Alternative Chronic Pain Treatments

Those same investigators note that naloxone injections can block pain relief produced by acupuncture. Others have not been able to repeat those findings. Skeptics also cite long-term studies of chronic pain patients that showed no lasting benefit from acupuncture treatments. Current opinion is that more controlled trials are needed to define which pain conditions might be helped by acupuncture and which patients are most likely to benefit.

Local electrical stimulation . Applying brief pulses of electricity to nerve endings under the skin, a procedure called transcutaneous electrical nerve stimulation (TENS), yields excellent pain relief in some chronic pain patients. The stimulation works best when applied to the skin near where the pain is felt and where other sensibilities like touch or pressure have not been damaged. Both the frequency and voltage of the electrical stimulation are important in obtaining pain relief.

Brain stimulation . Another electrical method for controlling pain, especially the widespread and severe pain of advanced cancer, is through surgically implanted electrodes in the brain. The patient determines when and how much stimulation is needed by operating an external transmitter that beams electronic signals to a receiver under the skin that is connected to the electrodes. Stimulation-produced analgesia is a costly procedure that involves the risk of brain surgery. However, patients who have used this technique report that their pain "seems to melt away." The pain relief is also remarkably specific: the other senses remain intact, and there is no mental confusion or cloudiness as with opiate drugs.

Placebo effects . For years doctors have known that a harmless sugar pill or an injection of salt water can make many patients feel better-even after major surgery. The placebo effect, as it is called, has been thought to be due to suggestion, distraction, the patient's optimism that something is being done, or the desire to please the doctor (placebo means "I will please" in Latin).

Later experiments suggested that the placebo effect may be neurochemical, and that people who respond to a placebo for pain relief-a remarkably consistent 35 percent in any experiment using placebos-are able to tap into their brains' endorphin systems. To evaluate it, investigators designed an ingenious experiment. They asked adults scheduled for wisdom teeth removal to volunteer in a pain experiment. Following surgery, some patients were given morphine, some naloxone, and some a placebo. As expected, about a third of those given the placebo reported pain relief. The investigators then gave these people naloxone. All reported a return of pain.