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Modern strategies for pain
management
RESEARCH PAPER
Ebuka Ibuoka, Varshini Sridhar, Victoria Ijezue, Unyime Ibanga, Emem Abasiekong, Dr. Esther Olunu
Abstract
Pain, as a concept is one of the most congruent human sensations, has the unusual ability to vary across
races, gender, class and from the moment we are born to the moment we die, we are experiencing one
kind of pain or the other. Pain, especially chronic pain, forces our ability to act in standard, coherent
ways to be affected to the point where we no longer function. However, no matter how congruent, the
idea of pain remains an ever-changing field of extensive studies on treating, managing, and
understanding pathways of pain. Pain is as much a part of human history as time, therefore an
understanding of the past, i.e., how pain has been treated historically needs to be juxtaposed with how
management of pain has changed with the rapid scientific advancements the world has seen in the last
two centuries, medically and pharmacologically is what the paper is about. Almost equally as important
are new ideas like using natural remedies involving the cannabis industry and old Asian techniques like
acupuncture, which are fringe but relatively effective management strategies that might change the way
we look at pain forever. Ultimately note that the role of modern pain management strategies depends
significantly on the evidence of their effectiveness in subverting pain and distress, and in improving
quality of life.
Methodology:
Well established and stipulated search criteria is necessary for any good review and on this paper, we
sourced a large amount of data from scientific journals and as much as possible, from the most recently
published papers in the field. We picked the data sources from a variety of pain articles dedicated to
different areas of pain. Reports ranging from treatment of cancer pain to cystic fibrosis were essential to
get a better all-around view of pain management.
Search organization:
The research team conducted searches on multiple broad criteria before being whittled down to the
most centrally relevant articles. These are the search criteria:
1. Year of publication. Majority of the paper focuses on modern strategies. However, there is a
sizeable portion of the research conducted on previous pain management strategies in history.
Therefore, we did not have restrictions on the years of publication beneficial to the study at
hand. On an excellent paper of scientific basis, emphasis must be placed on up to date research
as much as possible to avoid as many errors as one can. Thus, the focus searching through
articles in the last ten years. Mainly articles between 2008 and 2018 were eventually used for
relevance.
2. Source of the article. Even more important than the year of publication is the source of writing.
To keep this paper as relevant as possible, we worked mainly through PubMed and a few other
scholarly journal archives like ScienceDirect and even google scholar while making sure to use
criteria like the year of publication, type of publication and scientific relevance as filters.
Search words:
To keep the paper and themes incongruence, we used specific words and phrases as the backbone of
our online and textbook searches. Specifics are Words like Pain, management strategies for pain,
strategies for managing pain. Pain in different illness and the treatment. While streamlining, phrases like
fringe methods for managing pain, articles on pain and history of pain were also used to fund the
discussions component of this paper to explore the main ideas of this publication fully
To maintain the integrity of this article, we followed strict guidelines.
Introduction :
This paper aims to delve into the idea of pain as a concept and the treatment of pain. In the paragraphs
below, we aim to achieve a comprehensive review of articles and research centered around pain
management, its history and the current needs and processes of understanding the pain and managing
it in acute and chronic patients.
Pain management has advanced incredibly in the past century with the industrialization of many
developed nations and innovations in drug synthesis. It is also important to note how pain was treated
in the past and throughout history. Not only is it pertinent to this discussion to understand how we have
treated pain historically, but it also cuts across how medicine itself has evolved.
Currently, we have a myriad of pain treatment and management options that are always changing as
technology changes. A lot of the management possibilities we have today are still not very efficient,
however, and sometimes the incidence and prevalence of diseases and chronic pain in our society
seems to surpass the reach of technology and medicine. It is then essential to talk about how pain
management can improve in ways that it benefits the most people as much as possible with the most
efficiency, especially without addiction, as has been the case with drugs such as opioids and morphine.
Classification and understanding of pain
Pain is a complicated sensation felt by individuals experiencing damaged tissues at a cellular level
(1,6,7,8,9,10,11).
The cause of pain is usually a damaging stimulus described as nociceptive and through various
complications such as stepping on a nail, experiencing a burn, applying alcohol to a cut, etc.
1,6,7,8,9,10,11
We can typically classify pain as chronic or acute depending on the longevity and the incidence of the
discomfort. Referred pain is a mixture of somatic and visceral nociceptive inputs on the same projection
in the neuron in which the pain does not know the source of the pain (43).
Acute pain, also known as sharp, throbbing, burning and unusual sensations that increase our blood
pressure and heart rate at a specific point in time (1). It rarely lasts for more than six months in duration.
From time to time, individuals
experience acute pain - such as a deep
paper cut, sudden temperature changes
on the skin, toothaches, etc. Acute pain
can be further subcategorized (Figure
1.0).Some patients experiencing severe
pain respond well to medication and are
advised to follow the R.I.C.E. method of
healing comprised of

