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Pain relief doesn’t always come in a bottle of pills. Pain can take many forms and relief is not a one-size fits all process. This Special Health Report, Pain Relief Without Drugs or Surgery, explores beyond the boundaries of standard medical treatments (drugs and surgery) and describes the many other approaches that are available for pain relief.
Pain is debilitating, interfering with the ability to sleep, work, and enjoy life. It can aggravate other health conditions and lead to depression and anxiety symptoms. Relieving it often requires a trial-and-error approach that embraces the whole person, not just the source, which cannot always be identified clearly. Many people find it useful to choose from a menu of different pain treatments and remedies, combining them in a regimen that fits their lifestyles.
In addition to the standard pain medications, and surgical repairs of specific problems, patients and their clinicians also have access to a wide range of nondrug therapies for pain. Acupuncture, biofeedback, topical treatments, assistive devices, tai chi and yoga are just a few of the many options available. Not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions. The good news is that mainstream medicine is embracing a wider variety of treatments than ever before. And it’s important to recognize when it’s time to see a physician for an evaluation of pain. If a new pain develops and persists beyond a few days, check with your doctor. And see a doctor immediately if you have chest pain or anything else that could be serious. Severe pain should always be a signal that medical consultation is needed.
Pain Relief without Drugs or Surgery compiles the latest information on a variety of nondrug pain-relieving therapies and their applications to a number of common types of pain. It also provides specific treatments for 10 common pain conditions including low back pain, knee pain, shingles, heel pain, fibromyalgia, and others.
Pain Relief without Drugs or Surgery was prepared in collaboration with the editors of Harvard Health Publications and Diana Post, M.D. assistant professor of medicine, Harvard Medical School; physician, Department of Medicine, Brigham and Women’s Hospital (49 pages, 2012).
- Pain and its perception
- What is pain?
- How pain moves through the body
- Components of a pain assessment
- Who to see about pain
- Pain and the mind-body connection
- Neuroplasticity and pain
- The links among depression, anxiety, and pain
- Inflammation and pain
- Pain relief techniques
- Cold and heat
- Physical therapy and occupational therapy
- Mind-body techniques
- Yoga and tai chi
- Music therapy
- Therapeutic massage
- Pain-relieving devices
- Topical pain relievers
- Herbal or nutritional pain relievers
- 10 common types of pain and how to relieve them
- Shingles nerve pain
- Knee pain (osteoarthritis)
- Low back pain
- Abdominal pain: Irritable bowel syndrome (IBS)
- Headache: From tension headaches to migraines
- Carpal tunnel syndrome
- Plantar fasciitis
- Menstrual pain (dysmenorrhea)
- Hand osteoarthritis
Mind-body relaxation techniques have become well accepted as stress-reducing strategies and are commonly used at hospital-based pain clinics and recommended by mainstream health care providers and integrative medicine specialists. There are a number of techniques and philosophies, but, when used for treating pain, most have some basic themes in common. First, chronic pain conditions can rob people of a sense of control over their bodies and, thus, their lives. Eventually a person who suffers with chronic pain may become defined largely by the pain, planning his or her entire life around it. Therapies that address the whole person, including the mind and emotions, can help restore a sense of self-control and self-efficacy. For example, cognitive behavioral therapy (CBT) is a form of psychotherapy that seeks to break counterproductive thought and behavior patterns that may exacerbate pain. Because the perception of pain is unique to each person, you can use CBT to alter your perception of pain—to gain control of it. Similarly, relaxation therapies, such as meditation, can lower the stress and anxiety that accompanies pain, helping people regain some control over their response.
A common goal of many relaxation techniques and programs is to turn off what is known as the “fight-or-flight response” or the “stress response.” This is the reaction you feel when confronted with something frightening, like a bus veering in your direction. The hypothalamus, pituitary gland, and adrenal glands work together to release a stream of stress hormones that cause your breathing and heartbeat to quicken, your senses to sharpen, and your reactions to speed up to get you out of the way of the bus quickly. That’s good, but if a source of long-term stress keeps stimulating the stress response, a variety of problems, including the exacerbation of chronic pain, may occur. Relaxation techniques emphasize a strong connection between the mind and the body and can calm revved-up muscle, metabolic, and hormonal responses.
The relaxation response is the opposite of the stress response. Using a relaxation technique such as meditation, you can elicit the relaxation response at will to create a state of profound peace and rest. The relaxation response is a physiologic shift that puts the brakes on the biological stampede of hormones and metabolic changes of the stress response. When you practice relaxation response techniques, your heartbeat and breathing slow and your body uses less oxygen, according to Harvard Professor of medicine Herbert Benson, whose several decades of research described this response.
Achieving the relaxation response is the goal and the theoretical basis for many relaxation, meditation, and mindfulness techniques. Benson explains that there are two basic parts to achieving the relaxation response: first, you focus on a word, sound, sensation, or muscle activity that is repetitive and rhythmic, and second, you observe but do not react to or judge intruding thoughts.
Below are descriptions of commonly employed relaxation techniques. You can choose from or, you can simply learn a few techniques, such as mindfulness or controlled breathing, to use whenever your plain flares up.
