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.
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.
B.
Medical Treatments for Pain
 Acknowledging that treatment for pain is often
inadequate, the U. S. Congress declared the years 20012011 to be the Decade of Pain Control and Research.
 Treatment of acute pain is easier than for chronic pain, but
both present challenges.
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.

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.
 Due to the strength of oxycodone, the doctor can’t 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.
FYI:Oxycontin 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? We’ll 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’.
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.
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.
2.

Surgery
Surgery may be directed either to repairing damage that causes pain
or to altering the nervous system to change pain perception.
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.
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.
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.
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.
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.
II.
Alternative and Complementary Medicine
 When people combine these alternative treatments
with conventional approaches, the term
complementary medicine is appropriate.
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.
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.
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.

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.


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 body’s 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.
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.
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.
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.
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.
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.
A.
Relaxation Training
 Modern uses of relaxation training can be traced to
Edmond Jacobson who developed progressive muscle
relaxation during the 1930s.
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.
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.
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).
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.
1.

What Is Hypnotic Treatment?
Authorities disagree on a definition of hypnotic treatment, but most
recognize its potential for controlling pain and reducing stress.
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 trancelike state. Most authorities agree that hypnosis includes focused
attention and that all hypnosis is self-hypnosis.
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.
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).
C.
Biofeedback
 Biofeedback is the process of providing feedback
information about the status of biological systems.
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.
1.
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
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 Raynaud’s disease,
a disorder involving peripheral vascular constriction.
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).
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.
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 patient’s 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.
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.
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.
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.
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).
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.
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 selfreflection.
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.
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).
