Pain is one of the hallmark symptoms of arthritis. It may come and go as the arthritis goes into a flare or subsides
in remission,but for most people with RA, it may never entirely disappear. We understand a little of how pain works,but
not all by any means.
We have words to describe its effects,yet they can never entirely convey to someone else what we are feeling. And almost
any two people will experience different levels or intensities of pain from virtually identical causes. Because of the individuality
of pain,we may never fully understand exactly what some one else is going through.
Rheumatoid arthritis pain can be so intense and constant it dominates the patient's every waking moment and many a sleepness
night, It has a purpose,as we've seen. All those overexcited nerve cells are racing to inform the brain that harm is being
done to one (or more) of your joints. In response,the brain signals muscles in the affected area or areas to contract as a
form of protection. The resulting painful spasms prevents the patient from using the joint/joints normally,while the body
makes its mostly futile attempts to effect repairs.
Persistent,severe pain from rheumatoid arthritis requires a combination of therapeutic stratigies;no one pill or management
technique is enough to provide non-stop pain relief. Arthritis medications are only one part of an overall strategy that will
help reduce and cope with pain,improve joint function and daily-living activities,and learn to deal with emotional stresses
that arthritis can impose.
Maintaining that multi-part strategy successfully is only possible the patient understand as much as they can about the
disease and pain,how it can be treated,and what the patient can play in its relief. Not every strategy will be equally effective
for everyone;the patient need to discover what works for him/she,combining different approaches to prolong pain relief
There's a lot to learn,but the more one understands about every aspect of the treatment plan,the more likelyhood one
is to benefit from it. Knowledge is power. Learn to weild that power as an active participant of one's own treatment team
Learn as much as possible about all the strategies available--whether they're medications or non-medicinal techniques.
That understanding is an important step toward one becoming an arthritis self-manager. As repeated over and over again
early aggressive treatment to control the disease as early as possible is imperlative. An uncontrolled disease is a hallmark
of a painful associated disease,in our case,rheumatoid arthritis.
If the source of pain isn't tended to by a professional,there's a heavy price to pay. Studies show that muscle tissue
starts wasting away after only three to six days of inactivity-followed by a corresponding loss of strength and flexibility,
which of course leads to more pain. Unchecked,the underlying disease process continues its dogged work,which increases the
pain further. As already mentioned,persistent,severe pain from arthritis requires a combination of different strategies,a
blend of different approaches that will help one prolong pain relief.
Chronic pain is a significant public health problem and frustrating to everyone affected by it. Psychiatrists offer skills
with pharmacological and psychological treatments now recognized as effective in the management of chronic pain. Recent advances
in the treatment of chronic pain include the diagnosis and treatment of psychiatric co-morbidity,the application of psychiatric
treatments to chronic pain,and the development of interdisciplinary efforts to provide comprehensive health care to a patient
suffering chronic pain.
The psychiatrist can provide expertise in the examination of mental life and behaviour,an understanding of the individual
person and the systems in which they interact, and facilitate the intergreation of the delivery of medical care with other
health care professionals and medical specialists. However,not everyone with chronic pain require psychiatric evaluation,which
should be reserved for patients who have severe symptoms,multiple treatment failures,or problematic behaviors such as substance
abuse or noncompliance. The majority can be treated by the primary physician.
Today's health professionals have numerous therapies at their disposal. The first criteria is to get the disease under
control because when RA is under control, this means less inflammation and less pain. Inflammation and pain is indictive
of a condition that is not controlled. This is accomplished through (DMARDs)disease modifying drugs.
Supplemental therapies may include some of the following,in certain patients--They are not for everyone with arthritis
Behavioral therapies: Because the mind-pain connection is so strong, psychological counseling is often a component of
the pain management package In particular cognitive behavioral therapy can help patients develop healthier and more productive
thought patterns,emotions,and actions. Relaxation methods including bio-feedback,decrease anxiety and a more pain-free existence.
Nerve Block: Injections of local anesthetics into specific nerve bundles can suppress pain. The relief is usually temporary,but
even the momentary respite helps patients to get relief from acute pain.
Implantable Devices: When pain doesn't respond to therapy,certain devices can be implanted through the skin to provide
relief. Patients report satisfaction with the implanted pump,which delivers a tiny dose of opiate or other pain-killer directly
to the spinal cord where pain is processed.
