I. Medical Treatments for Stress and Pain

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I. Medical Treatments for Stress and Pain

• Medical treatments for stress and pain are those
  treatments that follow conventional Western
  medicine, but many alternatives exist, which we
  explore in the next section.

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A. Medical Treatments for Stress-Related Disorders

• Stress does not typically warrant medical
  treatment, but treatment for stress-related
  disorders such as PTSD may include drugs such as
  a tranquilizers or antidepressants.

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B. Medical Treatments for Pain

• Acknowledging that treatment for pain is often
  inadequate, the U. S. Congress declared the years
  2001-2011 to be the Decade of Pain Control and
  Research.
• Treatment of acute pain is easier than for
  chronic pain, but both present challenges.

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1. Drugs

• Analgesic drugs are the most common treatment for
  acute pain.
• These drugs fall into two groups opiates and
  non-narcotic analgesics.
• Opiate drugs have powerful analgesic effects but
  also produce tolerance and dependence. However,
  the fear of drug-related problems, such as
  addiction, leads to under-medication more often
  than to drug abuse.
• The recent increase in the use prescription
  analgesic drugs was due mostly for the demand for
  oxycodone and hydrocodone, both of which are
  opiates with a potential for abuse.

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FYI Oxycodone vs Hydrocodone

• Oxycodone and hydrocodone are two highly debated
  drugs often prescribed to relieve extreme pain.
  They are classified as narcotic analgesics. Being
  such, they can lead to some health hazards when
  not used as prescribed. The two are chemically
  similar and they give off almost the same range
  of side effects. But surprisingly, they also have
  lots of differences.
• Hydrocodone is usually prescribed by the doctor
  as a remedy for minor to moderate degrees of pain
  and, at the same time, helps manage coughing.
  Oxycodone, on the other hand, is considered to be
  more potent than the former because it is about 5
  times more effective in pain suppression.
  Therefore, oxycodone is given to patients
  suffering from more severe pain like those
  related to trauma, chronic pain injuries and even
  cancer-related pains.
• Although both hydrocodone and oxycodone have
  preparations that are classified as Schedule II
  narcotics, all other drugs that contain oxycodone
  like Tylox, Percocet and Roxilox are still placed
  under schedule II while the drugs that contain
  hydrocodone are only placed under Schedule III.
  Examples of such are Lortab, Lorcet and Vicodin.
  This means that Oxycodone has a higher potential
  for abuse compared to the former. Usually,
  acetaminophen is the other drug component added
  to the mixture to make the variety of branded
  hydrocodone and oxycodone medications.

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• Due to the strength of oxycodone, the doctor
  cant just do a call in of the drug at the
  pharmacy. There must be a written prescription
  for someone to be able to buy such a controlled
  drug. For the case of hydrocodone, the doctor can
  simply make a call in for the drug to be
  released.
• Lastly, both oxycodone and hydrocodone are
  available in their own generic forms. But it is
  only oxycodone which has a single ingredient
  preparation. This means that all hydrocodone
  medications are in combination with other drug
  components like (as mentioned) acetaminophen.
• With regard to the effectiveness in pain
  management, both can do the job although a lot of
  patients would testify that they were easily
  relieved by using oxycodone.
• Nevertheless, this is a case to case basis as
  some would claim otherwise.

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FYIOxycontin vs Oxycodone

• A number of people wonder if there is a
  difference between oxycontin and oxycodone. Are
  they the same medicines? Is oxycodone just a
  generic name for oxycontin? Well address these
  questions and other differences between the two
• Oxycodone hydrochloride is an opioid painkiller.
  It can be found in a number of prescription
  medications. When it is available by itself, it
  is available in the form of oxycontin. Oxycodone
  is also found in combination with other
  ingredients on a number of prescription
  medications e.g. Percocet.
• The main difference between the two relates to
  the onset of action. Oxycontin is a time released
  drug. This means that it acts over a period of
  time. Usually, oxycodone medications need to be
  taken every four to six hours. However, Oxycontin
  continues acting for at least 12 hours. That is
  why it needs to be taken only twice a day.
• You may come across certain articles that
  categorize oxycodone as a generic name for
  oxycontin because it is the active substance in
  the medication. However, it would be incorrect to
  say that because oxycodone is an active
  ingredient in other medications also. Most
  experts prefer calling oxycontin oxycodone
  extended release.

