Pain management a comprehensive review



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Polarity therapy

Polarity therapy is a therapy that believes that the balance and flow of energy within the human body is a foundation of good health. In this therapy, optimal health is attained when the energy systems within the body function naturally and the energy within the body flows smoothly with no blockages or fixations. Polarity therapy asserts that when energy within the body is not correctly balanced, or is blocked or fixed due to certain factors (such as stress), pain and disease are the result [132].

In the typical polarity therapy session, a trained practitioner assesses the energetic attributes present by utilizing such techniques as palpitations, interview, and observation. The polarity therapist works with clients through “energetic touch”, which means: “verbal interaction is energetic communication which has to do with reading the energy in people’s words and staying neutral vs. engaging in the emotions of the patient and verbal interaction” [132]. Energetic contact can be light, medium, or firm. Generally the effects the patient feels during a session are feelings of warmth and tingling. The goal of polarity therapy is to increase the individual’s awareness of the energy flow in the body. While there is no scientific evidence to support the claims that polarity therapy effectively rebalances the body, many individuals like the therapy and utilize it in conjunction with other alternative therapies or with conventional medical treatments.



  1. Acupressure

Acupressure is a “reflex therapy” [133] that is similar to reflexology. Acupressure works with different points on the body to affect problem areas or even entire body systems. However, there are differences between acupressure and reflexology, the most prominent being that while reflexology focuses on the hands, feet, and ears, acupressure practices according to meridians, which are thin energy lines that travel the entire length of the body. Acupressure manipulates the more than 800 points on these meridians in an effort to provide pain relief.

Some individuals confuse practices such as acupressure with massage therapy. However, massage therapy seeks to “work from the outside in” [133] by manipulating certain muscle groups to relieve pain and stress. Conversely, acupressurists view their work as “working from the inside out” [133] by applying pressure to certain points that in turn stimulates the nervous system and releases pain and stress.

Acupressure points are also called “potent points” [134]. These points on the meridians are believed to be places on the skin that are particularly sensitive to bioelectric impulses. When the points are stimulated, endorphins are released and pain is in turn blocked and relieved [135]. Additionally, the flow of oxygen and blood to the target area increases, which allows the muscles to relax. In addition to pain relief, acupressure may help deliver new balance to the body by relieving the tension and stress that is causing it to function irregularly.



Acupressure points along meridians.

Obtained from: www.medicinas-alternativas.net [136]

Emu oil therapy

Emu oil is an oil that contains elevated levels of Omega 3, 6, and 9. Emu oil is also a natural anti-inflammatory and is effective at easing the pain that comes from arthritis, back pain, and sports injuries as well as swelling [137]. Emu devotees utilize emu oil as a rub to relieve pain. Emu oil is considered safe for all ages – from babies to senior citizens – and there are no known side effects of the treatment. There are also no scientifically proven benefits to emu oil treatment either, although emu oil is claimed to relieve a variety of ailments, including: headaches, cough, certain skin or hair conditions, burns, a variety of wounds, muscle problems, joint problems, pain from shingles, itching from insect bites, and arthritis. Given the lack of scientific data on this treatment, emu oil is best utilized in addition to conventional therapies.



  1. Pectin therapy

Pectin therapy, while increasing in popularity, is not a proven remedy for pain management. However, it is popular among athletes in particular to use for aches and pains, particularly the types of aches and pains that accompany arthritis. In fact, in a profile of Bill Weinacht, and 84 year old champion sprinter, Weinacht detailed how he utilized the combination of Certo and grape juice to help him return to competition [138]. However, it is important to note that Weinacht admitted that he does not rely only on this remedy, but also take supplements such as glucosamine and chondroitin.

The source of pectin therapy is unknown, but this therapy has been around since the 1940s. Joe Graeden, who writes The People’s Pharmacy, has indicated that there are a couple recipes that are effective for managing osteoarthritis. The first recipe is a combination of Certo and grape juice, taken three times daily. The second recipe is also a combination of Certo and grape juice; however, it only needs to be taken once daily. Certo is a soluble fiber that is derived from the cell walls of certain fruit, including apples, bananas, grapefruit, and pears.

While there are no scientific studies that show that the combination of Certo and grape juice ease pain, some studies, such as a study done out of the University of Florida [138] have indicated that grapefruit pectin does lower cholesterol levels. Additionally, researchers are interested in pectin as a possible cancer inhibitor, although studies are still in the early stages and have only been done on mice.

Graedon has indicated that the proof for pectin therapy is mostly found through individual experience, and that this remedy does not work for everyone. If it does, pain relief is not immediate; pectin therapy can take up to 2 months to show results.