Opiates: There is a huge stigma attached to the use of morphine and its derivatives on the part of both physicians and
patients. This aversion is unfortunate because opiates are the only drugs that provide effective relief for many patients
with extreme chronic pain. The therapy program must be managed by a experienced,professional pain-management specialist found
in specialized pain clinics.
Studies have repeatedly shown that when prescription opiates are used under close supervision,the risk of addiction in
patients with chronic pain is quite low,around 1 per cent. Keeping the risk of addiction low requires careful evaluation of
a patient before and after starting opiates. When used correctly, opiates should liberate,not stupefy,the patient. If the
use of opiates increases a patient's mobility,mood and motivation to return to activities he/she had abandoned because of
extreme pain,then the drugs should be continued.
To avoid blood levels of opiates,patients often prefer time-release formulations,which decrease the chances of
becoming,overly sedated or high. Opiates are not for everyone and the pain-management specialist will determine who can be
helped. Abuse can occur in any therapy, but no patient should be subjected to high- extreme- pain levels that
normally can not be controlled with conventional therapy. The majority of RA patients will not be candidates for opiates therapy.
Terms such as addiction,misuse,abuse and dependendence have been inconsistently to describe various behaviours,making
interpretation of many research studies difficult. Nonetheless,studies investigating the risk of opiod abuse have been encouraging.
In one study of 12,000 medical patients treated with opiods only 4 patients without a history of substance abuse developed
dependence on the medication.
Dependence,in this article, was defined as a psychological rather than physical dependence involving a subjective sense
of need for a specific, psychoactive substance,either for its positive effects or to avoid negative effects associated with
its abstinence. This now is the approved definition of the American Society of Addiction Medicine for psychological dependence.
Dependence used alone should be reserved for physiological dependence that leads to a sterotyped withdrawal syndrome upon
discontinuation of the medication, particularily in the field of pain medicine.
Other studies of chronic opiod therapy found that all patients who developed problems with opiod use had a prior history
of substance abuse Even when the diagnosis of dependence is suspected in patients taking opiods for chronic pain,maladaptive
behaviors such as stealing or forging prescriptions rarely occur.
In a randomized,double-blind,placebo controlled trial,controlled-release oral opiods were more effective than tricyclic
antidepressants in decreasing the pain of post-herpetic neuralgia. Other studies have documented the presence of opioid receptors
in the peripheral tissues activated by inflammation. These findings suggest a role for opiods in the treatment of chronic
inflammatory diseases such as rheumatoid arthritis and connective tissue disorders.
In a study of patients attending a clinic specializing in pain management,almost 90 % of patients were taking medications.
Opiod analegesics were prescribed to 70 % while antidepressants and benzodiazepines were being taken by only 25 % and 18 %
respectively. In this population,12 % met DSM-111-R criteria(Diagnostic and Statistical Manual-111) for substance abuse or
dependence, however, the misuse and abuse of medications was not limited to just psychoactive substances.
In a review of 24 studies of drug and alcohol dependence in patients with chronic pain,only 7 studies used standard accepted
criteria for dependence and addiction. The prevelence of dependence/addiction in these studies ranged from 3.2-18.9 %. In
a study of chronic low back pain patients,34 % developed a substance disorder,and in all case,history of substance abuse prior
to study entry were found to be at increased risk for recurrence during treatment for chronic pain.
The mechanism of relapse back to substance abuse in these patients is not well understood and probably involves mutiple
factors;however,a cycle of pain followed by relief after taking medications is an example of operant reinforcement of their
future use. Therefore,if the patient has unresolved pain and perceives a lack of commitment to treatment by the physician,they
are at high risk for relapse into substance abuse. The best prevention of relapse comes from aggressive treatment of pain
and close follow-up to monitor the signs of relapse into dependence/addiction.
Opioids offer an appropiate and safe treatment when administered by a pain-specialist for some but not all patients with
non-malignant chronic pain. Experimental research and clinical experience are needed to define those patients most likely
to receive specific benefits from treatment with opiods.
The benefits of treatment are now being documented in controlled trials. Potential risks,including drug abuse and intolerable
side effects seem to be manageable in most cases. Anyone with chronic pain who has failed traditional treatments should be
considered for a trial of chronic long acting opiods. If they have neuropathic pain,then opiods are now worth considering
as a first line choice, especially if the patient cannot tolerate antidepressants or anticonvulsants.