R-Rest,

I-Ice,

C-Compression, and

E-Elevation (2).
Chronic pain refers to unease caused for weeks, months or even years after an injury lasting anywhere
from three to six months in length (4). Some may experience chronic pain caused by trauma, metabolic
causes, toxicity, pathogenic, autoimmune disease, etc. (43). The unusual feeling arises when the signals
are sent to the nervous system and stimulate the pain receptors in the somatosensory cortex of the
brain (5). This kind of pain affects around 20% of the population and is hugely detrimental to the quality
of life (43).
The signals received from the source of pain go in the form of an electrical signal traveling nerve to
nerve until it reaches the brain and becomes a habit of repeated receptors stimulus (1). The ganglia that
the pain reaches innervates only certain areas of the periphery (43). Within the ascending pathways, we
have categories of spinothalamic, spinoreticulothalamic and spinomesencephalic pathways where each
innervates various responses of the body.
This continuous inducement becomes chronic over time without any initial injury to the affected area
and can range from mild to severe in extent over time. Some people may experience pain as just one of
their many symptoms. However, it is vital to know the etiology to diagnose the issue successfully.
Instances of irritation in the endometrium of the uterus, fibromyalgia, inflammatory bowel disease of
the digestive tract, and temporal-mandibular joint dysfunction of the jaw may be a cause of discomfort
due to previously diagnosed health conditions (2).
There are certain conditions in which discomfort may persist nevertheless due to no known injuries. For
that, we use the term idiopathic. For example, some idiopathic causes of pain include the sense of
feeling fatigued, hungry, trouble sleeping, mood changes, weakness and lethargic.
Figure 1.0-Types of Acute pain
Name
Description
Chest Pain
Sharp to a dull pain
that radiates up the
neck and pierces
through the back and
down one or both
arms. Can be described
as crushing or burning.
Sometimes may involve
the heart or lungs.

Myocardial
Infarction

Heart Attack

Depression

Weakness

Reduced range
of motion
Also known as
reflective pain and is
identified at other
locations other than
the site of stimulus.
Radiation and referred
pain are distinguished
based on movement.
Referred pain is when
the pain is away from
the site of stimulus,
and radiating pain is
when the pain changes
position from the
organ involved.

Hard to focus

Exhaustion

Unfocused

Ischemia due
to Myocardial
Infraction

Stiffness

Soreness

Squeezing
Referred Pain
Effect
REF
(2)
(2)
Anesthesia Dolorosa
Anesthesia blocks pain
in a specific location
can be generalized or
regional in which it
provides a loss of
sensation by reducing
nerve activity until the
procedure (i.e.,
surgery) finishes.

Headaches

Forgetfulness

A sore throat

Confusion
(2)
Figure 1.1- Types of Chronic pain
Name
Description
Muscle Knots
Muscle fibers that stick
together and adhere to
each other, creating a
hard and lumpy feeling
known as a “Knot.”