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Oxycontin vs Oxycodone

• The two medications are prepared in a different
  manner. Though oxycontin contains more of
  oxycodone, it is also prepared in a manner that
  releases the medication gradually into the blood.
  So, even though the dosage is large, it is
  released slowly into the blood stream. Oxycodone
  is often used together with other chemicals in
  other medications like Percocet.
• The dangers of over dosage in oxycontin are more
  pronounced. Since the amount of oxycodone is
  large, lack of a sustained release may have
  severe effects on the patient. This is especially
  true for first time users. The danger becomes
  more apparent in the case of addicts who break
  open the capsule and snort it in.
• A common problem with quick acting painkillers is
  that they become nearly ineffective within a few
  hours. The action peaks within a few minutes, but
  falls within a few hours. Oxycontin aims at doing
  away with this problem by going for a sustained
  release.

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1. Drugs

• Aspirin and the other non-steroidal
  anti-inflammatory drugs (NSAIDs) such as
  ibuprofen and naproxen sodium, as well as
  acetaminophen drugs, are all useful in managing
  minor pain, especially pain due to injury.
• Antidepressant drugs and anti-seizure drugs also
  affect pain perception and may be useful in pain
  management for some people.

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2. Surgery

• Surgery may be directed either to repairing
  damage that causes pain or to altering the
  nervous system to change pain perception.

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2. Surgery

• Surgery is an attempt to control low back pain
  more often than other pain syndromes, and
  specific nerves or the spinal cord may be
  targets.

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2. Surgery

• Surgery may also be used to implant devices to
  stimulate the spinal cord to decrease pain, and a
  related technique is transcutaneous electrical
  nerve stimulation (TENS), which uses electrical
  impulses to stimulate skin stimulation to block
  pain messages.
• Spinal cord stimulation is more effective than
  TENS.

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3. Limitations of Physical Treatment

• Medical treatments are typically the first choice
  for acute pain, but they are less successful with
  chronic pain.
• Opiate drugs, the most effective analgesic drugs,
  have the potential to produce tolerance and
  dependence, making health care professionals
  reluctant to prescribe adequate doses.

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3. Limitations of Physical Treatment

• Surgery is not always effective, either in
  repairing damage or in producing pain relief,
  especially for people with low back pain.

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II. Alternative and Complementary Medicine

• Both the biomedical and biopsychosocial models of
  medicine arose within Western medicine, but other
  cultures hold different views of health and
  disease and alternative treatments.
• Alternative medicine may come from other cultures
  or from practices that are not well accepted by
  conventional practitioners.

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II. Alternative and Complementary Medicine

• When people combine these alternative treatments
  with conventional approaches, the term
  complementary medicine is appropriate.

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II. Alternative and Complementary Medicine

• Treatments that are alternative may become part
  of conventional medicine over time and with
  evidence for their effectiveness. The U. S.
  National Center for Complementary and Alternative
  Medicine is an agency created to prompt
  evaluation of alternative treatments.

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A. Complementary and Alternative Treatments for
Stress and Pain

• A wide range of techniques from complementary and
  alternative medicine (CAM) is available for
  managing stress and pain. These techniques
  include manipulation techniques and
  movement-based therapies.

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A. Complementary and Alternative Treatments for
Stress and Pain

• 1. Manipulation Techniques
• Manipulation techniques include massage,
  chiropractic manipulation, and acupuncture.
• Massage involves manipulation of the soft tissue
  and can be therapeutic for either stress or pain.

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A. Complementary and Alternative Treatments for
Stress and Pain

• Chiropractic manipulation of the spine can be as
  effective as analgesics in controlling back and
  neck pain.
• Acupuncture is an ancient Chinese form of
  analgesia that consists of inserting needles into
  the skin and stimulating or manipulating the
  needles.
• The effects are not due to the placebo effect but
  are rarely sufficient to produce a high degree of
  analgesia. However, acupuncture can be effective
  in helping people with back, neck, or joint pain.
  
• Acupressure is the application of pressure rather
  than needles to the points used in acupuncture.

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• 2. Movement-Based Therapies
• Two movement-based therapies have come from
  traditional Chinese medicine, qi gong and tai chi
  chuan. Both include a set of movements and
  exercises that are intended to balance the bodys
  energy and restore health. Both promote
  relaxation, flexibility, and balance and thus can
  be helpful in managing stress and some types of
  pain such as arthritis pain.

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B. Who Uses Complementary and Alternative
Medicine?

• The prevalence of CAM varies, depending on what
  is included in the definition. When prayers for
  health are included, 63 of people in the U. S.
  used some type of CAM in the year before the
  survey. Excluding prayer, 36 used some CAM
  approach. Most people use these techniques as
  complementary and not as alternative medicine.
  Well-educated Whites are most likely to be users,
  but some immigrants who hold to the traditions of
  their native culture continue with these
  approaches. Women are more likely than men to use
  CAM.