A recommendation approach is to start low and go slow with a willingness to increase the dose until the person becomes
toxic or delirious, complains of intolerable side effects,or gets complete relief from pain. Because patients with chronic
pain suffer many consequences of their illness,any treatment with the potential to improve their symptoms should be prescribed
and the results carefully studied.
Antidepressants: Before the introduction of such antidepressants as Prozac, Paxial and Zoloft and collectively called
selective serotonin reuptake inhibitor (SSRIs), there were tricyclic antidepressants,or TCAs. TCAs increase the body's own
inhibitory (anti-pain) mechanisms that modulate pain. For unknown reasons, having nothing to do with their depression-lifting
properties,tricyclics can be highly effective against headaches and neuropathic pain. Meanwhile,the SSRIs can be useful against
the depression that accompanies pain.
Anticonvulsants: The anticonvulsants were developed to treat seizures. However,in some abnormal pain conditions,the nerve
fibers become hypersensitive and start producing what amounts to mini-seizures,sending waves of pain racing to the pain. Anticonvulsants
especially the latest addition to this class gabapentin,slow down nerve impules. A pain-clinic should be consulted.
Papers:--Are cannabinoids an effective and safe treatment option in the management of pain? *Pain Management Centre,Undercroft,South
Block, Queen's Medical Centre----Another test report and viewpoint:
Objective: To establish whether cannabis is an effective and safe treatment option in the management of pain
Design: Systematic review of randomized controlled trials
Data sources: Electronic databases Medline,Embase,Oxford Pain Database:
Study selection: Trials of cannabis given by route of administration (experimental intervention) with any analgesic
or placebo (control intervention) in patients with acute,chronic non-malignant,or cancer pain. Outcomes examined were
pain intensity,pain relief scores,and adverse effects. Validity of trials was assessed independently with the Oxford scale.
Data extraction: Independent data extraction; discrepancies resolved by consensus.
Data synthesis: 20 randomized controlled trials were identified,11 of which were excluded. Of the 9 included trials (222
patients),5 trials related to cancer pain,2 to chronic non-malignant pain,and 2 to acute postoperative pain. No randomised
controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC)
5-20 mg,an oral synthetic nitrogen analogue of THC 1 mg,and intramuscular levonantradol 1.5-3 mg were about as effective as
codeine 50-120 mg,and oral benzopyranoperidine 2-4 mg was less effective than codiene 60-120 mg and no better than
placebo. Adverse effects,most psychotropic,were common.
Conclusion: Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central
nervous system that limit their use. Their widespread introduction into clinicl practise for pain management is therefore
undesirable. In acute post operative pain they should not be used. Before cannabiods can be considered for treating spasticity
and neuropathic pain,further valid randomized studies are needed.
What is known on this topic: Three quarters of British doctors surveyed in mid 90's wanted cannabis available on prescription
Humans have cannabinoid receptors in the central and peripheral nervous system. In animal testing cannabinoids are analgestic
and reduce signs of neuropathic pain.
The use of opiods for the treatment of non-inflammatory musculoskeletal conditions is more confusing. A randomized double-blind,placebo-controlled
crossover study of oral controlled crossover study of oral controlled release morphine was performed in patients with chronic
regional,soft tissue musculoskeletal pain conditions that were resistant to codiene,NSAIDs and anti-depressants.
Although patients experienced a decrease in pain pain,they did not experience significant psychological or functional
improvement. In contrast,another randomized,placebo-controlled trial in patients with chronic non-maligant pain found that
treatment controlled-release codeine reduced pain as well as pain-related disability.
In July 20,2001 the Narcotics Control Regulations was amended and the Marijuana Medical Access Regulations
act came into force. People who have terminal illness, whose life-span is less than 12 months and for those who have symptoms
associated with certain medical conditions such as M.S., Cancer, Spinal Cord injury,AIDs/HIV infection,Epilepsey seizures
and severe forms of arthritis etc., were allowed to apply for permission to use marijuana for pain relief. The federal government
have built a remote underground farm for the production of the plant. The federal Health Minister has released a press statement
reversing the decision.--8/14/02. The minister said further studies are required,to ensure safety to Canadians.
Acetaminophen is more of a pure anagesic or pain medicine and is not a NSAID. The good thing about it is it can be mixed
with NSAIDs. Mixing of two different NSAIDs is not recommended ,each of them will work less well. So, one can take say Vioxx
or Celebrex (either one but not together) with acetaminophen and get extra pain relief.
