of the spine is not the only advantage, this method of treatment is preferred for other reasons:

• versatility – the ability to treat osteochondrosis of any part of the spine;
• safety – unlike drug treatment, the method has few contraindications, and all techniques are used only after a thorough diagnosis by an experienced specialist;
• painlessness – the actions of a chiropractor do not cause discomfort and pain;
• fortifying effect – manual therapy allows you to improve overall well-being, stimulates the body’s own resources to recover;

• efficiency – the first results can be observed after one session, by the end of the course of treatment, a stable positive effect is observed in most cases.

Manual therapy for a hernia provides for a mild effect – pressure on certain centers, which allows the disc to return to the correct position. The goals of therapy are to relieve pinched nerves, eliminate muscle tone, and restore normal sensitivity to the limbs. With hernias of the lumbosacral region, it is possible to restore the pelvic function, relieve acute pain.

The results of the actions of the chiropractor can be as follows:

• improved blood flow in the muscle corset;
• normalization of tissue supply with oxygen, important substances;
• acceleration of recovery;
• normalization of the position of the spine;
• improvement of metabolic processes.

Manual therapy of the spine with a hernia can complement drug treatment, while it allows you to avoid surgery, reduce the dosage of drugs or even refuse them when it comes to a symptomatic approach (taking painkillers).

For whom manual therapy is contraindicated

The following diseases are considered absolute contraindications to manual massage:

• malignant formations of any localization;
• tuberculosis;
• osteomyelitis;
• 3rd and 4th degree of vertebral instability;
• 3rd and 4th stage of osteoporosis;
• stroke;
• vertebral artery thrombosis;
• inflammatory diseases of the central nervous system.

Relative contraindications are recent injuries, inflammatory diseases in a state of exacerbation, severe somatic diseases. In this case, the doctor decides on the need for treatment individually; consultation of another narrow specialist may be required.

Women need to postpone the course of treatment in the first days of the cycle. Better to choose the time between your periods. This is due to the fact that during the exposure, the blood supply to the tissues improves, especially when it comes to working with the lumbosacral spine.

Benefits of manual therapy

The advantages of manual therapy for diseases of the musculoskeletal system include the following:

• the possibility of effective treatment of chronic diseases;
• restorative and general health-improving effect on the body;
• fast analgesic effect;
• improvement of metabolic processes;
• increased range of motion;
• positive psycho-emotional effect.

Manual therapy is an art that requires impeccable professionalism. With one wrong move, a specialist can worsen the situation, so it is important to contact only qualified chiropractors with extensive experience. You can check certificates and other documents confirming the education of a specialist.

You can find an experienced doctor, clarify the price of a manual therapy session in Moscow and undergo preliminary diagnostics at the Family Doctor clinic.

For your information

It is necessary to distinguish between normal symptoms after a session and severe consequences of therapy. So, headaches and back pain can be observed as a common reaction to exposure. Sensations are associated with a change in the position of muscles and ligaments, an improvement in the functioning of the vessels of the brain. In this case, after 2-3 days, there is a persistent improvement, and the pain is mild. To improve your well-being, you can limit physical activity, massage and physiotherapy exercises prescribed by a doctor are allowed.If the pain is severe, does not tend to ease, or gets worse, you should see your doctor.

Dizziness is a rare side effect. However, it can arise as a response of the body to the redistribution of blood volume in the body. Normally, dizziness is mild, does not interfere with daily activities, there is no unsteadiness of gait and lack of coordination. If this symptom is pronounced or dizziness occurs after a sharp fluctuation in temperature, specialist advice is required.

An increase in body temperature occurs even less often than dizziness. But if this symptom occurs, we are talking about chronic inflammatory processes that are exacerbated by exposure. Only a doctor can clarify the reasons.

Recommendations after session

To consolidate the results obtained, it is necessary to adhere to several general recommendations after a manual therapy session:

• rest for 15 minutes after the procedure;
• dress appropriately for the weather, avoid hypothermia.A sharp drop in temperature can provoke fainting;
• give up heating procedures, hot baths, visits to the solarium, saunas and baths;
• after the session, get home by public transport or taxi, it is not recommended to get behind the wheel;
• try to avoid excessive physical exertion, sudden movements, head turns.

If during the session you feel severe discomfort, be sure to tell your doctor.

You can get the latest price for manual massage of the spine in Moscow in the Family Doctor clinic. We employ qualified chiropractors with extensive experience. We guarantee a comfortable reception, a friendly attitude towards each patient and an individual approach.

Make an appointment by calling the single contact center +7 (495) 775 75 66, through the on-line registration form and at the clinic’s registry.

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Treatment of osteochondrosis

1. Main
2. Medical activity
3. Treatment of osteochondrosis

Physiotherapy for osteochondrosis, depending on the patient’s condition, is used both in combination with drug therapy and independently.For osteochondrosis, the following types of physiotherapy are used: Laser therapy, Detenzor – therapy, Electrotherapy, Shockwave therapy, Magnetotherapy, Mud and Balneotherapy, Ultrasound therapy, Ultraviolet irradiation (UFO). After successfully relieving the exacerbation, massage and physiotherapy exercises are shown.

UFO : under the influence of ultraviolet radiation, vitamin D is formed in the skin, which helps to absorb calcium. The method is carried out using irradiators that have bactericidal, anti-inflammatory and analgesic effects.

Ultrasound therapy and phonophoresis: n During ultrasound therapy, the body is exposed to high-frequency sounds (from 20 kHz and more). Due to its effect, the method relieves pains of various localization. This method is combined with the introduction of anti-inflammatory and analgesic drugs (ultraphonophoresis) for their better penetration into the affected tissues.

Shockwave therapy : The method consists in transmitting an acoustic wave to a painful area of ​​the body.This type: eliminates pain, improves microcirculation, improves metabolism.