Myalgia

Dehydration
and Diet

Lifestyle Issues
Loss of energy, with
prolonged weakness

Insomnia

Brain
Inflammation

Infections

Peripheral
Edema

Hot Flashes
Chronic Fatigue
Syndrome
Endometriosis
Uterine lining grows
outside the uterus
Effect
REF
(2)
(2)
(2)
Fibromyalgia
Neuropathic pain
Pain in the bone and
muscles
Damaging the nervous
system

Muscle Tension

Stiffness

Depression

Anxiety

Anger
(2)
(2)
A category of the projections of neurons transmits information into the SCC= location and
intensity. There are the cingulate, and insular cortices via the PBN and amygdala together called the
affective component as well as the ascending pain information links with neurons in the RVM and PAG
collectively known as the descending control systems (43). The mechanisms of pain can be categorized
based on the pathways in which it alters the function of the brain. Nociception can fall under the
characteristics of anatomical and molecular groups ( figure 1.1 added below) (43). Nociception is the
usual response to pain management by the body itself without external factors involved (3). Nociceptors
fall under a subcategory of pain, and they express unique transductory signals and molecules associated
with a stimulus. Its central role is to activate various stimuli ranging from mechanical to thermal,
thermal to
electrical,
innervating the skin, viscera, muscles, joints, and meninges. Peptidergic C is composed of neuropeptides
and TrkA molecules and Non-peptidergic C bind IB4 and express c-Ret, Mrg GPCR’s, and purinergic
receptors including P2X3; additionally, we have a differential expression of channels that are critical for
transducing heat composed of TRPV1, cold composed of TRPM8, acids formed of ASIC’s and chemicals
comprising TRPA1 (43).
In situations where there is neurogenic inflammation, the direction of current passing can be
distinguished by the afferent pathway which is towards the CNS and efferent which is away from the
CNS. Furthermore, the inflammation that occurs at this site is called the axon reflex because it can occur
without contribution from the CNS (43). The two distinguishable fibers that conduct the stimuli are
through C fibers and A-delta fibers along with A-beta fibers. HTM’s include C fibers and AM fibers,
while LTM’s include A-delta fibers and A-beta fibers. The LTM’s also contain Meissner and Merkel cells,
and Pacinian and Ruffini corpuscles and hair follicles which detect texture, vibration, light, and pressure
(43). Alpha-Delta fibers are lightly myelinated and conduct signals at a rapid rate and are sharper in
response to mechanical and thermal stimuli (in particular). C fibers are slow conducting fibers due to
their unmyelinated signal conduction pathway system which consists of proteins in the membrane of
the receptors (4). They are known as polymodal, meaning multiple stimulus modalities are involved;
responding specifically to thermal, chemical and mechanical stimulus. Inflammatory mediators such as
bradykinin, prostaglandins, cytokines, H+, and serotonin are all stimulatory by releasing from damaged
tissue in response to an injury (5). The activation of voltage-gated channels leads to a stimulation of
action potentials to initiate the electrical singling into the nervous system, which then enhances the cells
behavior and types of channels present in the nociceptor to reduce the level of discomfort.
The neuronal arrangement at each synapse in these pathways is essential for processing the
information. Whether it is through convergence in signals from various neurons synapse with a single
neuron or divergence in which there are signals from one neuron
transmitted to others, and that gets amplified. In lateral
inhibition, signals get passed on from one neuron to another to
inhibit the nearby neurons; this enhances contrast. The
transmission of pain is mainly through the change in voltage
across the membrane potential; this then intensifies and
determines the frequency of action potential firing through the
voltage-gated ion channels (43). Sometimes, the ectopic
neuronal activity may occur in which after an injury, there is an
increased expression of sodium channels and a reduction in
potassium channels that generate enough action potentials to
cause spontaneous activity. Also, there may be abnormal
connections where the rewiring of the circuit may contribute to
continuous pain hypersensitivity cause sprouting of sympathetic
neurons in the DRG to cause neuropathic pain (43).
Pain also travels through the central nervous system and passes
through the dorsal grey horn of the spinal cord. The mechanism
is known as the gaiting theory. This process happens by
stimulating the somatosensory input to the projector neurons(6).