If certain patient's don't respond well to the standard NSAIDs,or Cox-2 inhibitors,and if acetaminophen was added to
that,a combinations of acetaminophen with a mild narcotic analgesic such as codiene can be used. Acetaminophen recently,has
been shown by recent tests,regarding high doses--i.e., 2 to 4 grams of it per day,can actually cause bleeding ulcers and stomach
problems at high doses,which is a new finding. It was previously though that acetaminophen was perfectly safe on the stomach.
Many other arthritis drugs,such as MTX may also contribute to stomach problems in some patients. Patients should be aware
of possible habituation with narcotics based medication when they take them. Narcotic can dull the mind and cause constipation,which
may be a problem especially with older patients With all the new drugs available RA patients should not require pain-killing,
dangerous drugs such as the outlawed pain-killer such as OxyContin or opiates-generally,for arthritis pain relief. Tylonol
has mutiple-strength tablets,with the stronger ones having codien-base in them. Tylonol is harder on the stomach vs acetaminophen.Vicondin,Lortab,Larcet
are common drugs that mix with acetaminophen,but the physician should be consulted.
The patient must realize,when they start a NSAID ,that there is a posssible risk of bleeding ulcers and stomach problems.
The Cox-2 type have a small chance that it may raise the blood pressure or affect the kidney. Darvon is a mild analgesic,used
as a additive agent. Patients may mix it with NSAIDs,even Cox-2 type. There are Darvon compounds and Darvon can be mixed with
acetaminophen,either at the pharmacy,or at home by the patient. It's commonly used.
Ultran or tramadol,which is the generic name and now a newer version called Ultracet,approved last August,which is actually
a combination of tramodol or Ultram,or Ultram plus acetaminophen,again has been effective--it is a non-narcotic analgesic
with less constipation problems,less central nervous system problems in older patients who have trouble with their head and
feeling-like thinking work quite well. It can mix with present DMARD and NSAIDs. Either Ultram,or the newer Ultracet is a
helpful agent in pain management.
All these medications work,some of them better than others for different people in different situations. Always consult
the physician before use. But like any medications side effects can occur. ---Dr. M. Schiff ----re:acetaminophen, analgesics.
Chinese proprietary medicine are very popular,and not only in the far east. A rheumatologist comments on a patient he
has who uses them: " I did persuade her to bring me the package she uses,and printed on the side were the ingrediants of each
tablet-a cortisone-like drug,two different NSAIDs (one restricted in Canada ) and a painkiller. Some of these ingrediants
were in laughable low doses,others in doses higher than I would use. Similar preparations obtainable in Hong Kong and presumably
contaminated have been linked to mercury,lead,cadium and arsenic poisoning."
"Periodically,I discover that a patient has obtained some arthritis remedy in Mexico,"he continues. "When these have
been analyzed,they too invariably contained cortisone-like drugs an an NSAID-a combination for high risk"
Herbal remedies have been around for a long time. We need to know more about them. We need to isolate the chemicals unique
to each herb and test them carefully,first in the laboratory and then in the clinic. We need regulation and control like drugs
are treated in this country.
I was told that "thunder god vine" was dangerous and avoid it in a "high profile medical publication".
The article cited bone density and other serious problems in some RA and Lupus patients who had been using them.
It has now been tested in the lab and shown to keep immune cells from turning on the inflammation chain reaction
(it may also have anti-cancer reactions). The leap from the lab is a big one, and manufacturing process is another. Can we
be assured of non contamination,the right dose- purity ? Currently,the answer is no,in the majority of cases. In Germany
they treat herbal products like we treat drugs,w.r.t. regulation.
you have inflammatory arthritis or you're going through a periodic inflammatory phase of osteoarthritis,you're
probably experiencing pain.
Since it usually takes al least two to four weeks before any NSAID begins to reduce inflammation-the source of the pain-patients
will want something that will help in the interim. That's where straighforward analgesics-pain relieving medications,come
in. For minimal to moderate pain,there are a number of over-the-counter formulations;for more severe pain,you may require
In the meantime,chart exactly how much pain you're experiencing. On a sheet of paper,draw a scale from 0 to 10,where
10 is the worst pain you've ever felt or can imagine.,then mark where you feel your present pain is. this allows you to measure
whether you're getting better or worse by giving you a baseline reference point,and it provides your doctor with valuable
information when prescribing your pain medication. If you're in a lot of pain,don't be bashful about asking your physician
for strong medicine.