Detensor therapy: method consists in stretching the spine using the patient’s body weight.

Laser therapy: has a healing effect using helium-neon lasers. Due to the activation of bioelectric processes in the tissues of the nervous system, laser therapy has anti-inflammatory and analgesic properties. Laser radiation is carried out along the inflamed spinal roots.With osteochondrosis, an effect on the paravertebral zones of the affected spine is used.

Electrotherapy: Electrotherapy has a multifaceted effect on the body: it eliminates pain and discomfort, improves nutrition and trophism of the affected tissues. Impulse currents have a very effective therapeutic effect. Their mechanism of action on the body is determined by the effect on nerve receptors. Low-frequency impulses contribute to the extinction of acute pain and are prescribed as first aid for severe pain syndrome.The following types of currents are used: diadynamic therapy (DDT), amplipulse therapy (SMT), interference therapy, transcutaneous electrical neurostimulation (TENS), UHF electric field.

Magnetotherapy: Physiotherapy for osteochondrosis includes the use of magnetotherapy, which has a decongestant, anti-inflammatory, antispasmodic effect. The inductors are placed on the affected spine and limbs.

Balneotherapy and Mud : balneotherapy for osteochondrosis consists in the use of mineral waters (local and general baths, pools, showers) for the purpose of treatment and rehabilitation.During the procedure, minerals penetrate the skin and act on receptors and nerve centers.

When treating with mud, the effect on the body occurs under the influence of temperature and the chemical composition of the healing mud. Mud is used in the form of applications. Balneotherapy stimulates metabolism, improves blood circulation and relieves inflammation and pain. Combined methods of physiotherapy : Combined methods of physiotherapy for osteochondrosis are most often prescribed. For example, with severe pain, diadynamic therapy and electrophoresis (diadynamophoresis) with the use of novocaine are used.For a one-step effect on biological active points, the method of acupuncture-laser puncture is used. Its action is to activate points with acupuncture needles and laser radiation. Mud therapy is often used with electrotherapy (electrophoresis with mud solution, inductothermy with mud, galvanic mud therapy).

Joint treatment

All diseases of the joints can be divided into two main groups – these are joint lesions, which occur due to metabolic disorders, and joint inflammation.Of course, in each case, joint treatment is carried out according to its own special program.

Treatment of joints , whether it be arthritis, arthrosis, rheumatism or other ailment, must necessarily be complex, and the main task to be solved is the elimination of the cause of the disease, and, consequently, the painful symptoms. Treatment with modern techniques is aimed at eliminating or minimizing pain, signs of local or general inflammation, and restoring the affected joints.Complex treatment usually begins with drug therapy. The patient is prescribed pain relievers and anti-inflammatory drugs, drugs that help restore articular cartilage, strengthen the immune system. Treatment of joints at this stage can relieve pain symptoms. Often it includes intra-articular administration of drugs so that the therapeutic substance in the desired concentration gets directly into the cavity of the diseased joint. This increases the effectiveness of drug treatment.Further, when the main symptoms of the acute stage have been safely eliminated, the treatment continues with the help of complex of physiotherapeutic procedures , physiotherapy exercises, massage. In particular, the treatment of joints with physiotherapeutic methods has found very wide application today. So, in EMNTs , pulsed currents (DDT, SMT), magnetotherapy, EHF therapy, laser therapy, electrophoresis with medicinal substances, ultrasound and phonophoresis are used. When the exacerbation subsides, balneotherapy (various types of baths) and mud therapy are connected.Physiotherapy and massage are prescribed.

Back pain treatment

There are many reasons for these pains. First of all, excruciating pain can appear due to a hernia (protrusion) of the intervertebral disc, osteochondrosis, and pathology of the nervous system. Most often, back pain occurs in those people who have been in the same position for a long time.

Yet the most common reason is lack of physical activity! This reduces blood flow to the ligaments, joints, and intervertebral discs, causing the cartilage that forms them to break down.It is the weakening of the ligamentous apparatus that is the cause of all diseases of the spine. When pain appears, you should immediately consult a doctor who will determine its cause, make the correct diagnosis and prescribe treatment. In order to reduce the risk of back pain, you need to move more, monitor your weight and do at least minimal gymnastics (15 minutes a day is enough). Proper nutrition is also very important – it is one of the keys to good health and longevity, and the spine needs protein to maintain flexibility and calcium for strength.Calcium is found in large quantities in hard cheese, liver, nuts, cottage cheese, eggs, and protein in meat and dairy products. The bones and ligaments of the spine also need microelements: phosphorus (there is a lot of it in bran, peas, fish), magnesium and manganese (they are found in sea fish, onions, potatoes), as well as fatty acids – their source is walnuts, fatty sea fish and olive oil.

When back pain worsens, treatment begins with medications – usually pain relievers, diuretics and medications that relieve muscle spasms.However, there are no drugs without side effects, they are used only for a limited time, and most importantly, they do not eliminate the cause of back pain and do not prevent the recurrence of the disease. In the acute period, treatment methods such as traction, as well as the wearing of collars and corsets, are also used, which makes it possible to relieve the diseased spine.

In addition to emergency aid – drugs that relieve muscle spasms and pain, the most important treatment for osteochondrosis is physiotherapy , which helps to reduce pain in the acute period of the disease, improve blood circulation in tissues, prevent nutritional disorders of ligaments, muscles and joints and prevent movement disorders …

Modern physiotherapy is a branch of medicine that has a powerful arsenal of treatment tools; two large blocks are distinguished in it – physiotherapy exercises with massage and electrotherapy. Therapeutic massage is one of the most effective methods of treating osteochondrosis and back pain, as it improves blood circulation in deep tissues and removes muscle blocks (“clamps”), which are the main cause of severe pain.

