© Munich American Reassurance Company

Alternative Therapy for Chronic Pain

Chronic pain has been estimated to affect more than 100 million people in the United States and is the reason for about one in five office visits to a physician.1 Chronic pain is often accompanied by psychological problems, especially depression, and frequently has an adverse impact on the occupational and social lives of those affected. Treatment of chronic pain syndromes with opiate medications has recently been recognized as a significant problem due to adverse side effects and the development of drug dependency. It has been found that individuals taking both low and high dose opioids for chronic pain actually have greater degrees of pain and depression than individuals who address their chronic pain with non-opiate therapeutic regimens. Discontinuing opioid medications results in significant and sustained improvement in pain severity and functioning.2

Recognition that there is a problem concerning use of opioid medications and that chronic pain sufferers have been shown to actually obtain greater relief through other methods of pain control has fostered interest in “alternative therapies” for pain management. 

Alternative therapy encompasses a variety of disciplines. In many cases, these therapies have not been empirically shown to be efficacious; however, many individuals report a degree of relief through their use. Included among alternative therapies are mind-body techniques such as guided imagery, some virtual reality software applications, acupuncture, yoga, and massage, among others. Chiropractic manipulation and mobilization treatments have been widely used in treating individuals suffering from chronic low back pain and have been found helpful to a degree in those suffering from neck pain and headache as well.

Guided therapeutic imagery is a technique in which a mental health professional helps a patient focus on various mental images that result in feelings of relaxation. This may include perceptions that are not only visual, but of phenomena relating to all five sensory modalities (smell, sound, texture, etc.). The therapeutic goal is to induce a state of calmness that not only relaxes the mind but also physical processes such as breathing and muscle tension. Once learned, the technique can be used without the assistance of a therapist.

A fully immersive virtual reality (VR) experience has been found to reduce levels of pain and unpleasantness.3 This was first described in a study from the University of Washington where a VR software program known as SnowWorld was found to significantly decrease discomfort associated with wound care for burn victims, a particularly painful process.4 The VR environment of SnowWorld features a snowy landscape where the user scores points by throwing snow balls at various targets by pointing his or her head towards the target and pressing a button. How VR works to reduce pain has not as yet been completely explained, but it is felt that multiple sensory modality stimulation might affect the “gating system” involved with transmitting to, and processing pain signals in, the brain. There is likely a distraction component as well. Brain scans on patients using VR during painful procedures have been found to exhibit a reduction in pain-related brain activity. Although VR has been found to be an effective modality in treating acute pain, resulting in diminished need for opioid medication, effective VR treatment of chronic pain syndromes still remains problematic.

Acupuncture is one of the oldest medical procedures in the world, having originated in China around 2,000 years ago. Although this treatment encompasses many varied techniques, most frequently thin, solid, metallic needles are inserted into the skin to stimulate anatomic points which are located in what acupuncturists identify as the body’s 14 major meridians of energy-carrying channels. Many of these “acu-points” are near nerves. It is postulated that acupuncture decreases pain through needle stimulation resulting in a message sent to the spinal cord and brain that causes release of endorphins. Endorphins are a member of a group of neurotransmitters that block the message of pain from being delivered to the brain. However, certain inconsistencies suggest that the endorphin theory, if true, is not the only factor involved if acupuncture does result in pain relief. Efficacy has been difficult to prove and some studies show no difference in results when acupuncture is compared with “sham acupuncture.”5

Yoga, through practice of its three main components—various postures, breathing techniques and meditation—has been found to improve some aspects of physical and mental health. A meta-analysis of controlled clinical studies assessing the efficacy of yoga in diminishing chronic pain in individuals suffering from back pain, rheumatoid arthritis, headache/migraine, and assorted other maladies, found moderate improvement in pain symptoms and associated disability.6 Individuals suffering from fibromyalgia who received a specific yoga program were found to experience reduction in pain and fatigue and improvement in mood and coping abilities, with most post-treatment gains demonstrated to persist for at least three months.7

Anxiety and cognitive stress are known correlates of pain; massage therapy has been shown to decrease their intensity. It is not known exactly how massage therapy accomplishes this, but it has been postulated that massage produces alterations in autonomic nervous system activity that ultimately produce attenuation of stress hormones in the body.  Massage therapy may also foster the release of the body’s own endogenous opiates into the blood stream. However, studies assessing the effectiveness of massage therapy in diminishing the pain associated with osteoarthritis or rheumatoid arthritis have found its effectiveness to be moderate to very low.8

Evidence supporting the efficacy of chiropractic manipulation and mobilization treatments in improving chronic low back pain is of only moderate-quality but chiropractic manipulation appears to be somewhat better relative to mobilization.9 Chiropractic treatment may be helpful to a certain degree in alleviating neck pain and headache.

At present a “multi-modality” approach to the treatment of chronic pain syndromes appears to be most effective. This method couples an alternative therapy for chronic pain with non-opioid analgesia (such as NSAID treatment along with a muscle relaxer) and pharmacologic treatment for the depression and anxiety that often accompany chronic pain.