Once you've established your pain reference point,you can determine whether nonprescription medication will provide enough
relief or whether you need stronger,prescription medication from your doctor. If,for example,your pain level is at 3 or below,try
a nonprescription analgesic,or even a nonmedical approach (such as a ice bag). If the pain persists for more than seventyotwo
hours or worsens,consult your doctor. But you be the judge;everybody experiences pain differently
There are are many nonprescription pain relievers for arthritis-acetaminophen (Tylenol,Panadol,Exdol etc.)
ASA (Aspirin,Entrophe,Anacin etc.) and ibuprofen (Advil,Motrin etc.). They're more or less equally effective and well tolerated,provided
you're not already taking prescription NSAID: ASA and ibuprofen are also anti-inflammatory medications and should't be taken
in addition to a prescription NSAID,because of a slightly higher risk of side effects. If you are taking aan NSAID,acetaminophen
is the preferred choice,because it can be safely combined with a prescrition NSAID for increased pain relief or for headaches
Acetaminophen is safe and effective,but it does have limits. You can take regular-strength tablets (325mg.) every four
hours to a maximum of 12 in a 24-hour period,or extra-strength tablets (500 mg.) every six hours,to a maximum of 8 tablets
in a 24 hour period. Be careful about exceeding those limits,a serious overdose can cause permanent liver damage If you find
yourself repeatedly taking acetaminphen repeatedly than recommended,consult your doctor about a stronger pain medication.
One option is an acetaminophen formulation with codeine,which affects the central nervous system,reducing pain sensivity.
It's most often available in combination with 325 mg. of acetaminophen and 32 mg of caffeine (the caffeine's to combat any
drowsiness the codeine causes). Regardless of the brand,the amount of codiene ranges from 8 mg. per tablet in nonprescription
formulations,such as Tylenol 1,Exdol-8,or Atasol-8,to 15 mg. of codiene in Tylenol 2,Tylenol 3 has 30 mg per tablet (which
requires a prescription.
A common fear about pain relievers is addiction (codiene is a narcotic) even some doctors are wary about prescribing
what some of their patients believe to be essential levels of pain-relieving medication. The important point is that pain
medications only make pain more bearable-they don't treat the underlying cause. Make sure you treat the underlying cause.
Make sure you also seek treatment for the real source of the pain. Certainly analgesics shouldn't be used to mask pain. If
you feel no pain at all from an arthritic joint,you might bbe tempted to overuse it,causing irrepairable damage. Again,the
best approach to controlling pain involves medication with complementary therapies and coping strategies (though if you're
in extreme pain,your doctor can prescribe a limited course of a stronger pain reliever).
Clinical research shows that people who take a narcotic at a appropriate dose for their level of pain are at a very low
risk of becoming addicted. Drug dependency is fuelled by a psychological cravings for the euphoric effects of certain narcotics,such
as the opiates.
Although codeine is a narcotic,when its used solely for pain relief it rarely produces the "highs" that drug users seek-if
anything,it tends to make life seem a little dull and colourless. Furthermore codiene is the weakest of all the narcotic agents
and can be taken for relatively long periods of time without fear of addiction-particularily if you decrease your daily dose
as your pain decreases over time.
Still concerned ? Then ask yourself these questions: If you're not in pain and you don't take the codiene,do you feel
a need for it ? Do you require rapidly increasing does to control the same level of pain ? Do you get "high" when you take
codiene ? Chances are, you answered "no" to all of these questions. If so,relax. You're not addicted to codiene.
The biggest problem with codiene is constipation (because it slows down the digestive tract). The best response is to
increase your fibre and liquid intake You can try Metamucil,a nonabsorbed fibre,which may take a few days or a week to work
but is an effective preventive (not a treatment) for most people. Psyllium,the active ingredient,is also available as Prodiem
Plain,in chocolate mint,some people find it easier to tolerate. N.B. Don't take Metamucil WITH your medications,because they
may pass right through your system with it,losing their effectiveness.
For the most part,stimulant laxatives aren't avisable,because the bowel can become "addicted" to them-i.e., it doesn't
evacuate easily without them Glycerin suppositories are an alternative. Tyhey hydrate the bowel,helping to soften stools.
Mineral oils aren't a good idea. They deplete the body of vitamin A,D,E,and K.