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C. Limitations to Alternative Therapies

• The main limitation to CAM is the sparse research
  on its effectiveness, but that research is
  growing. Research indicates that massage is
  effective for pain and stress, but those benefits
  do not persist beyond the treatment.
• Similarly, chiropractic manipulation may be
  effective for back and neck pain, but the
  effectiveness does not persist once the
  treatments are discontinued.

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C. Limitations to Alternative Therapies

• Acupuncture does not work for everyone, even for
  the conditions for which it is effective for some
  people.
• The movement-based therapies of qi gong and tai
  chi chuan pose few hazards and offer benefits for
  stress but their advantages are not specifically
  established, except for balance in older people.

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D. Integrative Medicine

• The movement toward integrative medicine comes
  from practitioners in both conventional and
  alternative medicine, who propose that an
  integration of these two treatment approaches
  would be beneficial to patients. This type of
  integration faces the challenge of melding very
  different philosophies of treatment but offers
  the promise of benefits from both approaches.
  Some pain clinics and wellness centers attempt
  this goal.

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III. Behavioral Techniques for Managing Stress
and Pain

• Some people classify behavioral techniques as
  alternative treatments, but others consider these
  approaches within conventional medicine because
  of the research support for their effectiveness.

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A. Relaxation Training

• Modern uses of relaxation training can be traced
  to Edmond Jacobson who developed progressive
  muscle relaxation during the 1930s.

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1. What Is Relaxation Training?

• Several forms of relaxation training exist, but
  the ones most frequently used to manage stress
  and pain are (1) progressive muscle relaxation,
  (2) meditative relaxation, (3) mindfulness
  meditation, and (4) guided imagery.
• With progressive muscle relaxation, patients
  learn to relax the entire body, one muscle group
  at a time, and to breathe deeply and exhale
  slowly. Herbert Benson's meditative relaxation
  combines muscle relaxation with a quiet
  environment, a repetitive sound, and a passive
  attitude.

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1. What Is Relaxation Training?

• Mindfulness meditation does not involve a focus
  on any specific thing but permits people to allow
  a flow of thoughts without evaluation or
  censoring and to gain insight into personal
  motivation and thoughts.
• Guided imagery asks patients to imagine a
  peaceful image and to concentrate on that image
  throughout the stressful or painful situation.

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2. How Effective Is Relaxation Training?

• All four approaches have had some success in
  helping patients cope with stress and pain.
• Relaxation is an effective technique for coping
  with stress but probably not sufficient for pain
  management.
• Meditation, mindfulness meditation, and guided
  imagery can be effective for both stress
  management and pain control (see Table 8.2).

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B. Hypnotic Treatment

• Hypnotic treatment can be traced almost to the
  beginning of human history, but modern hypnosis
  is usually traced to Franz Mesmer during the last
  part of the 18th century.

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1. What Is Hypnotic Treatment?

• Authorities disagree on a definition of hypnotic
  treatment, but most recognize its potential for
  controlling pain and reducing stress.

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1. What Is Hypnotic Treatment?

• Joseph Barber and Ernest Hilgard see hypnosis as
  an altered state of consciousness, whereas
  Theodore X. Barber views hypnotizability as a
  generalized trait. Moreover, Hilgard believes
  that induction (being placed in a hypnotic state)
  is central to hypnotic treatment, but Barber
  holds that hypnosis can be effective without the
  trance-like state. Most authorities agree that
  hypnosis includes focused attention and that all
  hypnosis is self-hypnosis.

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2. How Effective Is Hypnotic Treatment?

• Although hypnotic treatment is an important tool
  in the arsenal of the pain therapist, it is not
  effective for every pain or every patient.
• For suggestible subjects, hypnotic treatment
  works better than a placebo and provides high
  levels of relief from a variety of pains,
  especially acute pain.

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2. How Effective Is Hypnotic Treatment?

• However, low suggestible subjects respond no
  better to hypnosis than to a placebo, and
  hypnosis is not very effective for chronic low
  back pain or headaches.
• Hypnosis could be more useful, but its use is
  limited by widespread misunderstandings among the
  general public and among health care
  professionals (see Table 8.3).

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C. Biofeedback

• Biofeedback is the process of providing feedback
  information about the status of biological
  systems.

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1. What Is Biofeedback?

• Biofeedback techniques involve the electronic
  measurement of various biological responses and
  the immediate relaying of that information to the
  person being tested.
• This immediate feedback permits the person to
  alter physiological responses that could not have
  been voluntarily controlled without the feedback.

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1. What Is Biofeedback?

