Treatment of Pain and Inflammation
Techniques used to treat pain and inflammation include heat therapy, cold therapy, electrical stimulation, traction, massage, and acupuncture. Whether to use heat or cold therapy is often a personal choice, although cold therapy seems to be more effective for acute pain.
Heat Therapy: Heat increases blood flow and the manipulability of connective tissue. It decreases joint stiffness, pain, and muscle spasms. Heat also helps lessen inflammation and the buildup of fluid in tissues (edema). Heat therapy is used for inflammation and acute and chronic injuries, such as sprains, strains, muscle spasm, back pain, whiplash, and various forms of arthritis. The application of heat may be superficial or deep. Hot packs, infrared heat, paraffin (heated wax) baths, and hydrotherapy (agitated warm water) provide superficial heat. Diathermy (the generation of heat in tissues by electric currents) and ultrasound (the use of high-frequency sound waves) provide deep heat.
Cold Therapy (Cryotherapy): Application of cold may help relieve muscle spasms, acute low back pain, and acute inflammation. Cold may be applied using an ice bag, a cold pack, or fluids (such as ethyl chloride) that cool by evaporation. The spread of cold on the skin depends on the skin's thickness, the thickness of underlying fat and muscle, the water content of the tissue, and the rate of blood flow. The therapist takes care to avoid tissue damage and abnormally low body temperature (hypothermia).
Electrical Stimulation: Muscles that lack proper nerve function can be stimulated electrically to help prevent muscle wasting (atrophy) and spasticity. People with one-sided paralysis (such as after a stroke), those with peripheral nerve injuries, or those who have lost use of their legs (paraplegic) or of all four limbs (quadriplegic) after a traumatic injury may benefit from electrical stimulation in which electrodes are placed on the skin. For people with chronic back pain, rheumatoid arthritis, a sprained ankle, shingles, or a localized area of pain, a type of electrical stimulation that uses low current, called transcutaneous electrical nerve stimulation (TENS), may be helpful. TENS may be applied several times a day for 20 minutes to several hours, depending on the severity of the pain. The TENS device produces a tingling sensation without increasing muscle tension. Often, people can be taught to use the TENS device at home as needed. Most people tolerate the therapy well, but its effectiveness varies greatly.
Traction: Spinal traction is used to overcome muscle spasm and to keep bones aligned while fractures heal. A weight-and-pulley system, the patient's weight, or manual or motorized force may be used. Cervical traction is used for chronic neck pain.
Massage: Massage may relieve pain, reduce swelling, and help mobilize contracted tissues. Massage may help people with low back pain, arthritis, bursitis, neuritis, fibrositis, multiple sclerosis, cerebral palsy, or various degrees of paralysis.
Acupuncture: With acupuncture, thin needles are inserted through the skin at specific body sites, often far from the site of pain. The needles are twirled rapidly and intermittently for a few minutes, or a low electric current is applied through the needles. It is believed that acupuncture stimulates the production of endorphins (chemicals with analgesic properties that are found naturally in the brain), thus generating pain-relieving and anti-inflammatory effects (see Section 25, Chapter 302).
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