To some extent,everybody who has arthritis is going to suffer pain. How you meet the challenge of pain will in large
part determine not only how well you cope with your illness but how much pain you experience
Different people react differently to pain and illness. Some become paralyzed. They sit at home,don't go out,become more
and more aliented,depressed. Sit around with minimal physical activity. Other people say,'I can't let this pain get to me',and
they go out and do all kinds of things,trying to prove to themselves that they can do it,and finally they crash. We should
try to go the middle course,and utilize our good strategies and minimize our maladaptive strategies.
The first step is learning to understand and accept the pain. Easier said then done. But,only then can we begin to deal
with it,establishing priorities and setting goals-taking resposibility about ourselves. There are skill we can learn that
will help us to maximize our level of everyday functioning,but the first step is helping yourself. We have to be willing to
take a close look at ourselves and our lifestyle and learn to accept our limitations.
In other words,you're going to have to learn to accept that there are certain things you can't do any longer. Activities
that increase your pain will have to be modified or eliminated,and you may have to adopt practices that will maximize your
ability to do the everyday things you have to do to maintain your altered self-image and self-respect.
Painkillers are a partial answer at best;they only mask the pain,and they can cause you harm by allowing you to do things
that cause damage to arthritic joints,activities tht pain would"tell" you to avoid. No one expects someone with chronic pain
to stop taking medications,but there are complements to drug therapy that help people take repossession of their lives.
The pain of arthritis has an insidious side effect. People suffering pain in a joint naturally want to avoid using it.
When they do,the muscles and connective tissues surrounding the joint wither,contract and weaken. Disuse causes the joint
to become progressively unstable and deformed,causing more pain.
This vicious cycle can end in serious incapacitation and can dim prospects for successful joint replacement surgery.
In addition,incapacitation of a knee or hip joint can keep you getting the sort of exercise necessary for good health,
Exercise and various physical therapies have three purposes: to maintain the flexibility,stability,and strength of joint
support structures;to promote overall health;and to prevent obesity or undue weight loss. Because effective physical therapy
must be customized to individual circumstances a physiotherapist's help is preferable,or if that option is not available the
Arthritis Society has books and videos to assist you.
Exercise can help maintain the normal range of motion in joints and enhance strength and endurance. Joint-stabilization
exercises are of proven benefit. Physical therapy can improve physical functioning and limit pain by strengthening and stabilizing
joints. Each patient's circumstances differ, therfore, help is a preference.
Acute,or "fast",pain feels specific,localized,and definable. Most of the pain in arthritis is chronic,or "slow",pain,which
is controlled by the brain's limbic system. The limbic system is the center of emotions and instincts,which is why chronic
pain has a emotional component. People respond to chronic pain in various ways,depending on their personalities. Some rreact
with maladaptive behaviour,becoming sedentary,depressed,dependent on others,always seeking support and too reliant on pain
medications. Arthritic patiens must be aware that chronic pain can have an effect on their emotions.
There are effective means of managing pain without overreliance on drugs. This does not imply any sort of moral or judgemental
attitude toward analgesics. In cases of very serious,intractable pain,narcotics have unsurpassed analgesic effects and will
not cause addiction when used with the guidance of a pain specialist. But such potent drugs are temporary methods of last
Coginitive therapy is a concious effort to change one's attitude, It can be viewed as a sort of self-directed thought
control,capable of changing old ways of thinking and feeling about things,including pain. Cognitive therapy is most effective
when directed and supported by a trained therapist.
Autogenic training is a term that covers all the techniques designed to gain control over one's mental and nerve functions.
Autogenic training includes such techniques as biofeedback,meditation,guided imagery,and progressive muscle relaxation.
These techniquew can produce measurable changes in skin temperature, electrical activity in muscles,and brain waves.
One interesting biofeedback therapy helps patients gain control over tightness and pain through use of electromyograph machine,which
provides readout of electrical activity in muscles.
Relaxation is the original,instinctive form of autogenic training. Among other effects,it produces desirable changes
in brain waves and causes release of endorphins,which are endogenous (internally produced) chemicals with analgesic,mood-lifting
There are many techniques for inducing relaxation,including meditation and biofeedback. It is important to learn to how
to let go of negative thoughts and feelings about pain,which is not the same as adopting a fatalistic attitude. With assistance
from medical personnel,trained in pain management,people can learn to control pain instead of letting it control them.
Family physicians are not trained in pain management,exercise or diet, but have a "working knowledge" about the topics to
assist you if a specialist is not available.