• The two most frequently used biofeedback
  procedures for coping with stress and pain are
  the electromyograph (EMG), which measures
  electrical discharge in muscle fibers, and
  thermal (temperature) biofeedback, which uses a
  thermister to measure skin temperature.
• Raising skin temperature is a goal in treating
  Raynauds disease, a disorder involving
  peripheral vascular constriction.

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2. How Effective Is Biofeedback?

• Because biofeedback requires expensive technology
  and trained personnel, it must be more effective
  than hypnosis and relaxation to warrant its
  expense.
• In general, biofeedback has failed to demonstrate
  this advantage.
• Studies have shown that biofeedback is as
  effective as relaxation or hypnosis, but few
  studies have indicated an advantage for
  biofeedback in controlling any stress or pain
  problem (see Table 8.4).

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D. Cognitive Behavioral Therapy

• Behavior modification techniques are based on the
  principles of operant conditioning and are used
  by health psychologists to help people cope with
  stress and pain.
• The goal of behavior modification is to shape
  behavior, not to alleviate feelings of stress or
  sensations of pain.

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1. How Has Behavior Modification Contributed to
Pain Management?

• People in pain usually communicate their pain to
  others by complaining, moaning, sighing, limping,
  rubbing, grimacing, or missing work, which are
  behaviors that may continue because they receive
  positive reinforcers such as attention, sympathy,
  financial compensation, relief from work, and
  other rewards. Positive reinforcers may create
  pain traps that turn acute pain into chronic
  pain. The rationale behind behavior modification
  is to train people in the pain patients
  environment to discontinue reinforcement for pain
  behaviors, thus avoid the pain trap. Progress is
  measured in terms of observable behavior, such as
  amount of medication, absences from work,
  physical activity, and so forth. Behavior
  modification does not address the cognitions that
  underlie behavior.

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2. How Does Cognitive Therapy Help in Managing
Stress and Pain?

• Cognitive therapy rests on the assumption that a
  change in the interpretation of an event can
  change people's emotional and physiological
  reaction to that event.
• Because pain and stress are at least partially
  due to psychological factors, cognitive therapy
  attempts to get patients to think differently
  about their stress or pain experiences and to
  increase their confidence that they can cope with
  them.

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3. What Is Cognitive Behavioral Therapy?

• Cognitive behavioral therapy aims to develop
  beliefs, thoughts, and skills to make positive
  changes in behavior. Dennis Turk and Donald
  Meichenbaum have developed a cognitive behavioral
  program for pain management, and Meichenbaum and
  Roy Cameron have developed a parallel strategy
  for managing stress called stress inoculation
  training.

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3. What Is Cognitive Behavioral Therapy?

• These inoculation techniques have a similar
  approach and include the same stages (1) a
  re-conceptualization stage in which patients are
  encouraged to think differently about their
  stress or pain experiences, (2) an acquisition
  and rehearsal of skills stage when patients are
  taught relaxation and controlled breathing
  skills, and (3) a follow-through stage in which
  patients apply their coping skills to their daily
  environment.

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4. How Effective Is Cognitive Behavioral Therapy?

• Research has supported the effectiveness of
  inoculation programs for managing stress and for
  managing pain.
• Other types of cognitive behavioral programs have
  demonstrated effectiveness in helping people
  manage a wide variety of problems, including
  rheumatoid arthritis, headache, cancer, AIDS, and
  low back pain (see Table 8. 5).

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E. Emotional Disclosure

• James Pennebaker and his associates have
  demonstrated the therapeutic value of catharsis,
  that is, expressing emotions through talking or
  writing about them.

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1. What Is Emotional Disclosure?

• Emotional disclosure is a therapeutic technique
  whereby people express their strong emotions by
  talking or writing about the traumatic events
  that precipitated those emotions.
• The sessions typically last about 15 to 20
  minutes, three or four times a week. Emotional
  disclosure is different from emotional
  expression, which involves emotional outbursts or
  emotional venting, such as crying, laughing,
  yelling, or throwing objects. Emotional
  disclosure, in contrast, involves the transfer of
  emotions into language and thus requires a
  measure of self-reflection.

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1. What Is Emotional Disclosure?

• In an early study, Pennebaker and colleagues
  asked survivors of the Holocaust to talk for 1 to
  2 hours about their war experiences. Those
  survivors who disclosed the most personally
  traumatic experiences had better subsequent
  health than survivors who expressed less painful
  experiences.

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2. How Effective Is Emotional Disclosure?

• Emotional disclosure has brought about decreased
  distress and improvements in physical conditions
  such as asthma and arthritis.
• When people are urged to find a less negative
  interpretation for their trauma, they benefit
  additionally from the process of emotional
  disclosure (see Table 8.6 for a summary of
  research on emotional disclosure).

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