One of the most effective methods of electrotherapy is drug electrophoresis – it is a means of targeted delivery of drugs to a diseased organ, which improves blood supply to tissues.Impulse currents – DDT, SMT – have a pronounced analgesic, antispasmodic and trophic effect. Also, a laser, a magnetic laser is used to treat back pain. This method allows you to quickly relieve the swelling associated with inflammation, and, accordingly, the pain that occurs in the edematous and compressed tissues. Magnetotherapy is used in the form of constant or alternating magnetic fields, it is also able to quickly stop swelling and pain. D’arsonval currents are effective – these are “ozonized” currents used to relieve painful muscle spasms, high-frequency ultrasonic vibrations that eliminate inflammation and help scars to dissolve, increasing tissue elasticity.Physiotherapy plays a special role in physiotherapy. Its importance is often underestimated, and after all, without a full-fledged muscle corset, it is impossible to cure back pain and prevent recurrence of osteochondrosis. Physiotherapy is of particular importance in trauma and in the postoperative period. Its use will help prevent the recurrence of back pain that occurs due to the so-called “motor stereotypes”. For example, an office worker who spends his entire working day sitting at a computer, or a salesperson whose main workload falls on his feet.The usual health-improving gymnastics, yoga, Pilates and other types of exercises can also become a very effective way to combat “motor automatisms”.

Neck pain treatment

Pain can be caused by various reasons, ranging from muscle spasm and ending with herniated discs in the cervical spine. If neck pain appears once (due to a sharp turn of the head, an uncomfortable posture during sleep), then most likely it will go away by itself in a few days.To reduce pain, you only need to reduce the static load on the neck muscles (do not keep your head tilted for a long period of time), do not get carried away with excessive physical exertion, do not make sudden neck movements.
If the pain in the neck is constant or often recurring, accompanied by headache, numbness of the upper limbs, it is necessary to undergo a full examination.

Physiotherapy of neck pain is aimed at relieving pain syndrome, improving blood circulation and microcirculation in the affected segment, providing anti-inflammatory and anti-edema effects, eliminating metabolic and dystrophic disorders, and reducing movement disorders.Physical factors are used at the stages of inpatient treatment and outpatient treatment, after the patient is discharged from the hospital, as well as in early postoperative rehabilitation. In the acute period: after 4-5 days (as the severity of the process subsides), laser therapy, pulse currents (SMT, DDT, interference currents), magnetotherapy, UFO of the segmental zone, darsonvalization of the cervical collar zone of the spine and the occipital region of the head are prescribed, electrophoresis of substances with local anesthetic, ganglion-blocking action on pain zones

In the subacute period: are used phonophoresis with drugs, magnetotherapy, electrophoresis of drugs, microwave electromagnetic fields (SMV, UHF), laser therapy.

In remission: include thermal therapy, including ozokerite and mud therapy for the cervical-collar zone, balneotherapy (iodine-bromine, turpentine baths, laurel baths, bischofite baths), underwater shower-massage, therapeutic massage.

Treatment of back pain

The feeling of pain in the lower back appears due to an imbalance of the musculo-ligamentous apparatus. In this case, microtraumatization of soft tissues occurs, as a result of which chemical irritants (pain mediators) are released in excess.They cause muscle spasm and back pain. The origin of lumbodynia is mainly associated with osteochondrosis, which is localized in the lumbar region. Lumbodynia is characterized by aching pain in the lower back with moderate or traumatic factors of lumbodynia: physical fatigue, systematic or excessive physical effort; sharp movements; constant work in a “non-physiological” or prolonged stay in an uncomfortable position; bruised lower back, hypothermia, colds, etc. The treatment program for lower back pain includes the following main points: 1) Bed rest for eight to ten days.At the same time, the bed should be flat and firm. “Rest” on such a surface allows the back muscles to relax. 2) Medical treatment of lumbago involves the use of sedatives and pain relievers and the use of novocaine blockades (with severe increasing pain). From the methods of physiotherapy, you can use the electrophoresis of analgesics, impulse currents, ultraviolet irradiation of segmental zones. In an acute period, the patient may be prescribed non-steroidal anti-inflammatory drugs in the form of tablets, injections, suppositories or ointments that relieve muscle spasm.Warming creams can be used only during the rehabilitation period (on the third day of exacerbation). In the acute period, they can provoke swelling and increase pain. 3) After the elimination of acute pain, lumbago treatment is continued with the help of exercise therapy, massage and manual therapy. The main task at this stage is to strengthen the muscle corset and reduce the compression of the nerve roots. Special exercises for lumbago help normalize metabolism, improve blood circulation and nutrition of the intervertebral discs, relieve muscle tension, increase the intervertebral space and relieve the spine.Additionally, at the stage of remission, acupuncture, hydromassage, mineral baths, mud therapy and other physiotherapy are prescribed (see Treatment of back pain ). Thanks to this, blood circulation is improved, an anti-inflammatory and resorbing effect is provided.

