Pain

Every human will experience pain. It is inevitable. Pain is a miracle. People who have a limited capacity to experience pain (and they may seem on first thought blessed by this) die young. The lack of pain signal feedback is like driving in the dark without headlights.

Pain is a normal part of being human

Pain is a like a dashboard light in our cars (bodies). If we disable the sensor light, and the problem continues – for example if we are running low on oil – it will damage the engine. I know we don’t want to have any problems at all. No “pain” ever. We would rather the light would go off on its own, so we don’t have to get off the highway and add more oil. Worse yet, it may expose a leak or another big problem that will cost a lot more than just adding oil with the inconvenience of a short interruption of our trip. But … life is like that. Everything, our bodies and our material possessions, will eventually break down somehow. We will have to throw them away and replace them or repair them to enjoy them another day.  If we hear the pain signal early enough, the “cost” of repair may be a lot less. If we don’t hear the whispers, we will eventually not be able to ignore the shouts.

Pain is a signal from our nervous system that something is wrong. Acute pain – e.g., an inflamed and rupturing appendix – is a savior. How would you know you stepped on a nail and better clean and take care of the wound before gangrene sets in, otherwise? No, we need – maybe not really want – our ability to feel pain. We don’t want bumps in the road. They are inevitable. That is life! We need to learn to deal with it right.

There are basically two classes of pain: ute pain and chronic pain. Acute pain is extremely important to our survival – and we should never allow that ability to go away. Chronic pain, once we have identified what is wrong, becomes its own problem, on top of the underlying cause. Getting properly rid of the underlying cause is the right approach, not just treating the chronic pain symptom. Too often treatment is only targeted at relieving the symptom. The treatment then becomes another burden on the body.

Pain is transmitted by very tiny nerve fibers in our skin, blood vessels and muscles, to even larger nerves themselves moving up the extremities to the largest nerves in our spinal cords and brains. There are myriads of different types of nerve fibers all over our bodies. Pressure cells, temperature cells, touch cells, chemically sensitive cells, cells sensitive to electromagnetic stimulation, and so forth. Once a nerve is irritated, it is more and more excitable, with a less and less strong stimulus. Eventually, it becomes overwhelmed and may not be as sensitive anymore. That is, it becomes numb.

In any event, pain is a complex subject. We only want to suppress pain when we know what’s wrong and either have a solution to remove the cause or know that it cannot be cured. You can read more about pain in these resources:”Pain: Clinical Manual” by Margo Mcaffrey or “Pain” by Patrick D. Wall.

Magnetic fields can be helpful with all kinds of pain problems, acute and chronic. Because magnetic fields can be so helpful, even for acute problems, they should never be used without knowing what is causing the pain. For example, the pain of a rupturing appendix may be made better by magnetic therapy, but the appendix may rupture anyway. A rupturing or ruptured appendix is a medical emergency and needs appropriate medical management immediately. While it’s possible that magnetic therapy may stop an inflamed appendix from rupturing, I wouldn’t stake my life on it. It would work best with an early inflammation of the appendix but most appendicitis comes to attention when it is already fairly far along. In this case, magnetic therapy is useful after the crisis is handled, to aid with the recovery after surgery and the pain, inflammation and need for repair that comes after that. That’s only one possible example of  the many things that can go wrong in the belly. The same principles apply to all possible abdominal problems.

However, the chronic abdominal pain of someone suffering from Crohn’s Disease, irritable bowel syndrome (IBS), ulcerative colitis, etc, can be very well relieved by magnetic fields – and along with it the inflammation present in the abdomen. Even here, conventional medical care may still be needed. Since conventional care in these kinds of chronic conditions is not curative of the basic condition, and only may be only half the treatment, the other half will come from complementary treatments like magnetic fields.

