Pain and acupuncture Acupuncture is an ancient Chinese technique that involves insert- ing needles into specific points (acupoints) of the skin. As taught in Chinese medicine, the Vital Energy of the Body, “Qi”, flows along the energy channels, “meridians”. Internal organs intercon- nect via these channels and open to certain dermatological areas of the body. Blocking these energy channels may cause problems in the respective internal organ. To increase or decrease the flow of energy or to unblock the flow of energy, needles are inserted into the acupoints over the particular dermatological area. There are 365 traditional acupoints, but nearly 2,000 acupoints have been discovered within the past few decades. These acu- points are located along 14 meridians: 12 of them represent organs and related structures including: Lungs, Heart, Pericardium, Stom- ach, Small intestine, Large intestine, Liver, Gall Bladder, Spleen, Pain relief by reflexology The American Reflexology Certification Board defines reflexology as “a non-invasive, complementary practice involving thumb and finger techniques to apply alternating pressure to reflexes shown on reflex maps of the body located on the feet, hands, and outer ears [43] .” This ancient Chinese technique alleviates pain and other symptoms in the internal organs of the body. It can be used as a diagnostic method of pathologies of the internal organs. Reflexology also includes the belief of Qi energy. The energy channels of Qi end at the hands, feet, or ears. An internal disease may be discovered by the pain or tenderness in the peripheries.
Kidneys, Bladder, and Triple heater (Thermoregulatory organs). The remaining two meridians, Du (Governor’s vessel) and Ren (Concep- tion vessel), are the midlines of the body. The Ren is the front line, which anteriorly extends from the top of the head to the mouth and from the chin to the base of the trunk . The Du meridian is the back- line, which runs posteriorly and extends from the top of the head, along the vertebral column, to the coccyx level [40] . There are many indications for acupuncture including headache, diabetes mellitus, depression, low back pain, pelvic inflammatory disease, carpal tunnel syndrome, osteoarthritis, Bell’s palsy, post- operative dental pain, neuralgia, sciatica, tinnitus, dizziness, vagi- nitis, tennis elbow, fibromyalgia, myofascial pain, acute pains, and asthma [41][42] . In the same way, some diseases can be treated by applying exter- nal pressure over the zone that defines the particular organ. There is evidence that reflexology is good for relieving pain (e.g., back pain, neck pain, shoulder pain, headaches, toothaches), treat- ing digestive disorders, cardiovascular issues, diabetes, sinusitis, asthma, cancers, and reducing stress and anxiety [44][45] . Reflexology cannot used on patients with foot/hand infections, wounds, heart disease, phlebitis, thromboembolism, disorders of the thyroid gland, recent surgeries, and high risk pregnancies [45] .
MANAGING PAIN IN PSYCHOLOGICAL PERSPECTIVE
As discussed earlier in the course, pain has an emotional/psycho - logical aspect. Therefore, addressing the pain in a psychological perspective is as important as treating the physical pain. Personal beliefs, emotional reactions, and coping strategies can be used to deal with chronic pain [46] . Psychotherapy Psychotherapy is a talking therapy. Usually, psychotherapy deals with people who cannot resolve the problems they have on their own; however, patients who are suffering from acute and chronic pains may also benefit from psychotherapy. Most medically un- identifiable pain or psychosomatic pain is found to be more re- sponsive to this technique. [47] Psychotherapists are specially trained to deal with patients with unresolved pain. When a pain persists for more than 6 months, Cognitive behavioral therapy (CBT) According to the Royal College of Psychiatrists, “CBT is a way of talking about how you think about yourself, the world and other people, and how the things you do affects your thoughts and feel- ings” [48] . This technique helps change the way an individual thinks and acts in certain situations. CBT concentrates on current issues and problems a person has and by finding solutions to improve the present state of mind. References 1. Injury. (n.d.). Retrieved April 27, 2014, from Merriam-Webster Incorporated: http://www. merriam-webster.com/dictionary/injury 2. Knight, K. L. (2008). More Precise Classification of Orthopaedic Injury Types and Treatment Will Improve Patient Care. Journal of Athletic Training, 43 (2), 117–118. 