There are nerve gates that need to be passed to reach the brain.
What happens is by closing this gate and inhibiting interneurons
which decrease transmission of the nociceptive signals that get
sent to the thalamus, you get diminished pain. Figure 1.2
explains the appropriate scheme in which pain is perceived
and transmitted. As injury persists, the microgliamacrophages of the CNS accumulate and induce various
molecules including cytokines to enhance central
sensitization. For example, CX3CL1 is released and acts on
CX3CR1 on the glia (43). Astrocytes are also activated, and
this is delayed and persists longer in the maintenance of
central sensitization and persistent pain.
According to Sarah Lawson, the author of
Fundamentals of nursing: Factors affecting individualized
responses to pain. Woman have a lower pain threshold
compared to men who have a much higher distinguishable
range of pain thresholds which directly relates to lifestyle
including their daily diet, age, gender, and physical factors.
(7) Pain sensations and elements are what distinguishes
how different people respond to different kinds of pain.
For example, an adolescents’ pain tolerance may be high in
comparison to an elderly aged 65+ overcoming the same
stimulus of psychogenic pain (i.e., a headache). An athletic, trained individual compared to an obese
individual sensing nociceptive pain such as falling off a chair will have different responses (8).
When a patient complains that they have pain, that is subjective. However, if while an attending
physician is examining the patient and then the patient complains of pain, that is said to be objective.
Pain management is a method of appointing an interdisciplinary approach to revealing the illness and
improving the quality of life using various strategies. In previous decades, one of the main complaints of
returning patients was that they faced difficulties managing pain, but in recent studies, there is evidence
that one can better manage pain through by various methods (12, 13, 14, 15)
Addressing the treatment of pain
The American Board of Pain Medicine(2011) states that you can treat pain in several ways including
evaluations, rehabilitation processes, comprehensive care, and physician aid. For many individuals, pain
can be a disease, a symptom or as both. For a physician to treat a patient’s discomfort, there must be
effective pain management techniques, patient-centered communication, and education. Furthermore,
Methods to manage and address pain vary from psychological to physical to the chemical. The role of
psychosocial interventions in the management of patients is concerned with pain assessment scales and
non-verbal cues. These can be used to help those who are unable to report their pain sensations (40).
Also, communication with close family and caregivers could potentially be an avenue for pain reporting.
Psychiatrists are encouraged to request patients to provide self- reports of pain as they are the most
reliable pain indicator. Also, during the patient’s report, questions relating to their symptoms will allow
patients to relay communication to the doctor so that the treatment plan can go along with the best
conclusion of their diagnosis. Listening to the patient’s feelings and analyzing their stories allows the
Doctor or psychologist to educate the patient, guiding them to a more educated decision towards taking
the next step in their pain management. Also, note that increasing K channel activity could potentially
treat persistent pain. However, besides treating pain by a psychological means, patients have often
prescribed drugs as a method of treatment(40).
Beneficial psychological approaches to managing pain include treatments that increase selfmanagement, changes in behavior and cognitive changes rather than directly elimination of pain at a
locus. Psychologists can also try to alleviate pain symptoms in patients by increasing pain-coping
resources and reducing emotional distress. Through the implementation of non-chemical steps like the
above, psychologists can effectively help patients feel more in control enabling them to live a normal life
despite their pain as well as ensure that they become more active in the management of their illness in
a way they can employ throughout their lives (41). In contrast, some drugs that doctors prescribe could
potentially cause brain damage leading to maladaptive behavior as an effect of the medication that may
interfere with normal physiology. (42)
History of pain management
The phenomenon of pain and its understanding was affected by culture and infringed on the methods
used in its control (31). Before the introduction of anesthesia (a sedative ether gas) in 1846, surgeons
