The most common treatment for chronic pain is drug therapy. The problem with this is that many of the medications can be addictive. And the addiction can sneak up on you. Before you know it, you might be craving to have this medicine. This has contributed to many problems in the country, one of which is the over-dose deaths from Oxycontin. In my office I use biofeedback and neurofeedback to treat pain conditions, and it has been effective. I will describe some of these methods below. Later I will discuss the drug treatments. Keep in mind that the drug treatments can also be related to cognitive impairments.
Biofeedback has several different modalities: EMG Biofeedback, Heart Rate Variability Biofeedback and EEG Biofeedback. These are the 3 most common modalities. EMG biofeedback (electromyography) is when electrodes are placed on the muscles and the patients learn to control their muscle tension. This is seen on the computer screen in terms of tiny electrical amounts, in terms of microvolts. This level of electricity emitted from the body in a volt divided by one million — a level that the vast majority of people cannot sense. As a person is able look at the computer display and relax their muscle tension, the pain can decrease. It makes sense that if a person can relax their muscles, pain can go down. When this skill is mastered, the patient can control their own physiology and alleviate pain.
Another modality of biofeedback is heart rate variability (HRV). The heart rate varies in beats per minute, from 50 to 120 or so. When the heart rate varies with the respiration, this can calm the whole autonomic nervous system. In my office I have used HRV biofeedback to help reduce tension, anxiety, and to some extent this can also reduce depression. Pain relief is a common result. A graduate student of mine did her dissertation on using HRV to improve executive functions in brain injury patients!
EEG biofeedback, also known as neurofeedback or neurotherapy, can also be used to reduce pain. In many people with chronic pain, after an injury is healed, the pain can persist. It is sometimes found that a certain part of the brain becomes over-excited (the anterior cingulate). By training this area to become normal with neurotherapy, pain can be reduced. Neurotherapy can also help balance the brain so that depression and anxiety are reduced. By reducing anxiety and depression, this can help to reduce the perception of pain.
Brain stimulation, with very small amounts of electrical stimulation (smaller than the amount from your cell pnone), can be used to manage chronic pain. A recent Cochran review (7) of clinical trials concluded that high-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the motor cortex may yield small short-term improvements, although the authors identified potential biases that may have exaggerated these effects. On the other hand, low-frequency rTMS, rTMS of the pre-frontal cortex, cranial electrotherapy stimulation (CES), and transcranial direct current stimulation (tDCS) did not appear to be effective over sham treatments and placebos.
The above treatments of biofeedback, neurofeedback and neurotherapy and electric stimulation are done in Dr. Thomas’ office. Because insurance does not always reimburse for these treatments, Dr. Thomas is paid directly.
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