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brief course of treatment will be sufficient to ensure sustained relief. This type of injection is generally used to treat muscle pain in the arms, legs, lower back, and neck and, more recently, it has been used in the treatment of both fibromyalgia and tension headaches.


Botox More commonly known for its aesthetic results, Botox (onabotulinumtoxina) is a toxin that helps to block signals from the nerves to the muscles. Botox is also used in the treatment of chronic migraine headaches. In this case, the patient receives multiple injections around the head and never every three months and may alleviate pain for up to three months.


TENS Transcutaneous electrical nerve stimulation therapy, which is more commonly referred to as TENS, uses electrical stimulation to relieve pain. TENS delivers a low-voltage electrical current through electrodes which are placed on the skin close to the source of the pain. The electricity that is produced through the electrodes stimulates the nerves in the area and sends signals to the brain that ‘scramble’ normal pain signals. The procedure is often used by women during labour.


Bioelectric therapy This type of therapy relieves pain by blocking pain messages to the brain. It also encourages the body to produce chemicals called endorphins (sometimes referred to as the ‘happy hormones’). These chemicals help to decrease or eliminate painful sensations by blocking the message of pain from being delivered to the brain. This therapy is often used to treat both chronic and acute conditions, such as back pain, muscle pain, diabetic neuropathy and headaches.


Bioelectric therapy has been proven to be effective in providing temporary pain control, but is generally used as part of a total pain management programme. When used along with conventional pain-relieving medications, it may allow pain sufferers to reduce their dose of some pain relievers by up to 50 per cent.


Surgical implants On occasions when standard medicines and some forms of physical


therapy have failed to provide adequate pain relief, surgical implants are brought into the pain management process, although this does not happen on a frequent basis.


There are two main types of implants to control pain:


Intrathecal drug delivery Also referred to as infusion pain pumps or spinal drug delivery systems, this type of drug delivery involves a surgeon making a ‘pocket’ under the skin that's large enough to hold a medicine pump. The surgeon will then also insert a catheter, which carries pain medicine from the pump to the intrathecal space around the spinal cord.


These implants then deliver medicines such as morphine or a muscle relaxant directly to the spinal cord. There is no doubt that intrathecal drug delivery can provide significant pain control through a dose that is a fraction of that which would be required with tablets.


Spinal cord stimulation implants In spinal cord stimulation, low-level electrical signals are transmitted to the spinal cord or to specific nerves to block pain signals from reaching the brain.


In this procedure, a device that delivers electrical signals is surgically implanted in the body and a remote control is then used by the patient to turn the current off and on or to adjust the intensity of the signals.


Pain clinics Many people suffering from chronic pain are able to gain some measure of control over it by trying many of the above treatments on their own.


For others, however, there is seemingly no end to their pain. For these patients, pain clinics are often the answer. Pain clinics generally employ a multidisciplinary approach, involving clinicians, psychologists and physical therapists.


The aim of pain clinics is to not only alleviate pain, but to teach the chronic sufferer how to come to terms with pain and function in spite of it. Various studies have shown as much as 50 per cent improvement in pain reduction for chronic pain sufferers after visiting a pain clinic.


Alternative therapies Pain specialists are increasingly recommending a wide range of other non-


medicinal therapies, which have proven to be successful in pain management programmes.


Mind-body therapies These are based on the mind's ability to affect the functions and symptoms of the body. Mind-body therapies use various approaches including relaxation techniques, meditation and hypnosis. Relaxation techniques can also help to alleviate the discomfort that is often related to chronic pain.


Physical therapy Physical therapy helps to relieve pain by using special techniques that improve movement and function in addition to stretching, strengthening, and pain- relieving techniques.


Exercise Exercise is increasingly being advocated as a factor in diminishing pain by improving muscle tone, strength, and flexibility. Regular exercise – such as swimming, cycling, walking and yoga - also release endorphins, the body's natural painkillers.


Psychological treatment Pain – and chronic pain in particular – can lead to low mood and depression. Psychological treatment can provide patients with skills to help them manage their pain and offers safe, non-drug methods that can treat pain directly by reducing the high levels of physiological stress that often aggravate pain.


Chiropractic treatment and massage Chiropractic treatment involves the non-surgical treatment of disorders of the nervous system and/or musculoskeletal system. Generally recommended for back and neck pain, the core of chiropractic usually involves the treatment of common lower back pain conditions through manual therapy:


• Spinal manipulation and manual manipulation: This type of manual manipulation refers to a high-velocity, short lever arm thrust that is applied to abnormal vertebra with the goal of improving functionality, reducing nerve irritability and restoring range of motion in the back.


• Mobilisation: Chiropractic mobilisation refers to low velocity manipulation, movement and stretching of the muscles and joints, with the goal of increasing the range of motion within those areas.


Massage Massage can reduce stress and relieve tension by enhancing blood flow. It is increasingly being used by people suffering from pain, mostly to manage chronic back and neck problems.


SCOTTISH PHARMACIST - 21


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