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Assessing & Treating Persistent Nonmalignant Pain: An Overview

Management of Persistent Nonmalignant Pain

Cognitive-Behavioral Therapy (continued)

Biofeedback
In biofeedback, the patient is trained to change specific physical parameters to reduce undesirable symptoms. Biofeedback is a noninvasive form of treatment, requiring little effort; however, it does require a trained professional to control monitoring equipment. Sensors or electrodes attached to the patient’s body provide ‘feedback’ measuring skin temperature, muscle tension, and/or brainwave function. With this information, patients learn to make subtle changes, and with practice, new responses and behaviors can help to bring relief and improvement.

Relaxation and Imagery Training
Expert review of relaxation techniques concluded that pain reduction occurs through a decrease in oxygen consumption, a lowering of blood pressure, respiratory rate, and heart rate, an increase in EEG slow brain waves, and possibly reduced awareness of pain.

There are numerous techniques to achieve relaxation.  Some may be utilized by nonspecialists. Some of the common types follow:

1. Breathing patterns that potentiate relaxation.
  • Patient may be instructed to take slow, deep breaths with exhalation lasting longer than inhalation
  • Technique is practiced for 5 to 10 minutes/day
2. Progressive muscle relaxation
  • The patient is instructed to tense and then relax muscles in one region of the body.
  • Patient learns to recognize undesirable tension in the body and relax it.
3. Guided imagery
  • The patient is directed to recall or create a pleasant and relaxing image
  • Patient focuses attention on the sensory details of image (e.g., sensations of light, color, sound, texture)
  • Technique intended to provoke a quick relaxation response and a brief respite from a stressful situation
  • May be used with deep breathing exercises and progressive muscle relaxation.

Hypnotherapy
A more complex technique than relaxation therapies, hypnosis requires specialized training for both the practitioner and patient. Hypnosis assists patients in obtaining deeper levels of relaxation, which often leads to more peaceful sleep, increased energy, and diminished pain. Research has not yet been able to delineate the mechanism underlying hypnosis’ effect, but it appears to be more effective than placebo.21 Analgesia produced through hypnosis requires the patient’s full cooperation, and some patients are more susceptible to hypnosis than others.

 

Last updated: August 2007
Content provided by: Healthcare Education Products & Standards Group