  1. Aromatherapy

Aromatherapy involves the use of certain sensory experiences to alleviate pain and stress. A variety of scents may be utilized in aromatherapy. There have been some studies done on the effectiveness of aromatherapy. One study [139] conducted on 40 arthritic patients utilized aromas from essential oils lavender, eucalyptus, peppermint, marjoram, and rosemary mixed with carrier oils that where 45% almond oil, 45% apricot oil, and 10% jojoba oil. The study indicated that aromatherapy decreased pain in participants a significant amount as well as had an effect on decreasing symptoms of stress and depression. Researchers concluded that aromatherapy works well at decreasing levels of pain and depression and may be useful for pain intervention.

Aromatherapy is increasingly becoming a complementary treatment for certain pain sensations, including chronic pain sensaitons. This is primarily because even if aromatherapy does not contain ingredients that are known to be pharmacologically active, it does promote relaxation. Relaxation is key to pain relief. Relaxation leads to a lower heart rate, reduced blood pressure, and greater pain threshold. Relaxation also offers the individual a focus other than their pain, which has the potential to lead to pain relief. Therefore, there is merit to the idea of utilizing aromatherapy in conjunction with other, more conventional, treatments.



  1. Homeopathy

Homeopathy is a system of medicine that is based in three main principles [140]:

  • Like cures like. One example of this principle is if you have a cold and the symptoms are similar to mercury poisoning, then you would use mercury as the homeopathic remedy.

  • Minimal dosing. It is important to remember that homeopathic remedies are taken in a very diluted form.

  • Single Remedy. Only one remedy is given regardless of the number of symptoms being experienced, but the remedy will be targeted at alleviating all of those symptoms.

Homeopathy ranks second as the most widely utilized system of medicine across the globe. It has gained in popularity in the U.S. at a rate of 25 – 50% over the last decade. This rise in popularity is influenced by certain factors, including:

  • Homeopathy is considered very effective. Homeopaths believe that when the correct remedy has been administered, improvement will be seen rapidly.

  • Homeopathy is considered safe, with treatment available even to babies or pregnant women. Homeopathy is not considered to interact with conventional medications.

  • Homeopathic remedies are natural and usually based on the use of natural ingredients.

  • Homeopathy is intended to work in harmony with the immune system. This is compared against conventional medication, some of which may suppress the immune system.

  • Homeopathy offers remedies that are not addictive. Further, use of the remedy is only taken until the individual feels relief. If the remedy has not provided relief then the individual is likely taking the incorrect remedy.

  • Homeopathy addresses the root cause of the ailment and treats the cause as opposed to the symptoms.

However, even though homeopathy has its advantages, there are also disadvantages, primarily on the side of the practitioner. Selecting the correct remedy often takes more time than it does when utilizing conventional medication. There are no standard correct remedies or doses, so the practitioner must be precise. Also, there is a huge range of homeopathic remedies, which presents problems for most pharmacies. This makes homeopathic remedies at times difficult to obtain.

  1. Macrobiotic dieting

The term macrobiotics is derived from the Greek, with “macro” meaning great and “bios” meaning life. Macrobiotic dieting is considered a tool that helps individuals live within what is considered the “natural order” [141] of life and effectively adapt to the constantly changing nature of life. Macrobiotics is not generally considered a “diet”; more, it is considered a lifestyle by those who adopt this way of eating and working at their health.

The macrobiotic diet emphasizes eating whole grains and fresh vegetables. It mandates that individuals should generally avoid eating meat, processed foods, or dairy. The goal of macrobiotic dieting is to provide body systems with needed nutrients without loading in toxins that need to be eliminated or stored as fat. There are frequent changes within the body as it adjusts to environmental changes and the aging process, so needs also change as time passes; therefore, the idea of the macrobiotic diet is that it aims to balance the effects of the food eaten with other external or internal influences on the body. In doing this, the body adjusts to changes in a way that is peaceful and controlled.

Those who practice eating macrobiotically believe that all things are made up of yin and yang energy, with yin being energy that moves outward and yang being energy that moves inward. The belief is that though everyone has both types of energy in their body, there is often an excess of one type of energy and a deficit of the other. Macrobiotics therefore believes that in balancing out these energies, the body will run more efficiently and with fewer problems. Further, macrobiotics devotees believe that in balancing the body’s energies, the individual is able to gain some sense of control over what happens in their body as well as freedom from fear over what happens in their body, and can take comfort in the balance.