used to take pride in operating within a limited time to minimize patients' agony (32). The use of
anesthesia was opposed by some medical factions, especially among doctors who were not enthusiastic
about a sedative which could render a patient unconscious during a procedure — Doctors who were
worried about operating considered this a source of considerable debate.
By the 19th century, Doctors began using opiates (opium) in the treatment of acute and chronic
conditions such as Injury related pain, headache, toothache, gastric pain, dysentery, diarrhea, and
smallpox.
In 1840, morphine, a derivative of opium, was industrially manufactured in Germany by Friedrich
Serturner (33). It changed the pain treatment landscape, and the use of morphine became global with
the invention of hypodermic needles (34). Morphine administered subcutaneously was believed to be
void of the side effects accrued with oral opiate consumption. However, the absence of morphine
regulation and the presence of hypodermic needles led to its overuse and abuse. By the 1870s,
physicians had witnessed the effects of opium abuse on the physical and mental wellbeing of individuals
(35).
Following morphine addiction, diacetylated-morphine was manufactured to help in pain management.
After studies of its effect on different animal groups, there was a realization that diacetyl-morphine was
more effective in the treatment of respiratory complications such as a cough and less effective in pain
management. Diacetyl-morphine under the registered name heroin was believed to be less addictive
than codeine and became a morphine substitute. Just like morphine, heroin became a drug of abuse but
was even more potent. With the innovative means of pill-crushing (breaking down of tablets into half
size or powder), people could sniff or smoke Heroin. Heroin abuse led to strict government regulations
in the USA promoting the limited production of heroin and guiding against illegal production of opium,
morphine, cocaine and other substances (31,35,36). Due to scientific progress made, a various
semisynthetic and synthetic derivative of morphine and codeine such as hydromorphone,
dihydrocodeine, hydrocodone, oxymorphone became new opioid analgesics (38). By 1953, production
started on fentanyl, a drug 40 times more active than morphine in relieving pain. The understanding of
the pharmacokinetics and dynamics of Fentanyl led to the manufacture of more potent analgesics such
as carfentanil, sufentanil, alfentanil (39)
In the 19th and 20th century, scientists began synthesizing non-opioid drugs from the bark of willow
trees. The drugs like aspirin (NSAIDs) are antiphlogistic (capable of reducing inflammation), antipyretic
(reducing fever) and analgesic (Pain relief). Also, Other NSAIDs, there was the introduction of drugs such
as indomethacin and ibuprofen for the treatment of rheumatoid arthritis and pain.
MODERN STRATEGIES FOR THE MANAGEMENT OF PAIN
Central sensitization is a mechanism of the nervous system that deals with and is concerned with
chronic pain and how it progresses and is managed over time (30). Once activated the nervous system
goes to a state of high reactivity where it lowers the threshold for pain (30). This mechanism has a very
crucial part to play in post-surgical and post-traumatic pain. Central sensitization has two types:
allodynia and hyperalgesia (25,30). In allodynia, the patient experiences pain to harmless stimuli like
massage or a simple touch on the skin that they usually won't feel pain to (30). This feeling is due to the
heightened sensitivity of the nervous system and release of specific sensitizers like PGEs, leukotrienes,
bradykinin, etc. (25). Hyperalgesia, however, has to do with increased response to pain, things that may
typically cause pain like a nail prick, these patients feel this pain a lot worse. Primary hyperalgesia is due
to the response from peripheral pain receptors while secondary hyperalgesia is due to the reaction of
the spinal cord and CNS (25,30). Neurokinin receptor (NK1) and cyclooxygenase-2 (COX 2) have to do
with central sensitization (25). Understanding this mechanism of pain has led to the establishment of
multimodal analgesia and new pharmaceutical products to treat pain (25).
Two significant advances are the development of extended-release epidural morphine (EREM) and
iontophoretic transdermal fentanyl. EREM makes use of a system known as DepoDur to provide longerlasting pain relief within 48hrs after initial dosage (25). This technology combines extended analgesia
with epidural morphine and is administered epidurally at the lumbar region. It yields lesser side effects