Treatment of bronchial asthma

Physiotherapy is used both for relieving attacks of bronchial asthma and in the interictal period, as well as for its prevention in case of pre-asthma. To stop attacks of bronchial asthma, inhalation of bronchodilator and anti-inflammatory (inhaled steroid hormones) agents is used both through nebulizer inhalers and individual aerosol cans.After stopping the attack and in the interictal period, it is necessary to inhale drugs that thin the sputum in order to remove it more freely. In order to stimulate the impaired glucocorticoid function of the adrenal glands, as well as to influence the inflammatory process and altered bronchial reactivity, electromagnetotherapy is prescribed. Depending on the characteristics of the course of bronchial asthma and concomitant diseases, the effects can be limited only to the adrenal glands or include the lungs.Inductothermy is applied with a slight sensation of warmth to the adrenal glands. Prescribe electromagnetic waves (UHF), UHF electric field, magnetotherapy to the area of ​​the lower and middle parts of the lungs with coverage of the projection of the adrenal glands. In cases where the phenomena of bronchospasm are expressed mildly, but there are pleural layers, the use of ultrasound is indicated. With severe bronchospasm, when ultrasound alone is not enough, phonophoresis of hydrocortisone is performed on the chest area.Patients with bronchial asthma with a neuropsychic variant of predominantly mild course are shown the use of electrosleep. To suppress allergic reactivity and improve the functional state of the nervous system, patients are prescribed electrophoresis of calcium, magnesium or bromine, ultraviolet erythemal irradiation of the anterior and posterior surfaces of the chest as auxiliary agents. Patients with bronchial asthma in the absence of an active inflammatory process are shown treatment with “dry” carbon dioxide baths.Patients in the phase of fading exacerbation and remission of bronchial asthma are successfully prescribed therapeutic exercises with an emphasis on breathing individually selected exercises, classes in the pool (water temperature 37-38 ° C), as well as various types of therapeutic massage. After the exacerbation subsides, patients with a mild course of the disease are shown treatment in a halo chamber (speleo chamber).

Treatment of chronic bronchitis

The method of choice in the treatment of respiratory diseases and chronic bronchitis, in particular, is inhalation therapy.With the help of inhalers, drugs are administered – antibacterial drugs, bronchodilators, mucolytics, expectorant herbs, etc. Simultaneously with drug therapy, physiotherapeutic procedures are prescribed (UFO of the chest, ultrasound, inductothermy, UHF, magnetotherapy, magnetic laser therapy, etc.), chest massage, etc. breathing exercises.

From physiotherapeutic procedures, balneotherapy (medicinal baths and showers) is also prescribed. Carbon dioxide (water and “dry”) baths are effective.Normobaric hypoxic therapy (treatment with “mountain air”) – allows not only to significantly reduce the frequency and severity of dyspnea attacks due to restructuring of hemodynamics and gas exchange, as well as reducing the sensitivity of bronchial receptors and facilitating the evacuation of sputum, but also to reduce the total dose of bronchodilators. In addition, it has been proven that after undergoing a course of hypoxic therapy, the susceptibility of patients to respiratory viral infections decreases, which is an important condition for prolonging the remission of the disease.Speleotherapy or halotherapy (treatment by natural or artificially created microclimate of salt caves and mines). Treatment in natural salt, as well as in artificially created speleoclimatic rooms (halotherapy) allows to stimulate mucociliary transport, stimulates the local bronchopulmonary immunity system, provides bactericidal, anti-inflammatory, mucolytic, bronchospasmolytic effects. This type of therapy is indicated for patients with mild to moderate severity of the course of the disease.Acupuncture is prescribed in the presence of bronchospastic syndrome. The most general principle of the use of reflexology should be recognized as a combination in one appointment of impact on the points of general, central and segmental action. Aerofitotherapy (aromatherapy) – treatment by saturating the air with vapors of essential oils. It helps to reduce the susceptibility of patients to ARVI, improves the psychoemotional state of patients.

Physiotherapy after fractures

Physiotherapy after a fracture plays a decisive role both in the prevention of complications after a fracture and in complete and early functional recovery.An important role in the patient’s recovery is played by a properly conducted rehabilitation with physiotherapeutic agents. It should be carried out simultaneously with surgical and orthopedic measures and carried out until complete recovery. Physiotherapy should be started as early as 2–5 days after the injury. In the first period (the first 10 days after injury) after reduction and immobilization, the clinical picture is dominated by pain, edema and muscle spasm. For anesthesia, elimination of edema, resorption of hemorrhages and acceleration of bone regeneration, the following physiotherapy methods are used.1. Interference currents. They have an analgesic effect, accelerate the resorption of edema and hematomas and quickly regulate disturbed trophic processes 2. Ultraviolet erythemal irradiation in the segmental zone or on a symmetrical unaffected limb. 3. Electrophoresis of bromine in the form of a galvanic collar or underpants according to Shcherbak – recommended for patients with severe pain syndrome and increased irritability.

Irradiation with a Solux or Minin lamp, 5–6 sessions in total (if the above methods cannot be applied).5. Therapeutic gymnastics: it begins on the 3rd day after injury in the form of exercises for a symmetrical unaffected limb and small movable joints located below the fracture; The second period covers, on average, the time from the 10th to 30-45th days after the injury, i.e. formation of connective tissue and primary bone callus. The goal of physiotherapy is to stimulate its formation and prevent functional disorders (joint stiffness, muscle atrophy, etc.). The following methods are applied. 1. Interference currents of constant frequency.

UHF electric field – electrodes are located transversely in the fracture area. 3.General (suberythemal doses) or local (erythemal doses) ultraviolet radiation, and in the summer months – air and sun baths. 4. Therapeutic massage (first symmetrically to the healthy limb, and then to the affected one, above and below the fracture site) and physiotherapy exercises. The third period covers on average the time from the 30th day to 2.5 months after the injury, when the final formation of callus occurs.The main goal of physiotherapy is to improve tissue trophism and prevent complications (muscle atrophy, joint stiffness, contractures, etc.). This is helped by interference currents, electrophoresis of a 5% solution of calcium chloride on the affected limb or in the form of a galvanic collar, ultraviolet irradiation, electrical stimulation, mud applications, massage, physiotherapy exercises. Underwater gymnastics has the best effect; exercises (active and passive movements of the affected limb) are carried out carefully, without causing pain, with a gradually increasing dosage.Hygienic gymnastics is also carried out, which is aimed at eliminating the consequences of trauma, such as muscle atrophy, contractures, etc. Active movements with a load, occupational therapy, games, etc. are used.

