Page 73 Guide to Pain Management in Low-Resource Settings

Complementary Th erapies for Pain Management 61

7) Risk/benefi t ratio is an important aspect to con- What about massage therapy?
sider. Most of the non-oral complementary therapies
are low-risk and benefi cial. Massage therapy dates back thousands of years and is
practiced by cultures around the world. It involves ma-
What is the fi rst step in choosing nipulating, applying pressure to, rubbing, or stroking
complementary medicine ? soft tissue and skin to promote circulation, relaxation,
and pain relief. Particular techniques and degrees of
In selecting a particular traditional or complementary pressure may vary in each of the many types of mas-
therapy, the patient’s preferences for use of a passive sage therapy. Swedish massage is the predominant style
therapy (e.g., massage or acupuncture) versus an active used in the Western world. Sports massage, Shiatsu,
therapy (e.g., meditation or self-hypnosis) should be and deep tissue massage are modalities that involve
considered—each of these is eff ective in relieving pain. deeper pressure, whereas Reiki (very light touch thera-
Herbal medicines must be considered in terms of any py) involves the gentle brushing of hands over the body.
prescription medication the patient is using. Th e degree of pressure used must be adjusted to ensure
that no damage is done to wounds, fractures, and the
Would acupuncture be like. Refl exology (massage of the feet, hands, or scalp)
a good choice? is especially useful for people who are frail or are re-
covering from surgery. All types of massage therapy
Acupuncture, an important component of Traditional relieve and loosen sore muscles, as human touch itself
Chinese Medicine, originated more than 2,000 years is usually benefi cial and can reduce pain. Th e many
ago. It involves the stimulation of predetermined physiological eff ects of massage include enhanced im-
points on the body with sterile, fi liform, disposable mune function, as measured by increased levels of
needles, sometimes using heat (moxibustion), pres- natural killer cells, decreased cortisol and epinephrine,
sure (acupressure), or electricity to enhance therapeu- and improved blood and lymph circulation, in addition
tic eff ect. Th e ancient theory underlying acupuncture to patients’ self-reports. In studies, massage eff ectively
assumed that “qi” (pronounced “chee”), or life energy reduced pain and other symptoms, including nausea,
fl ows through meridians, which were thought to con- fatigue, depression, stress, and anxiety associated with
nect the body organs. It was believed that disease oc- cancer treatments.
curs when the meridians become blocked. Acupunc-
ture was thought to relieve the blockage and permit And mind-body therapies?
the normal fl ow of qi, thereby restoring health. Th e
idea of “life energy” or “vital energy” has never been Mind-body medicine includes teaching patients how to
substantiated by scientifi c understanding. Instead, control aspects of their physiology to help reduce pain,
physiological and imaging studies indicate that acu- anxiety, tension, and fear. Th is category encompasses
puncture induces analgesia and activates the central yoga and hypnosis, where a therapist suggests changes
nervous system. Additional studies of acupuncture’s in perceptions of sensations, thoughts, and behaviors.
mechanisms are underway. Guided imagery and relaxation techniques such as pro-
Th e WHO supports the use of acupuncture as gressive muscle relaxation and controlled deep breath-
an eff ective intervention for low back pain, postopera- ing are also types of mind-body medicine. Th ese thera-
tive pain, and adverse reactions to radiotherapy and pies can be learned and used by patients. Training may
chemotherapy. A 1997 Consensus Conference at the be given by therapists, but training often is available on
U.S. National Institutes of Health (NIH) concluded compact disk (CD).
that acupuncture is eff ective in relieving pain, nau-
sea, and osteoarthritis. Since that conference, a large And hypnosis?
research literature has expanded the evidence for ad-
ditional benefi ts, and the NIH continues to support Hypnosis is a state of focused attention or altered con-
clinical trials of acupuncture as well as studies of its sciousness in which distractions are blocked, allowing
mechanisms. Substantial data support acupuncture’s a person to concentrate intently on a particular subject,
ability to alleviate pain. memory, sensation, or problem. It helps people relax and