THE PLANNER
WHAT A HEALTH PROVIDER SEES
Acupuncture and acupressure techniques involve the inser-
tion of needles or application of pressure to strategic parts
of the body, which helps to relieve pain in other parts of the
body. The areas stimulated by the techniques share the spi-
nal segments with the area that will ultimately be “treated"
by the procedure.
Biofeedback can sometimes be used to help patients man-
age chronic pain by helping individuals learn to control the
impact of the pain on their daily lives.
Video
Pain M anag em ent
H
ealth providers vary their treatment of pain, depending on
the type of pain being experienced. Most pain can be man-
aged with medications (analgesics), which act at different places
in the somatosensory pathway:
When an injury causes pain, damaged cells or immune cells
release certain products (such as bradykinin, prostaglan-
dins, and histamines) that activate nearby nociceptors.
A n t i - in f l a m m a t o r y a n a lg e s ic s ,
such as aspirin, ibuprofen,
acetaminophen, or naproxen, interfere with the enzymes
that make these products.
A class of neurotransmitters called opioids (such as endor-
phin, dynorphin, and enkephalin) is responsible for synaptic
transmission in CNS pain pathways. At
the synapse,
o p io id a n a lg e s ic s
(such
as morphine, meperidine, oxycodone,
and codeine) bind to the opioid recep-
tors but do not activate them. Health
providers use opioid analgesics to treat
high levels of pain. Opioid analgesics
can become addictive and are easily
overdosed; therefore, health providers
must closely monitor their use.
Pain relievers called
a d ju v a n t a n a lg e s ic s
( c o - a n a lg e s ic s )
are used to treat other
conditions and also help relieve pain.
For example,
a n t i- e p ile p t ic d r u g s
(such
as phenytoin) reduce the ability of CNS
neurons to conduct action potentials.
T ri-
c y c lic a n t id e p r e s s a n t s
(such as amitripty-
line) block synaptic transmission involving the neurotransmit-
ter serotonin.
A n e s t h e t ic s
(such as lidocaine and benzocaine)
block sodium and potassium channels, thereby preventing
propagation of action potentials; most are applied topically or
injected locally to relieve pain.
Other therapies can also be used to manage chronic pain without
the use of medications or in conjunction with smaller doses of
pain medications: •
Physical therapy involves a series of exercises, massage, ther-
mal stimulation, and electrotherapy to release muscle tension
and build muscle strength that can help to relieve pain caused
by pressure on peripheral nerves.
Transcutaneous electric nerve stimulator (TENS)
units produce electrical pulses via the skin to stim-
ulate the release of endorphins and enkephalins
within the CNS. These neurotransmitters help to
block pain signals from reaching the brain.
ThinkCriticallyl
1. M igraine headaches are th ought to involve areas of the
brain where the prim ary neurotransm itter is serotonin. W hich pain m edica-
tion m ight w ork b est for this condition?
2. Je n n y is 10 years old and has a cold. She fell from a step and tw isted her
ankle, and her ankle is b egin n ing to sw ell. Pediatricians do not recom m end
givin g children aspirin as it has been im plicated in a dead ly condition called
Reye's syndrom e. W hat m edication m ight be b est to give Je n n y for the pain?
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