Devotees of this diet believe that macrobiotics allows the body to effectively heal itself according to the natural order of life. The macrobiotic approach is opposite of the conventional approach. The conventional approach to nutrition mandates that every individual requires certain amounts of protein, carbohydrates, fats, and vitamins and minerals each day. This approach determines these amounts by utilizing statistical averages to apply a blanket recommendation across many people. Conversely, macrobiotics approaches nutrition with the idea that the same thing may not work for every person as well as the thought that personal needs can change from day to day. This therefore means that when using macrobiotics the individual is tasked with determining the type of food that is best suited to them at that current time. Macrobiotics devotees believe that the macrobiotic approach “leads to real freedom” [141] since it requires a shift in thought from a static view of nutrition to a more dynamic, flexible one.



There are several stages to becoming a macrobiotic eater, as most people find it difficult to shift from a diet that emphasizes meat and sugar (the typical American diet) to one that emphasizes grains and vegetables. These stages are:

  • Beginning/Basic stage. This stage is focused on cleaning the body of toxins and easing into the dietary changes. The idea is that in doing this, old excesses and pain are removed from the body. The mind is also clarified, allowing the individual to better use their natural good judgment in what they choose to eat. It is wise for the patient to consult someone well-versed in macrobiotic dieting as they start the regimen, as this type of plan has to be tailored to each individual and their unique circumstances.

  • Intermediate stage. In this stage, individuals learn about the principles of macrobiotics: that there is a “natural order” to all life and that what the individual eats in large part determines who they are and how they feel. Therefore, if an individual lives and eats in such a way that the natural order is maintained then that individual will experience good health and happiness. Conversely, if the individual lives and eats in such a way that is disharmonious, that individual will experience illness that eventually becomes serious illness and imbalance. Individuals in this stage of macrobiotics are urged to study yin and yang and to come to an understanding of what this means for their life and health. The idea is that the more an individual’s understanding of yin and yang is, the more that individual will enjoy life and experience an improvement in overall health on all levels. This increases confidence and leads to a greater positive outlook where life is concerned.

  • Advanced stage. Individuals in the advanced stage will have reached the dietary goals of macrobiotics, which is to eat what they desire without fear. The advanced stage is much different than the beginning stage. In the beginning stage the individual is guided by the rules of macrobiotics as they learn how to eliminate toxins from their diet. The advanced stage is considered a stage of complete freedom wherein the individual has developed such good judgment when it comes to a healthy balance that they don’t have to stop to review the rules or the principles of macrobiotics. Individuals in this stage also search for more tools with which to improve their lives. Devotees of this diet believe that people in the advanced stage are easily recognized by the way they emit happiness, honesty, and a state of complete health.

Macrobiotics claims to have wide-reaching benefits, although these benefits are not hard claims and rather vary from individual to individual. These benefits include:

  • Little to no fatigue

  • Overall better health and relief from ailments and pain, particularly things such as the flu, colds, or cancer.

  • Overall better appetite and an ability to consume food with joy.

  • Better sex drive and satisfaction with sex.

  • Deep sleep on a nightly basis that is free of disturbing dreams as well as an ability to fall into a restful sleep within minutes of getting into bed.

  • Improvement in memory, which in turn leads to an improvement in personal relationships. Also, an improvement in thought process and reasoning.

  • Freedom to live without fear, anger, or suffering.

  • A new ability to view difficult times as positive experiences.

  • The ability to act I ways that are more generous.

  • Greater honesty and a heightened understanding of Oneness (God)

A number of these benefits are generally linked to good health. However, there is not much scientific evidence supporting the idea that a change in eating patterns such as macrobiotics leads to much better health or relief from illnesses and pains. Macrobiotics may, however, be somewhat effective because it focuses on low fat and high fiber food choices, contributing to decreases in blood pressure and cholesterol levels, which may in turn calm individuals and lead to feelings of a more centered, controlled life.

Consultation with a medical professional is essential before beginning a macrobiotics regimen. Those who have serious illnesses are often not suited to this type of diet, although there are those who may benefit. Determining whether an individual will benefit from a macrobiotic diet should be made after a thorough physical examination.



13. Future Therapies

The primary goal of researchers with regards to pain is to develop better treatments to help alleviate or prevent pain more effectively. One important goal as pain medications are developed is to block or interrupt pain signals, particularly when there is no trauma to the tissues. While there is currently no ideal pain medication, researchers are examining the body’s “pain switching center” [1] in an effort to formulate new drugs that will keep pain signals from becoming amplified or even will stop them before they start. There are quite a few areas where research has and is being conducted in efforts to come up with new and more effective pain treatments, including:

Imaging advancements. There are now imaging techniques such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) that provide a vivid picture of what is occurring in the brain as pain is processed. Researchers have discovered that pain activates a minimum of 3 or 4 key areas in the cortex of the brain. Further, researchers have discovered that when patients are hypnotized in order to keep from feeling pain sensations, activity in many of the brain areas is severely reduced. This is one indication that pain involves more than the sensory experience of pain, and that there is an emotional component to pain as well.