Physiotherapy

Physiotherapy (from the Greek physis – nature and therapy), a branch of medicine that studies the healing properties of physical factors and develops methods of their use for therapeutic and prophylactic purposes. In modern physiotherapy, magnetic, electric and electromagnetic fields of low, high, ultrahigh and ultrahigh frequencies, artificial light radiation (from infrared to ultraviolet and monochromatic coherent), mechanical vibrations (from infrasonic to ultrasonic), etc. are used.Physical factors have influenced humans throughout its evolution, therefore physiotherapy procedures have a greater physiological effect on the body than many drugs. Physiotherapy treatment can be used both independently and in combination with drug therapy, manual therapy, massage, physiotherapy exercises. The variety of factors and techniques used in physiotherapy determines the possibilities of individual impact on the body and targeted influence on the pathological process without negative side effects.The use of physiotherapy is possible in almost all areas of medicine: otolaryngology, gastroenterology, gynecology, urology, pulmonology, orthopedics and traumatology, neurology, surgery, cardiology and others. The EMNC has a fairly wide range of physiotherapeutic treatment, namely mud therapy, hydrotherapy (various mineral and aromatic baths, underwater shower massage), magnetotherapy, laser therapy, various types of currents (galvanic, pulse, high frequency), electromagnetic waves UHF, microwave, EHF , inhalations of medicinal herbs, halotherapy, vibration traction apparatus, physiotherapy room, staff of qualified masseurs.Also, in the department of physical methods of treatment, therapeutic methods of acupuncture, electrical stimulation for various neurological diseases are carried out. All physiotherapy treatment is prescribed by the physiotherapist of the department, taking into account the disease and the general condition of the patient.

Rehabilitation

Medical rehabilitation is a complex of therapeutic and preventive measures, which is aimed at the maximum possible restoration of the patient’s lost abilities after various diseases.Rehabilitation is also aimed at restoring the patient’s muscle strength, as well as preventing recurrence or complications. Today, medical rehabilitation is not just about prescribing any kind of exercise after discharge from the hospital or a course of physiotherapy at the end of the inpatient period. Rehabilitation is a complex of activities that include the participation of doctors from different fields – physiotherapists, massage therapists, psychologists, speech therapists and others. As a result, it is complex rehabilitation that allows the patient to recover completely, and not partially.The success of the treatment depends both on the correct diagnosis and on the optimally selected and performed treatment, as well as on the correct and timely rehabilitation of the patient. Rehabilitation has one single goal – the fullest possible restoration of the lost functions in the patient, based on the existing consequences of the injury or disease, and the treatment carried out. Depending on the area of ​​application, rehabilitation can be: Orthopedic – it is carried out after injuries and operations for diseases of the musculoskeletal system, fractures, malformations of the spine and posture disorders.Neurological and neurosurgical is one of the most serious types of rehabilitation, since the largest number of specialists are involved in its implementation – neurologists, physiotherapists, massage therapists, psychologists and psychiatrists, speech therapists, occupational therapists, etc. This rehabilitation is required after injuries and operations on the nervous system (head , spinal cord), with diseases of the peripheral nervous system (nerve bundles), strokes, paresis and paralysis. Cardiological rehabilitation – rehabilitation after an acute heart attack, with diseases of the heart and blood vessels.The goal of rehabilitation is the rapid regeneration of muscles with their atrophies associated with prolonged physical inactivity, in order to restore the strength and tone of the limb, restore the full range of motion in the joints after immobilization (after fractures), accelerate the regeneration of cartilage tissue, improve trophism of organ and bone tissues, increase mobility with adhesions in the abdominal cavity after abdominal operations, increasing the general tone of the patient and improving the psychoemotional state, relieving pain and swelling after joint injuries, restoring physical activity after strokes, paresis and paralysis, as well as in the postoperative period in patients after operations associated with diseases and injuries musculoskeletal system (after injuries, fractures, bruises and sprains).It is worth noting that the process of rehabilitation itself is based on stimulating the patient’s own capabilities under external influence. Physical exercises, modern equipment help to stimulate local and general immunity, improve tissue repair processes, restore blood and lymph circulation.

The methods of medical rehabilitation include the following methods: therapeutic gymnastics, massage, kinesitherapy, physiotherapy treatment, manual therapy, electromyostimulation (it consists in improving the conduction of nerve impulses to skeletal muscles), psychological assistance, speech therapy . It should be noted that one of the key points in any rehabilitation is physiotherapeutic methods, which are aimed at restoring lost functions and stimulating movements in the patient, accelerating reparative processes in tissues and organs, especially in the musculoskeletal system, nervous system and circulatory system. One of the advantages of physiotherapy methods is that they do not use medications, which means that there is no risk of allergic reactions and side effects, drug dependence does not develop, and the methods of treatment used are usually not invasive.A properly selected complex of the rehabilitation program will help the patient recover as quickly as possible after an illness, injury or operation, will return him a feeling of freedom of movement and the ability to communicate with people around him without any restrictions.

90,000 Ultrasound therapy for chronic low back pain

Relevance

It is not uncommon for people to experience lower back pain. When the cause of the pain is unknown, we say the pain is “nonspecific.”Pain that lasts more than three months is considered “chronic”.

Chronic non-specific low back pain can be disabling. It can be a cause of labor loss. Often, people with chronic, nonspecific low back pain seek medical attention.

Ultrasound therapy is the application of sound waves (vibrations) in treatment. It is often used to treat low back pain. A healthcare professional runs a hand device over the skin in the lumbar region.The device generates vibrations that are transmitted through the skin. The goal is to transfer heat and energy to the areas of the body under the skin to reduce pain and speed healing.

This Cochrane review was aimed at investigating whether ultrasound is effective in the treatment of chronic non-specific low back pain, and whether it has any undesirable effects. Specifically, we wanted to know if ultrasound affects the following outcomes: pain, feeling limited in daily life due to pain, satisfaction with treatment, well-being, disability, and other unwanted effects.

