Management of Persistent Nonmalignant Pain

Physical and Rehabilitative Therapies (continued)

Cutaneous Stimulation (Heat, Cold, and Massage Therapy)
Additional physical therapeutic modalities (e.g., self-administered heat and cold, massage and the use of liniments and other topical agents) may be helpful in some patients experiencing persistent pain. Patients with regional pain, particularly musculoskeletal pain, may find superficial heat or cold (e.g., hot-water baths, ice packs, vapocoolant sprays) brings some relief; hot or cold treatments should not be applied to areas with diminished sensation or in patients who are unable to communicate. Some data suggest that massage therapy can be an effective component of a pain management plan (specifically for relief of persistent low back pain or to reduce the incidence of persistent tension headaches). Therapeutic massage is thought to transiently alter physiological responses and induce relaxation.

Transcutaneous Electrical Nerve Stimulation (TENS)
Some patients report analgesic effects when treated initially with TENS, a neurostimulatory approach in which low electrical current is applied to the skin. Although the evidence continues to be relatively weak,²² there is extensive experience suggesting that TENS can reduce pain in selected patients.