[SOUND] In the previous class, we reviewed the pharmacological treatment of pain, acknowledging that it is a cornerstone in the treatment of pain. Yet many other treatments are frequently employed, mostly for patients with chronic pain. By non-pharmacological treatments, we refer to a wide range of therapies starting from physical therapies, pharmacological interventions, invasive procedures and complementary medicine. Non-pharmacological treatments have to be aimed at specific targets like pain reduction, improved function, better control of anxiety, anger and depression, and even reduced drug consumption. So if a patient with chronic pain is referred to physical therapy, for example, specific goals have to be set. These goals include not only pain reduction but also decreased muscle spasm, improved body mechanics, posture, endurance, and muscle spasm. The same is true for psychological interventions which consist of individual and group therapies, social counseling, relaxation techniques, biofeedback, hypnosis and so on. These interventions can diminish negative feelings of anxiety, anger, helplessness, and enhance positive emotions, improving coping skills, and strengthen social activities and family relationship. A growing emphasis is put on the employment of self-administered physical and psychological. Invasive procedures are directed mainly at pain control. [SOUND] Among them, one can find various types of injections aimed at a trigger points in muscles, ligaments, joints and the spine, as well as nerve blocks. If pain becomes intractable, ablation of nerves is proposed. Various techniques of electrical stimulation of peripheral nerves, the spinal cord and even specific targets in the brain are employed for difficult to treat neuropathic and ischemic pain. Ischemic pain, which we haven't yet touched on, is pain caused by reduced blood flow to specific organs like the heart or other body parts, commonly the legs. So intractable angina pectoris is treated with electrical stimulation of the spinal cord. Implantation of pumps that infuse low doses of opioids, local anesthetics, and other substances directly into the spinal fluid can be useful in a carefully selected group of patients with otherwise unmanageable chronic or cancer pain. Lastly, a huge variety of complimentary techniques are used in pain medicine, although there is little or no scientific evidence, to prove their effectiveness. Mapping out all of these techniques can be confusing, but the two take home messages are that pain treatment is not just about taking more and more drugs. And that doctors specializing in pain should be able to guide patients and help them select the treatments that suit them best.