What were we looking for?

We searched for studies published up to January 2020 that:

• were randomized controlled trials — medical studies in which participants were randomly assigned to two or more treatment groups. This type of research provides the most reliable evidence as to whether treatment is producing any change; 90,063 • included people with chronic nonspecific low back pain aged 18 years or older;
• compared ultrasound (alone or in combination with another treatment) with placebo (sham treatment) or with other treatments for chronic non-specific low back pain.

What have we found?

We found 10 studies that included a total of 1025 people treated for non-specific low back pain.

Most of the people in the studies had mild to moderate low back pain, which means that daily activities may be painful for them. They were treated in outpatient departments or clinics, where they usually received six to eighteen ultrasound sessions.After the end of treatment, the study participants were followed up for some time (usually over several days or weeks).

Studies compared ultrasound to one or more treatments: placebo (five studies), no treatment (one study), electro-pulse therapy (one study), manual therapy (one study), osteopathy (one study), and laser therapy (one study) study). Three studies compared ultrasound in combination with exercise to exercise alone.None of the studies were commercially funded.

Key Findings

There is little to suggest that ultrasound is an effective treatment for people with nonspecific chronic low back pain.

Ultrasound versus placebo

We do not know if ultrasound reduces mean pain intensity, as it has been studied in very few people in studies with deficiencies in their conduct and responding with varied responses.Ultrasound may have little or no effect on the number of people with a decrease in pain intensity of 30% or more in the short term (i.e., less than three months after the start of the study).

Ultrasound may have little or no effect on people’s well-being. It has little or no effect on feeling limited in daily life due to low back pain or on satisfaction with treatment.

Ultrasound may have little or no effect on unwanted effects.We do not know if ultrasound affects disability, as no studies have examined this.

Ultrasound plus exercise versus exercise alone

conducting research.

Certainty of Evidence

Based on the studies found, there was generally low and very low certainty evidence that ultrasound had little or no effect on pain and well-being compared to placebo.For other outcomes and comparisons, we are less confident about the results we presented. This is due to imprecision and poor research performance.

Physiotherapy stronger than pain

After an active summer vacation and intensive work in the beds, we remember our joints and spine. Rather, they themselves remind of themselves.Autumn is traditionally considered a time of exacerbations of arthritis, arthrosis and osteochondrosis. When the knees swell, the foot hurts when walking, or the lower back aches – citizens run to pharmacies. And it would be necessary – to a physiotherapist. What is the difference between a pill and physiotherapy treatment and what myths about physiotherapy are misconceptions, says Alexandra Moiseenko, a physiotherapist at the Panorama Med medical center.

– Alexandra Valerievna, what happens to bones and joints in autumn?

– Old injuries and chronic diseases are exacerbated after intense physical exertion in the summer and as a result of autumn hypothermia.Moreover, not only large joints – knee and hip joints, but also small ones – on the hands and feet become inflamed. And of course, osteochondrosis shows itself and spinal hernias “come out”.

– At the same time, many people prefer to take pills, considering physiotherapy treatment as collateral and frivolous. Where does this mistrust come from?

– I think, because the action of the pill is much faster, I took it and after a while the pain went away. And the fact that she will appear again tomorrow does not bother a person at that moment.As well as the fact that all non-steroidal anti-inflammatory drugs and analgesics have the strongest side effects on the stomach and kidneys. For those who have gastritis and ulcers, these drugs are strictly contraindicated. Even injected intramuscularly, they have strong side effects, not to mention allergic reactions. Well, physiotherapy, of course, takes time and patience. But this method of treatment practically does not give side effects and allergic reactions, and its effectiveness is much higher.

– What is the difference between the effect of the drug and the effect of physiotherapy?

– No tablet affects the cause of inflammation and pain, but eliminates the symptom. When it enters the body through the mouth, the medicine spreads everywhere, and physical therapy is directed to a specific inflamed organ. This targeting effect does not give side effects. If we inject the same drug by electrophoresis, then it is localized in a certain place and will not enter the stomach or kidneys.Moreover, its dosage is several times less than in a tablet. Therefore, neither an ulcer nor gastritis is a contraindication to physiotherapy. In addition, the physiotherapy treatment is multicomponent. For example, in case of osteochondrosis, we prescribe either CMT therapy or diodynamic therapy – a pulsed current, which, in addition to the analgesic effect, also has an anti-spastic and anti-inflammatory effect.

– Perhaps the natural factors used in physiotherapy do not very well convince patients that such a treatment can be highly effective?

– There are many methods of physiotherapy, and they are all really based on natural factors – solar radiation, heat, magnetic and electric fields.However, you shouldn’t underestimate the power of nature. The volumes of physiotherapeutic effects are calculated with no less accuracy than the dosage of drugs. Physiotherapy can be seriously harmful if used improperly or incorrectly. And at the same time, with its help, it is possible to achieve high results in treatment, much more effective and long-lasting.

– But patients are right that physiotherapy should not be expected to have a momentary effect? How long can this treatment be?

– Cannot be cured with physiotherapy in one session.The minimum course of treatment is five procedures, but we usually prescribe about ten. During each procedure, we act on the diseased organ with minimal doses, so the therapeutic effect accumulates and increases with each procedure.

– Can I skip a few days and continue the physiotherapy treatment again?

– No way. The break between procedures can be no more than three days, otherwise you will have to undergo the course of treatment again.

– People are often frightened when, after several procedures, their condition worsens. Some even quit treatment, blaming the doctor or the physical therapy method itself, which supposedly did not help them. What is really going on?

– This is a normal reaction of the body, because any physiotherapy procedure increases blood flow to the sore spot and a person experiences subjective sensations of increased pain. But over time, these sensations diminish and pass.In addition, the positive effect of physiotherapy techniques continues for one to three weeks after the end of the treatment course. Therefore, you should not lose faith in physiotherapy, and even more so not trust the doctor.