Channels. These are gate-like passages that are found along cell membranes that allow for electrically charged ions to pass in to cells. The study of channels leads researchers to explore the development of new classes of pain medication – including medication cocktails – that would work at the site of channel activity to alleviate pain.

Trophic factors. Trophic factors are natural chemical substances that are found within the body that affect the function and survival of cells. These also promote cell death, but there is little that is known about how trophic factors can go from being beneficial to being harmful. Researchers have discovered that the over-accumulation of some trophic factors within the nerve cells in animals result in heightened sensitivity to pain as well as the fact that certain receptors found on cells react and interact to trophic factors. These receptors offer new area of study and a target for a new class of “restorer” [1] drugs.

Plasticity. After an injury, the nervous system experiences a large-scale reorganization, which is referred to as plasticity. Researchers are now able to identify and examine the changes that occur in the body as pain is being processed. One example of this is the use of a technique known as polymerase chain reaction, wherein scientists can research the genes that are induced by an injury or persistent pain. Evidence has been found that proteins that are synthesized by the genes may be good targets for new therapies. Scientists assert that the changes that occur when a person is injured or experiences persistent pain should be thought of as a nervous system disorder, not simply a symptom of the injury. Therefore, scientists have the hope that new therapies that are focused on preventing long-term changes in the nervous system will allow prevention of development of chronic pain.

Neurotransmitters. Researchers believe that gene mutation may have an impact on the number of neurotransmitters that are involved in controlling pain. Researchers are now able to utilize certain imaging techniques to see what is occurring chemically when a person is injured. This is important work because it may offer the opportunity to develop new therapies that would reduce or destroy severe and chronic pain.

Future research on headache relief:

Studies being done or sponsored by the National Institute of Neurological Disorders and Stroke are examining the ways headaches progress and searching for new treatments to relieve the pain of headache or block the headache altogether [25].



A number of factors affect headache and are being researched in an attempt to develop new treatments. These include:

  • A molecular basis for migraine. While researchers currently do not entirely understand migraine headache and aura. There are several studies being done to determine how migraine and migraine with aura affects metabolism and neurophysical function. Researchers are also examining whether or not certain regions in the visual cortex are more susceptible to the events leading up to headache with aura [25]. Results from this research could provide a larger-scale understanding of migraine and help with the development of new migraine treatments.

  • The mast cells that are involved in the inflammation response in headache. Researchers are studying the relationship the cells’ antianalgesic components and the proximity to nociceptors. It has been posited that mast cells may release certain substances that activate nociceptors. Discerning the link mast cells have to the resultant headache pain may help determine drug targets that could in turn lead to the development of new analgesics.

  • Cortical spreading depression, which is the process that occurs in migraine with aura were there is a period of increased activity in the brain followed by a period of decreased activity. There are currently some drugs being tested in clinical trials that inhibit cortical spreading depression to determine the effectiveness of such drugs in treating migraine. Research into these drugs may lead to a greater understanding of how migraine begins and offer an opportunity for the development of new treatment options that would interrupt the process and in turn prevent migraine.

  • The examination of why cutaneous allodynia is present in the head or face in those who suffer from cluster headaches. In researching cutaneous allodynia, researchers are looking to gain a greater understanding of the kinds of neurological changes that occur with cluster headaches. This research may offer a greater understanding of how and why the nervous system changes and experiences heightened sensitivity post-repeated stimulation (which leads to chronic pain) and offer the opportunity for the development of new medications to effectively treat headache pain before it becomes a chronic issue.

  • Certain other social and genetic factors that may make a difference in who gets a migraine and how they experience the pain. Such factors include race, psychiatric conditions, quality of life, ability and willingness to follow a treatment protocol, and response to treatment. These factors are currently being examined in those who suffer migraine, tension headache, headache resulting from substance abuse, and cluster headache. Genetics in particular has been found to predispose individuals for migraine. In general, those who suffer migraine have at least one family member who also experiences migraine. Determining whether or not there is a certain gene responsible for migraine is currently being researched. In one study [25] conducted using 1,675 participants who either suffer from migraine or are close relatives of those who suffer from migraine, findings indicated that there is a link between a gene variant on certain chromosomes and the susceptibility to developing migraine. Another study [25] replicated these findings and indicated that there was in particular a link in females who suffered from migraine. Other factors, such as sleep patterns, were also determined to play a role in migraine development. Researchers found that those older adults who experience migraine are often triggered by changes in sleep patterns. Therefore, it is essential that individuals who are susceptible to migraine maintain a regular sleep pattern.
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