• Overview
  • Ethnicity and Culture
  • Models of Pain Management
  • Evaluating Literature
  • Professional Training, Licensure & Credentials
• Interventions
  • Common Approaches
  • Theories of Mechanism
  • Safety and Adverse Effects
• Conditions
  • Selected Conditions
  • Text Resources
  • Web Resources

Common Approaches: Selected CAM Therapies

This section provides a brief overview of the most common CAM approaches to chronic pain, as well as a range of references and resources for further study.

Biofeedback

The use of electrical instrumentation can provide moment-to-moment feedback to the patient about the state of any of his/her internal processes for example, thermal biofeedback measures finger temperature, an electromyogram (EMG) measures skeletal muscle activity and an electroencephalogram (EEG) measures brain wave activity. As patients learn to modify these physiologic responses, they are also modifying different aspects of the pain response cycle as they quieten over-activity in the sympathetic branch of the autonomic nervous system. [1,2]

Hypnosis

Hypnosis is the use of sustained and focused attention to render the mind susceptible to therapeutic suggestion. A highly refined form of distraction, there are no specific rituals necessary to induce this state - even story telling or TV advertisements can create a state of heightened suggestibility. Guided imagery is a subtype of hypnosis, with the choice of imagery aimed at specific target symptoms. Applications for pain include acute and chronic pain states. [3,4,5]

Meditation

Several forms of meditation all aim to provide access to a state of consciousness beyond awareness of thoughts. Mindfulness, e.g., vipassana meditation, involves focus on the cycle of the breath; mantra e.g., transcendental meditation (TM) and the “relaxation response” of Benson, uses a sound or phrase as the focus; concentration, e.g., Zen, focuses on an external object, like a candle. In pain management, meditation is often combined with cognitive-behavioral psychotherapy to help patients become aware of and then change maladaptive thought patterns. [6,7,8,9]

Training

• The Mind Body Medical Institute, Herbert Benson MD, Director. Boston MA

• Center for Mindfulness in Medicine, Health Care and Society, University of Massachusetts Medical School.  Jon Kabat-Zinn, Founder and Director Emeritus.

Acupuncture

Acupuncture is a key element of Traditional Chinese Medicine (TCM).  It is a method of activating and balancing the flow of vitality, or Qi, by inserting very fine needles into strategic energy points. Studies describing validated applications for pain management are innumerable, with musculoskeletal aspects of pain being the best documented. For further information see the Acupuncture section of the East Asian Medicine module on this website. [10,11]

Medical Acupuncture Training:

1. Structural Acupuncture for Physicians.  Harvard Medical School, Department of Continuing Education.  Course Director: Joseph Audette MD search for the word acupuncture to retrieve the course information.

2. Medical Acupuncture for Physicians at the Helms Medical Institute, CA

Homeopathy

Homeopathy is the use of extremely dilute preparations of natural agents that paradoxically mimic the symptoms of concern and thereby stimulate the body’s innate healing response. Despite the counter-intuitive rationale, and lack of an adequately proved mechanism of action, homeopathy has been proven effective in double blind studies of such conditions as pediatric diarrhea, allergy, and pain. [12]

Reiki/Therapeutic Touch

Reiki/Therapeutic Touch is the manual manipulation of the subtle energy field surrounding and interpenetrating the body, to remove blocks to the flow of this healing force. Therapeutic Touch was devised in the 1970’s in America for use by nurses.  Reiki is reputedly of Tibetan origin, and has become quite widespread in the past 10 years.  Both involve the use of the hands to balance this energy field, though no physical contact is necessary in TT. [13,14,15]

• Training: Nurse Healers – Professional Associates International Association,

Manual Medicine: Myofascial Release (MRF) & Craniosacral Therapy (CST)

CST is a simplified form of osteopathy in the cranial field, in which practitioners use gentle hand pressure to facilitate the unwinding of restrictions in the dural tissue that surrounds the spinal cord and brain.  It was developed by John Upledger, DO, and is hypothesized to improve the flow of cerebrospinal fluid throughout the CNS.

MFR uses similarly light hand pressure to unwind restrictions in the connective tissue or fascia surrounding muscles and was developed by physical therapist John Barnes.

The research literature for these two modalities is unfortunately very sparse due to the developers’ emphasis on training and clinical use, rather than on research. [16,17]

Herbs

Much of allopathic pain medicine is actually a refined form of herbal medicine. All narcotics, from opium to Percocet to Oxycontin, are derivatives of the poppy plant’s resin. The classic anti-inflammatory aspirin (acetylsalicylic acid) is derived from the bark of the willow tree (Salix, in Latin). Chili pepper extract (capsaicin, Zostrex) is used topically to treat a range of pain syndromes, while the tetrahydrocannabinol (THC) from cannabis has been used successfully to treat the pain from multiple sclerosis (MS) and cancer. [18,19]