– How wide are the possibilities of physiotherapy? For example, if the joint is very swollen and painful, you still need to go to a physiotherapist, and not run for a pill?

– Of course, because the method and amount of exposure is selected individually.And even with advanced arthrosis, we can choose a technique that will help a person get back on his feet and forget about pain. Choosing a method of treatment, the doctor focuses not only on the degree of inflammation of a particular organ or joint, but also on the general condition of the body and the presence or absence of concomitant diseases. We meticulously ask the patient whether he had any injuries, whether he is currently experiencing a cold and fever. For some reason, many hide these symptoms and consider them insignificant. But even a slight injury to the head can provoke a displacement of the vertebrae in the cervical spine, and this, in turn, is a contraindication for certain types of physiotherapeutic effects.

– So, there are still contraindications?

– Of course they do. But for different types of physiotherapy. In this case, you can choose such a treatment or such dosages that will be absolutely safe for the patient. After all, there are a lot of physiotherapy techniques. For example, we will never prescribe impulse currents to a patient who has uterine fibroids. But in this case, you can use a local effect on the diseased organ (with the exception of the lower back) with direct current.An absolute contraindication to physiotherapy is only oncology. You can not perform these procedures in case of violation of blood clotting and febrile conditions with a body temperature above 37.5 degrees.

– Can I go to a physiotherapist right away or do I need to visit a therapist, traumatologist or other specialist in advance?

– Usually, specialists refer patients with a certain diagnosis to me. After all, a person himself can guess and assume, but he is unlikely to assess his condition correctly.I, as a physiotherapist, in turn, myself often refer my patients to consult with other doctors to clarify the diagnosis. For example, a woman comes to me complaining of back pain. She is sure that she has osteochondrosis, and the neurologist confirmed this diagnosis. But I need to make sure she doesn’t have uterine fibroids, which often happens with back pain. Therefore, I will suggest that she go to the gynecologist. After all, the choice of a safe method of treatment depends on this. Or the patient has a lot of birthmarks on his back that fall into the zone of physiotherapy.I will ask him to go to a dermatologist to make sure that this is not an oncology.

– Women often prescribe a massage for themselves, considering this procedure to be completely harmless and purely health-improving, correcting the figure. This is right?

– Massage also has contraindications, so it can play a bad role if a person hides a disease from the doctor, the same myoma. I had a case when a girl came for a massage, believing that she had osteochondrosis of the lumbar spine.Our experienced masseuse was alert and called a doctor. It turned out that the patient had frequent urination and even had a fever the day before. They sent her to a urologist who discovered kidney stones. If it were not for the vigilance of the masseuse, massage could provoke increased pain and even renal colic and, as a result, hospitalization.

– Is a spinal hernia massage a contraindication?

– This is a common misconception.A hernia can be perfectly treated with massage, but in this case we use gentle techniques. Osteopathic and acupressure massage will be useful here, but deep massage is really contraindicated. When contacting a physiotherapist, it is very important to know your diagnosis exactly and not hide concomitant diseases from the doctor. Then physiotherapy treatment will be of great benefit.

90,000 Back pain. Neurosurgeon Dr. Stavru

Back pain

Low back pain

Back pain can occur due to many factors or be a side effect of various diseases.

Very often, back pain affects the lower part of the spine – the lumbosacral region. This area of ​​the spine is subject to the greatest loads, which cause muscle overstrain, wear and tear of bone tissue, deformation, and, as a result, lower back pain.

Most often, back pain is associated with nerve irritation or changes in the spine itself, such as osteochondrosis, herniated disc, stenosis, spondyloarthrosis.If the problem is in the spine itself, the symptoms are aggravated by movement.

Pain can also come from muscle tissue and ligaments through physical overload, sprains, overexertion or hypothermia. These pains often go away on their own, especially if the irritant is eliminated. Less commonly, back pain is triggered by diseases of the internal organs, vertebral fractures, infections, tumors and other diseases.

For the success of therapy, it is important to distinguish between acute and chronic pain.Sudden, sharp back pain has a warning function and indicates, for example, muscle damage, inflammation or injury. Chronic pain is often an indicator of degenerative degenerative processes in the spine. Chronic back pain can develop into an independent clinical picture and continue to exist even after the disappearance of their root cause. Timely diagnosis and therapy can prevent acute pain, which often responds well to treatment, to chronic low back pain.

Diagnostics for back pain

To diagnose low back pain, a whole range of methods are used, such as examining the patient, checking the condition of muscles, ligaments and the general condition of the body, neurological examination, as well as radiography, computed and magnetic resonance imaging, laboratory tests. However, the key point, especially in the diagnosis of regular and chronic back pain, is a general survey of the patient and a detailed study of the medical history.Low back pain is very individual in nature. A similar clinical picture can provoke a strong pain reflex in one patient, while for another it can be absolutely painless. Imaging techniques (X-ray, MRI, CT) and laboratory findings are effective in diagnosing specific back pain — pain that is caused by one clearly limited cause. Most of the patients suffer from nonspecific pain, the cause of which is unclear or due to multiple factors.

So, the latest clinical studies of a herniated disc contain important statistical data: some patients with an unambiguous picture of a disc herniation do not have any of its symptoms.On the other hand, X-ray images, computed tomography and magnetic resonance imaging of some patients with pain characteristic of a hernia and other complaints do not contain pathological features. This phenomenon is familiar to many patients for whom the chosen therapy or even repeated operations did not bring the desired relief.

The choice of treatment methods depends on the successful establishment of the cause of back pain: drug therapy, physiotherapy procedures, surgery, treatment of primary diseases of other organs.

Cervical osteochondrosis

Osteochondrosis is one of the most common causes of back pain.