of nausea, vomiting, sedation, constipation, enhances pain relief and provides extended analgesia even
in the absence of opioids and enhances patients' activity levels. It is in use in knee surgeries, and
cesarean operations and various studies have shown that it yields longer and extended pain relief.
Common side effects that can arise from the administration of EREM are pruritis (or severe itching) and
respiratory depression seen in about 12% of patients, which opioid antagonists treat. Note that the
elderly are more susceptible to these side effects and should be monitored closely upon administration
(25).
Fentanyl iontophoretic transdermal system is the new patient-controlled analgesia (PCA) that uses
iontophoretic technology to administer fentanyl across the skin and into the systemic circulation by
applying a low-intensity electric field (25,29). It has been approved for use to treat acute, moderate to
severe postoperative pain in the USA and Europe (29). Unlike other PCAs which have provided
limitations like programming errors, reduced patient's mobility due to pumps, lines, and tubing, fentanyl
it gives the patient the opportunity to administer pre-programmed doses of fentanyl non-invasively to
themselves using iontophoretic technology and its method of delivery prevents risks of complications,
programming errors and overdose (25,29). Its effectiveness has been demonstrated to be like morphine
IV-PCA producing similar side effects as IV opioid administration. These side effects include nausea
(most common, affecting about 26-67% of patients), vomiting, pruritis, headache, and dizziness. Skin
hypersensitivity, skin redness and hyperpigmentation like other transdermal systems are possible
problems that can occur. The system has not been thoroughly studied and understood in children and
should be used cautiously in patients with severe hepatic dysfunction, head injuries, sleep apnea,
imminent respiratory failure and increased intracranial pressure of any cause (25).
Other pharmacological products that are in development for the management of pain are:
1. Analgesic adjuvants: adjuvants are being developed for the management of postoperative pain
to prevent unfavorable side effects of opioid analgesics which delay recovery. Although when
administered separately, it is not as effective when mixed with opioids, it provides better pain
relief with less unfavorable side effects (25).
2. Capsaicin: and several related compounds called capsaicinoids is an analgesic found in seeds and
stem of chili peppers that acts on TRPV-1 as an agonist (25). TRPV-1, transient receptorpotential cation-channel subfamily V member 1’ receptors are present in nociceptive neurons of
the peripheral nervous system, on unmyelinated C fibers and are involved in the transmission
and modulation of pain. Capsaicin as a TRPV-1 agonist acts to activate TRPV-1 to release
substance p which produces the initial feeling of “burning.” Subsequent activation of TRPV-1
with the prolonged discharge of substance p in the presence of capsaicin results in the
exhaustion of available capsaicin and an eventual reduction in activation of the c fibers. You can
administer capsaicin topically or intravenously, and it acts peripherally. Topical capsaicin can be
applied in combination with narcotic analgesics and NSAIDs to provide relief for back pain,
arthritic joint aches, sprains, and strains and can be an adjuvant for the elderly (25). IV capsaicin
is used to manage postoperative pain. It is important to note that capsaicin is inadvisable to use
in patients age less than 2, with elevated liver enzymes, those on ACEI and patients with signs of
joint infections and septic arthritis.
3. Ketamine: This is an NMDA antagonist used in low doses in the clinic as an analgesic in the
control of pain before, during and after surgery. It is usually injected into the muscle or given
through IV, and it provides relaxation and pain relief. Its use is currently in restriction due to the
adverse side effects associated with its use. Common side effects include hallucinations,
dizziness, blurred vision, nausea, and vomiting. It can produce feelings of dissociation when
abused.
4. Gabapentin and Pregabalin: Gabapentin has been shown to be useful in diabetic neuropathy,
post-herpetic neuralgia, and neuropathic pain. Its analog pregabalin is also an anesthetic and
sedative. Studies are still ongoing for their use as multimodal analgesia. Their opioid-sparing
effect has shown to be helpful in the management of acute and postoperative pain (25).
Other pharmacological products recently in use for the management of pain are local anesthetics,
Dexmedetomidine, and tapentadol. Attention is also coming back to other pharmacological methods