Contact the Author:
Dr. Gina Guzman
Gina Guzman, MD, DBIM, FAAIM, FALU, FLMI
Vice President & Chief Medical Director
References: Rosenquist EWK, Evaluation of chronic pain in adults, UpToDate January 2018: 18 pages. Townsend CO, et al, A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission, Pain 2008;140:177-189. Li A, et al, Virtual reality and pain management: current trends and future directions, Pain Management 2011;1(2):147-157. Panjwani L, Virtual “SnowWorld” Helps Burn Victims Cope with Extreme Pain, https://www.rdmag.com/article/2017/08/virtual-snowworld-helps-burn-victims-cope-extreme-pain, accessed 3/8/2018. Ahn AC, Acupuncture, UpToDate February 2018. Bussing A, et al, Effects of yoga interventions on pain and pain-associated disability: a meta-analysis, Journal of Pain 2012;13(1):1-9. Carson JW, et al, A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia, Pain 2010;151(2):530-539. Nelson NL, et al, Massage Therapy for Pain and Function in Patients With Arthritis; A Systematic Review of Randomized Controlled Trials, Am J Phys Med Rehabil 2017;96:665-672. Coulter ID, et al, Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis, The Spine Journal 2018.

Rechtlicher Hinweis

Die gewünschte Information bezieht sich auf Finanzinstrumente, Wertpapiere oder diesbezügliche Angebote, die nicht in oder in die Vereinigten Staaten, Kanada, Australien oder Japan und von US-Bürgern (gemäß der Definition in der Regulation S des US Securities Act 1933) angeboten werden, noch in und von diesen Ländern bzw. US-Bürgern akzeptiert werden dürfen. Folglich wurden diese Finanzinstrumente oder Wertpapiere sowie diesbezügliche Angebote (i) weder nach dem Amerikanischen Wertpapiergesetz noch nach einem Gesetz eines US-Bundesstaates registriert; (ii) diese Finanzinstrumente oder Wertpapiere dürfen nicht direkt oder indirekt in oder in die Vereinigten Staaten angeboten, verkauft, wiederverkauft, verpfändet oder geliefert werden, es sei denn, es liegt eine Befreiung von den Registrierungsanforderungen des Amerikanischen Wertpapiergesetzes vor; und (iii) solche Finanzinstrumente oder Wertpapiere können dem US-Steuerrecht unterliegen. Keine der hierin enthaltenen Unterlagen begründet ein Verkaufsangebot oder eine Aufforderung eines Angebots zum Kauf von Finanzinstrumenten oder Wertpapieren in den Vereinigten Staaten, Kanada, Australien oder Japan bzw. an US-Bürger oder in eine andere Rechtsordnung, in der ein solches Angebot oder dessen Einholung rechtswidrig ist. Personen, die ein Angebot annehmen möchten, dürfen weder die Post der Vereinigten Staaten, Kanadas, Australiens oder Japans oder irgendein Mittel oder Instrument (wie z.B. Faxübertragung, Telex oder Telefon) des Zwischenstaatlichen- oder Außenhandels, noch irgendwelche Einrichtungen einer inländischen Wertpapierbörse der Vereinigten Staaten, Kanadas, Australiens oder Japans für irgendeinen Zweck benutzen, der direkt oder indirekt mit der Annahme eines Angebots zusammenhängt. Annahmen oder andere sich auf ein Angebot beziehende Unterlagen dürfen nicht postalisch in den Vereinigten Staaten, Kanada, Australien oder Japan frankiert oder abgestempelt werden. Alle Personen, die ein Angebot annehmen möchten, müssen eine Adresse außerhalb der USA, Kanada, Japan und Australien für den Erhalt jeglicher Finanzinstrumente oder Wertpapiere angeben. Darüber hinaus wird von jedem Inhaber der relevanten Finanzinstrumente oder Wertpapieren angenommen, dem Emittenten dargelegt zu haben, dass (i) er kein US-Bürger ist und (ii) dass er diese Finanzinstrumente oder Wertpapiere nicht auf Rechnung eines US-Bürgers erwirbt.

Weder die in diesen Seiten enthaltenen Informationen, noch irgendeine Meinungsäußerung begründen ein Angebot oder eine Aufforderung, Finanzinstrumente oder Wertpapiere in irgendeiner Rechtsordnung zu erwerben. Jegliches Angebot oder jegliche Aufforderung wird nur in Unterlagen gemacht, die dafür rechtzeitig veröffentlicht werden; und jegliches Angebot und jegliche Aufforderung ist beschränkt auf die in diesen Unterlagen bereitgestellten Informationen.

Please scroll and read to the very bottom, before you can confirm.
We use cookies on our websites to improve your experience as an internet user, and to optimise our online services. They comprise cookies that are required for technical purposes, and without which the website functionality could not be guaranteed. We also employ cookies to carry out statistical evaluations of the reach of our websites. These evaluations are anonymised. You can find further information on the cookies we use, and ways to object to the use of cookies for statistical evaluations, in our cookie guidelines.