Osteochondrosis is a wear of the spine, which manifests itself in degenerative changes in the intervertebral discs. The intervertebral discs act as cushions between the vertebrae. They contract from the vertical position of the spine and unclench due to the change in position and support of the muscles and ligaments. Osteochondrosis occurs as a natural aging process of the spine and the body as a whole.From a sedentary lifestyle, hard physical labor and muscle weakening through inactivity and obesity, as well as from other factors, the intervertebral discs prematurely lose their ability to regenerate. The discs remain compressed, their height decreases, and they cease to absorb the movements of the spine. As a result, the adjacent vertebrae succumb to constant pressure and injury, from which pathological bone growths – osteophytes – are formed on their surface. Friction of these growths against nearby tissues causes pain, the spinal canal narrows, the roots of the spinal nerves are pinched, the spine loses its healthy shape and flexibility.

Osteochondrosis can affect every part of the spine. Most often, the lumbosacral spine is affected, since it is the lower back that lends itself to maximum physical exertion. The second after frequency is cervical osteochondrosis. The peculiarity of the cervical spine is great mobility – it is responsible for holding, tilting and turning the head – in combination with a relatively weak muscular corset. Due to a violation of the blood supply to the brain, cervical osteochondrosis is sometimes accompanied by headache, dizziness, hypertension and other symptoms.

Timely diagnosis and therapy of osteochorondrosis can prevent its complications, such as protrusion and herniated intervertebral discs.

In addition to non-invasive methods of treatment, in severe cases of osteochondrosis, there may be a need for surgical intervention. During the operation, the damaged intervertebral disc and bone growths on the adjacent vertebrae are removed. An implant (artificial intervertebral disc) is inserted into the place of the removed disc and, if necessary, the corresponding part of the spine is stabilized (fusion).

Herniated disc

As one of the complications of osteochondrosis, a herniated disc can develop.

An intervertebral hernia is an outward displacement of the intervertebral disc. Back pain and other complaints occur when a bulging disc or disc tissue rubs or pinches a spinal nerve or nerve root. The more the nerve root is affected or compressed, the more symptoms appear. Occasionally, nerve root damage occurs or the nerve root dies off.

If the displaced disc does not affect the nerve, the hernia does not cause any symptoms.

In accordance with the directive of the World Health Organization, a patient with a herniated disc without symptoms is considered healthy and does not need medical attention.

The cause of a herniated disc is often the wear of the spine, improper posture and incorrect load on the back, which may not bother the patient for years.At a certain moment, one awkward movement, a sharp turn of the spine, hypothermia or a draft is enough – and the symptoms of a hernia are manifested in full. In this case, many are familiar with the typical sharp pain, which is popularly called “lumbago”.

Pain in the back, leg or arm is the most common symptom of a herniated disc. Depending on the severity of the symptoms, numbness and muscle weakness may appear in the zone of influence of the compressed nerves, in extreme cases, also dysfunction of the pelvic organs and paralysis.

A herniated disc is diagnosed by magnetic resonance imaging or, alternatively, computed tomography. Because approximately 30% of healthy 30-year-olds and more than 60% of people in their 50s have asymptomatic and no medical intervention for herniated disc, positive MRI and CT results do not necessarily explain the source of pain. Therefore, before starting treatment, it is critically important to undergo an examination by a qualified specialist in order to determine whether the patient’s complaints are really provoked by a herniated disc.

Treatment of intervertebral hernia

In most cases, a hernia is effectively treated with conservative methods, which primarily include gentle (but not bed) rest, pain therapy and therapeutic exercises, along with other physiotherapeutic measures. In contrast to popular belief, bed rest with a spinal hernia is not recommended; it is important for the patient to maintain mobility and an active (albeit gentle) lifestyle. Many clinical studies show the ineffectiveness and sometimes counterproductiveness of bed rest.

If mobility is limited by a strong pain reflex, anti-pain therapy is prescribed; after (partial) pain relief, the patient should start therapeutic exercises as soon as possible to strengthen the muscles of the back and learn the correct movements. Strong, well-developed muscles of the back and abdomen are the key to a healthy spine.

If conservative therapy does not show the expected result, the symptoms do not disappear or even intensify, surgical intervention is necessary.In case of paralysis or dysfunction of the pelvic organs, the operation is prescribed immediately.

Statistically, only 5-10% of cases of intervertebral hernia require surgical intervention. Surgeons have at their disposal both minimally invasive procedures (chemonucleosis, laser ablation of the disc, etc.), as well as traditional open surgery, for example, microsurgical decompression (especially in complex herniated discs).

The pain does not always go away completely after the operation.In the first days after the operation, the pain syndrome is caused by the operation itself, namely by trauma (incision) of soft tissues and irritation of the nerves, it goes away as the wound heals. On the other hand, the scar tissue can overgrow and put pressure on the nerve itself, which after a certain time provokes new pain.

Recovery after intervertebral hernia surgery

After surgical treatment of a hernia of the spine, the patient needs to undergo rehabilitation.Manual therapy and remedial gymnastics, starting from 2-3 weeks after the operation, will help to strengthen the muscles of the back and resume the impaired functions. At the same time, it is very important that the patient, even after the rehabilitation course, continues the selected exercises at home and maintains an active lifestyle – in order to prevent a new intervertebral hernia. The so-called “orthopedic sports” are also recommended: swimming, dancing, walking (walking), cycling (without excessive bending forward).

If you have any questions regarding back pain, osteochondrosis, intervertebral hernia, and you would like to receive detailed advice (in Russian) – please contact us.

We also provide:

• full spectrum neurosurgical consultations

• second (alternative) opinion regarding your diagnosis and treatment

• planning diagnosis and treatment in Austria

• in particular planning and carrying out brain and spine surgeries

• medical supervision after surgery and / or treatment

• planning rehabilitation after trauma and / or treatment

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