which were previously in use like NSAIDs, coxibs, and acetaminophen (25). Development of newer
surgical techniques with less invasive methods like arthroscopic surgery, eye surgery, laparoscopic
cholecystectomy, sterilization procedures has also helped to minimize postoperative pain and
complications and reduce the length of hospital stay and recovery time (26).
Apart from pharmacological therapies, there is also increasing awareness of nonpharmacological
methods like acupuncture, herbs, magnets, hypnosis which can yield maximum pain relief with lesser
side effects and future complications (25,27).
Fringe approach to pain management
Music
Music and other fringe pain management tools are used to change the perception of pain in patients.
Music does not stop the pain; rather, music could modify how a patient feels. Most notably according to
Bernatzky on “Emotional foundations of music as a non-pharmacological pain management tool in
modern medicine” patients have reported during the stress of surgery, that music stimulation reduces
the way they feel pain. It can be a stand-alone method or included in a multimodal pain management
program, Ultimately music and other fringe methods for pain management reduce the need for
pharmaceutics which has major side effects and can be detrimental in the same vein that they are
helpful. (16,19,20)
Psychological interventions
Psychological interventions are a new but very useful tool of modern pain management practice and an
endorsed feature of current pain treatment service. The evidence for effectiveness is most significant for
cognitive behavioral therapy (CBT) with an emphasis on cognitive coping strategies and behavioral
rehearsal. It is possible to cause changes in pain, mood, and disability by this type of treatment.
However, the overall results of procedures using CBT for adults, across all trials, have been modest so it
is still new to most people and further research needs to be performed(17,20).
CBT
Cognitive behavioral therapy has been proven to be effective in reducing pain immediately after
treatment compared with doing nothing, but the effect is minimal in the grand scheme. That is, Behavior
therapy has no real objective impact on pain. However, CBT has been found to be effective in reducing
disability or at least the perception of immediately after treatment, even without long-term results. (17).
Overall, the findings for behavioral therapies are promising. And can lead to positive changes in the
future
Cannabinoids
Cannabinoids for cancer pain are relatively new, and there is growing excitement among the
public, especially for patients who have used, or experienced cannabis-induced pain relief. However, the
term “medical marijuana” can be confusing. It encompasses endogenous cannabinoids, plant-derived
cannabinoids—such as tetrahydrocannabinol (THC) and cannabidiol (CBD)—and synthetic cannabinoids:
nabilone and dronabinol. There is a huge difference between THC and CBD, and although the latter is
not concerned with hallucinations or the high induction capabilities of THC, it has not been studied well
enough or long enough to be fully confirmed as a beneficial treatment possibility for chronic pain,
especially cancer pain. (21,22)
Acupuncture
Many cancer centers offer acupuncture as part of their services. At this time, a comprehensive
systematic review of acupuncture in cancer care has not occurred. However, a few studies have been
conducted, albeit on small groups of people. (18)
The studies include people with pain involving symptoms like nausea, hot flashes, fatigue, radiationinduced xerostomia, prolonged postoperative ileus, anxiety/ mood disorders, and sleep disturbance.
About half of the trials resolved with positive results, but the other half had little to no observable,
gradable change in pain.
Conclusion: Acupuncture is a good alternative treatment for chemotherapy-induced nausea/vomiting
and pain, but further research and studies are required. For many other symptoms or types of pain of
the chronic or acute kind, the efficiency of acupuncture as a treatment method remains unknown due to
the lack of current objective understanding of the field. Future research should focus on standardizing
comparison groups and treatment methods, should be at least single-blinded, compare to biologic
mechanisms, increase or level statistical power, and should use multiple acupuncturists. (18,23,24)
Acknowledgments
All Saints University school of medicine
Dr. Esther Olunu (Research Professor, Professor of Embryology and Microbiology, All Saints University
School of Medicine, Dominica)
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