Other medications, such as anticonvulsants, tricyclic antidepressants, and steroids, may also modify the peripheral pain stimulus. Antispasmodics, antiarthritis drugs, and muscle relaxants are given for skeletal and smooth muscle relaxation, which can help decrease the reaction to pain. However, because many clients with chronic pain have comorbid psychiatric and somatic diagnoses, complications with medication management can arise. According to Cicero and Ellis (2017), these comorbidities can influence the progress to a substance use disorder. Chronic pain was two times more Complementary and alternative treatments The National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) funds research on complementary and integrative health interventions. The Center defines complementary as “non-mainstream practice that is used together with conventional medicine,” and alternative as “non-mainstream practice that is used in place of conventional medicine” (NCCIH, 2018). The term integrative medicine involves bringing conventional and complementary approaches together in a coordinated manner. This approach to health and wellness has grown across the United States. Currently, complementary health approaches refer to practices and products that are of nonmainstream origin. Integrative health is the incorporation of the complementary approaches into mainstream health (NCCIH, 2018). Using the National Health Interview Survey 2012 data, 29.6% of adults in the United States reported using at least one form of complementary approaches in the previous 12 months (Yan et al., 2015). When looking at the sociodemographic characteristics of the complementary approach users, Yan et al. (2015) reported that they were more likely to be non-Hispanic White females, living with a spouse or partner in the Western or Midwestern regions of the United States. They were likely to have a least baccalaureate degree with higher personal earnings and greater family spending on health care. The authors also report the top 10 health conditions included back pain, neck pain, joint pain or stiffness, arthritis, muscle or bone pain, cholesterol, anxiety, headaches, stress, and other nonspecified conditions (Yan et al., 2015). Women report that their motivation for using complementary approaches is to improve health and well-being, where men report that they wish to improve athletic or sports performance (Yan et al., 2015). According to NCCIH (2018), natural products, deep breathing, movement techniques (yoga, tai chi, qi gong), chiropractic or osteopathic manipulation, meditation, massage, special diets, homeopathy, and progressive relaxation are the 10 most common complementary health approaches used. Below is a limited list of CAM treatments commonly used in pain management: ● Acupuncture : Though widely used for pain relief, continues to have little evidence supporting the mechanisms of action that produce the analgesic-like effects (Lin et al., 2016). Recently, there is increasing evidence to support the use of acupuncture for pain management (Ning & Lao, 2015). Ning and Lao (2015) found that often there are challenges with the design of studies, most critically with the selection of controls and the design of sham needling. In a systematic review of randomized control trials, Xiang, Cheng, Shen, Xu, and Liu (2017) found low to moderate quality evidence supporting the use of acupuncture for immediate pain relief management is imperative. All involved members of the client’s healthcare team, including occupational therapy practitioners, should be aware of this plan. Ho (2017) describes a plan that promotes “mutual, collaborative, and shared decision making” (p. 34). Without a clear and comprehensive plan, there can be confusion regarding what expectations a client might have for pain management (Geurts et al., 2017). These misunderstandings Pain management barriers The development of a treatment plan that includes pain
likely to be associated with psychiatric diagnoses in a study by Pereira, França, de Paiva, Andrade, and Viana (2017). The diagnoses Pereira et al. (2017) included were mood disorders, anxiety disorders, attention disorders, and substance use disorders. Given multiple diagnoses and medications, medical management of a client’s symptoms requires expert attention. Often healthcare professionals can play a role in helping a client organize and take the appropriate medication at the appropriate times. when compared to sham acupuncture, analgesic injection, or no treatment. One qualitative study shows improvements in quality of life measures resulting from the use of acupuncture (Kligler et al., 2015). Many reported the therapeutic connection between the mind and body and the effects this had on stress reduction, resulting in deep relaxation. Others found it helpful for other conditions (depression, anxiety, and sleep) that were not the primary focus of treatment. When asked specifically about the effectiveness for pain management, participants reported acupuncture to be helpful; however, the relief was only temporary (Kligler et al., 2015). ● Tai chi : A review of the literature identified a number of studies of moderate quality that found tai chi to be more effective than no treatment or treatment as usual for short-term reduction of pain resulting from osteoarthritis, back pain, and headache (Hall et al., 2017). Chenchen et al. (2016) evaluated the effectiveness of tai chi to standard physical therapy treatment for osteoarthritis pain in the knee. Although findings indicate no significant difference between the tai chi and physical therapy treatment in management of pain, the authors do identify a significant improvement in depression symptoms as measured by the Beck Depression Inventory-II scores and the physical components on the 36-item Short Form Health Survey (SF-36). While the number of studies about the effect of tai chi on pain is increasing, there is a need for improved methodology, sample size, and long-term assessment for these studies to provide the evidence necessary to be considered an effective treatment (Hall et al., 2017). ● Yoga : Has been found to provide significantly greater reduction in chronic neck pain and functional disability than no treatment or treatment as usual in a review of the literature by Sang-Dol (2016). In one study, fewer sick days were used by participants with back pain when yoga or strength training were performed at least two times per week, indicating a need for improved follow-through with recommendations for movement-based interventions (Brämberg, Bergström, Jensen, Hagberg, & Kwak, 2017). ● Mindfulness-based stress reduction (MBSR) : A structured 8-week group program originally developed for chronic pain populations, incorporates components such as “sitting meditation, walking meditation, hatha yoga and body scan, a sustained mindfulness practice in which attention is sequentially focused on different parts of the body” (Cramer, Haller, Lauche, & Dobos, 2012, p. 2). There is promising evidence to support the use of MBSR to manage low back pain. Vitoula et al. (2018) completed a review of the literature and found a number of studies with evidence to support the use of MBSR with all clients who present with low back pain. can lead to a distrust by both practitioner and client, potential stigmatization, and often client dissatisfaction (Ho, 2017; Zoëga et al., 2015). The treatment plan contains information regarding the therapies, both pharmacologic and nonpharmacologic. Early development of the treatment plan and goals and regular reviews will provide clear objectives that guide the interventions for the client and the practitioner (Workgroup on the Model
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