3. Leach, R. E. (2013, September 30). Ligament Sprains. Retrieved April 30, 2014, from NYU Lan- gone Medical Center - Department of Pediatrics: http://pediatrics.med.nyu.edu/conditions- we-treat/conditions/ligament-sprains 4. Mueller-Wohlfahrt, H.W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., et al. (2012, October 18). Terminology and classification of muscle injuries in sport: a consensus statement. British Journal of Sports Medicine , 1-9. 5. Bruise. (2013, April 14). Retrieved April 30, 2014, from U.S. National Library of Medicine - National Institutes of Health: http://www.nlm.nih.gov/medlineplus/ency/article/007213.htm 6. Treating sports injuries. (2010, February). Retrieved April 30, 2014, from Harvard University: http://www.health.harvard.edu/newsletters/treating-sports-injuries 7. Chapter 9: Soft tissue damage and healing - IAAF Medical Manual. (n.d.). Retrieved May 1, 2014, from International Association of Athletics Federations: http://www.iaaf.org/download/ download?filename=abc15012-7233-41f3-9ff2-2480dd2ebdd1.pdf&urlslug=Chapter%20 9%3A%20Soft%20tissue%20damage%20and%20healing 8. Soft Tissue and Limb Fracture Management associated with Road Trauma. (2004, September). A Resource Manual for General Practitioners . Wagga Wagga, New South Wales, Australia: Riverina Division of General Practice and Primary Health Ltd. 9. Swenson, C., Swärd, L., & Karlsson, J. (1996). Cryotherapy in sports medicine. Scandinavian Journal of Medicine & Science in Sports, 6 (4), 193–200. doi: 10.1111/j.1600-0838.1996. tb00090.x
Psychotherapy, cognitive behavioral therapy (CBT), relaxation, mindful meditation, and self-hypnosis are some of the valuable practices that can be used in pain management.
the person feels it as a continuous pain. This pain may not wear off though they are given strong pain medication. In such cases, supportive therapy would help in managing the pain. Support- ive therapy mainly encourages empathy towards the patient. The psychotherapist shares the experiences of the patient and let the patient feel that he/she is not alone. This offers a huge relief and comfort for the patient. A person with chronic pain may find it hard to bear. He or she may get frustrated and become hopeless as the pain increases. These issues can be addressed by CBT. CBT involves self-work. It incorporates tracking one’s own feelings and thoughts related to pain. Also it encourages problem solv- ing approach. Any action to reduce pain may comfort the patient rather than sitting and thinking of pain. A good cognitive behav- ioral therapist must be able to guide the patient towards the tar- get of pain relief through coping mechanisms. 10. Kellett, J. (1986). Acute soft tissue injuries--a review of the literature. Medicine and Science in Sports and Exercise, 18 (5), 489-500. 11. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The Use of Ice in the Treatment of Acute Soft-Tissue Injury - A Systematic Review of Randomized Controlled Trials. The American Jour- nal of Sports Medicine, 32 (1), 251-261. doi:10.1177/0363546503260757 12. Pain. (n.d.). Retrieved May 1, 2014, from Merriam-Webster, Incorporated: http://www.merri- am-webster.com/medical/pain 13. Moayedi, M., & Davis, K. D. (2013, January 1). Theories of pain: from specificity to gate con- trol. Journal of Neurophysiology, 109, 5-12. doi:10.1152/jn.00457.2012 14. Findlater, B. (n.d.). Theories of Pain Perception. Retrieved May 1, 2014, from University of Calgary: http://ucalgary.ca/pip369/mod7/tempain/theories 15. EMERGENCY TRIAGE EDUCATION KIT: TRIAGE QUICK REFERENCE GUIDE. (2013, January 30). Retrieved May 01, 2014, from Australian Government - Department of Health and Age- ing: http://www.health.gov.au/internet/main/publishing.nsf/Content/387970CE723E2BD8C A257BF0001DC49F/$File/Triage%20Quick%20Reference%20Guide.pdf 16. Volochayev, R. (2008, August 11). Pain Management: Acute and Chronic. Retrieved May 2, 2014, from Clinical Center - National Institutes of Health: http://clinicalcenter.nih.gov/ccc/ nursepractitioners/pdfs/pain_management_text.pdf 17. WHO’s cancer pain ladder for adults. (n.d.). Retrieved May 2, 2014, from World Health Orga- nization: http://www.who.int/cancer/palliative/painladder/en/ 18. Painkillers, paracetamol . (2012, June 25). Retrieved May 2, 2014, from NHS Choices: http:// www.nhs.uk/Conditions/Painkillers-paracetamol/Pages/Introduction.aspx 19. Anti-inflammatories, non-steroidal . (2012, June 6). Retrieved May 2, 2014, from NHS Choices: http://www.nhs.uk/Conditions/Anti-inflammatories-non-steroidal/Pages/Introduction.aspx
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