Meditation and mindfulness
Mindfulness medication is closely related to other techniques that elicit the relaxation response. The core concept of mindfulness is the practice of purposely focusing your attention on the present moment—and accepting it without judgment. Mindfulness meditation is a common and increasingly popular form of meditation being used in pain clinics today. Mindfulness is the opposite of multitasking. It has its roots in Buddhist practices and teaches us to live each moment as it unfolds but without judging what we are feeling and perceiving. It involves letting go of the past and future in your mind. Mindfulness is a component of many other relaxation techniques, including yoga, deep breathing, tai chi, massage, reflexology, journaling, and prayer.
Mindfulness is now being examined scientifically and has been found to be a key element in happiness. Professor emeritus Jon Kabat-Zinn, founder and former director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, helped to bring the practice of mindfulness meditation into mainstream medicine and demonstrated that practicing mindfulness can bring improvements in both physical and psychological symptoms as well as positive changes in health attitudes and behaviors.
Scientists have discovered the benefits of mindfulness techniques to help relieve stress, treat heart disease, and alleviate conditions such as high blood pressure, chronic pain, sleep problems, and gastrointestinal difficulties. Mindfulness meditation may help control people’s pain by breaking anxious and depressive thought patterns and restoring some sense of control over their condition.
In several research studies, Kabat-Zinn demonstrated that mindfulness meditation could provide dramatic and lasting pain relief in a variety of conditions. He showed that meditation can be a valuable add-on therapy to drug treatment. In one study, he taught mindfulness meditation to half of a group of 42 patients who were being treated with medications and physical therapy at the University of Massachusetts’ pain clinic. The meditation boosted these patients’ pain relief by 36%, while also improving their mood and reducing psychological distress.
More recently, in a Wake Forest University study, 15 healthy volunteers were taught mindfulness meditation and then monitored by MRI while a pain-inducing heat device was applied to their leg for six minutes. The meditation reduced pain unpleasantness by more than half (57%) and pain intensity by 40%. The study also showed that mindfulness meditation affected pain-processing areas of the brain such as the primary somatosensory cortex, the anterior cingulate cortex, the anterior insula, and the orbitofrontal cortex.
Progressive muscle relaxation
This form of relaxation therapy focuses on relaxing your muscles in a sequence from the tips of your toes up to the top of your head or vice versa. You might begin by gently curling up your toes, holding the contraction, and then gently releasing them. Then move on, contracting and releasing the muscles around your ankles, calves, knees, buttocks, hands, and so forth on up to your face and head. You can coordinate progressive muscle relaxation with your breathing—tightening your muscles as you inhale and relaxing them as you exhale. As with other relaxation therapies, progressive muscle relaxation can help lower the stress and anxiety that accompanies pain, helping you regain some control over your response.
Self-aware, controlled breathing is a building block of many relaxation therapies. The Lamaze technique used by women in labor is an example of a well-known, pain-reducing relaxation technique based on breathing. But controlled breathing can be done anywhere and anytime. One of the essential aspects of breathing exercises is concentrating, in a calm way, on your inhalation and exhalation, an activity that you ordinarily take for granted but that is crucial to your survival. You can improve your breathing by relaxing your stomach and shoulders and taking deeper, slower breaths. Breathing exercises are designed to teach you to draw oxygen deep into the lungs, expanding the belly as well as the chest with each breath. If you want to try breathing exercises, see “Eliciting the relaxation response,” page XX.
Clinical hypnosis is a procedure in which a trained clinician or therapist gives a patient a series of verbal instructions with the goal of helping the patient enter a state of deep relaxation. In this relaxed state, the patient is aware of everything that is going on, but at the same time, becomes increasingly absorbed in using his or her imagination as directed by the therapist. Therapists use a variety of techniques to help their patients acquire the self-control and confidence to visualize, realize, and achieve goals such as reducing sensations of pain. Therapists often teach their patients self-hypnosis methods that they can employ on their own to reinforce and continue the process at home.
Hypnosis has been used to relieve pain and influence behavior for more than 150 years. Evidence-based research on the use of hypnosis to relieve pain is limited, but a large, well-designed study did boost its credibility as a useful and cost-saving pain relief method for hospital procedure rooms. Published in The Lancet in 2000, the study evaluated the effectiveness of hypnosis—termed “nonpharmacologic analgesia”—in easing pain and anxiety in people who were having minimally invasive surgical therapies such as angiograms, angioplasty, simple kidney procedures, or liver biopsies, during which they remain conscious. Patients participated in a self-hypnosis relaxation session that involved deep-breathing and concentration techniques. The researchers found that these patients required less than half the amount of painkilling drugs used by those receiving standard treatments. Procedures also took less time for the hypnosis group, and they had lower levels of anxiety and pain at both one hour and four hours into the procedure.
In addition, a review of 13 studies of chronic pain published in the International Journal of Clinical and Experimental Hypnotherapy in 2007 found that hypnosis consistently reduced pain and was more effective than physical therapy and educational efforts. Clinical research shows that hypnosis can be effective in treating fibromyalgia and migraine headaches.
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