How badly are the pain fibers or nerves damaged?
There is a range of sensations generated by the same nerves – from an itch to an intense stinging, lancing or even burning pain, even from weak nerve stimulation. Eventually any nerve-conducted sensation can become bothersome and perceived as pain. All nerve conducted sensations, even the pathologic absence of pain, can be helped by using magnetic fields. Irritated or damaged nerves give off pain signals. However, magnetic fields probably won’t make a dead nerve function again. But nerves may look like they are dead but may just be bruised or swollen. Bruised or swollen nerves stand a chance to recover and magnetic fields can be very helpful here. Even if a nerve is severely damaged, magnetic fields have been found to help nerves regrow, or sprout new nerve endings. We just don’t really know what the limits of nerve treatment are at this point, even for the brain.

How is pain typically treated?
You and your doctor must work together to treat your pain. Treatment should help ease your symptoms and not create new problems for you. Improving sleep and stress are key to reducing your pain. Good nutrition is foundational. Exercise often helps, unless movement it makes it worse. Support groups or behavioral therapy or counseling may be needed too.

Pain medicine is good and bad. It can certainly help to relieve pain. Short term courses – several days to several weeks may be necessary. Long term use of any pain medication carries risks, even Tylenol. These risks need to be understood. Besides causing heart, liver, stomach and bowel and kidney problems, they can also often reduce the ability of the immune system to function. Almost always, pain medicines only treat the symptom. Reduction of pain can certainly reduce the secondary problems caused by the pain itself, such as depression, insomnia and anxiety. Clearly, potential problems caused by the treatment need to be weighed against problems caused by the original condition itself. It has been estimated that about 10,000 people die per year in the USA from complications from anti-inflammatory pain medications. By far, the most would not have died from their pain. It is easy to see that alternatives need to be available to treat chronic pain, other than pain pills.

Physical therapies are often very helpful, especially for pain in the musculoskeletal system. Treating or removing the underlying cause is a first objective, but often not possible. Changing behavior that accentuates the pain may be all that is needed, whether it is a cause or a contributing factor.

Because the symptoms of pain can wax and wane, treatment (as with that of other chronic conditions) is an ongoing process (the marathon) vs a single episode (the sprint). Flare-ups of pain often happen with any underlying stress. Stress, even day-to-day hassles, can cause flare-ups. Treatment approaches need to be individualized, as not all individuals show the same response to any given program.

Other options for pain management

Besides pain medications, typically anti-inflammatory pain killers or narcotics, other treatments can be tried: acupuncture, massage and physical therapy, cranial electrical stimulation using the Fisher Wallace machine (formerly the Liss machine), relaxation response training, meditation and movement therapy, training in coping skills and/or chiropractic, and many others. In some people, hypnosis can improve functioning and reduce pain more than physical therapy. TENS machines, lasers, infrared, moist heat, cold packs, stretching, conditioning exercises, etc., can also be appropriate depending on the problem.

All of these therapies can be used alongside magnetic fields to create even better pain control. I have found that magnetic field therapies are often the best for chronic pain, without any other treatment approaches. Also, magnetic therapies can be used in the comfort of your own home, at your convenience. You usually don’t have to make as many trips to a practitioner.

Removal of Exacerbating Factors
Eliminate stress and consumption of coffee, tobacco and alcohol. Worsening factors include improper body mechanics at work or play, flat feet and anxiety.

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How can magnetic field treatment help with pain?

Treatment Goals

• Maintaining good health is basic.
• Whole body balancing is pivotal to regulate the sympathetic and parasympathetic or autonomic nervous system balance. Imbalance here is a major contributor to feeling stressed and amplifying the pain.
• Control the pain and improve energy, sleep, rest, capacity for recovery and overall function.
• Attempt to reduce the cause/s.
• Daily use.
• Stress reduction.
• Blocking electrosmog.
• Reduce dependence on medications for the long haul.

The basic actions of magnetic fields that can help pain:

• reducing muscle tension
• improving circulation
• reducing nerve irritability
• stimulating the immune system
• improving cell function
• helping the body to detoxify
• improving the uptake of nutrients
• helping nerve function
• helping liver function
• balancing the acupuncture meridians
• improving sleep
• reducing stress
• balancing the endocrine system
• reducing trigger point tenderness
• reducing inflammation
• regenerating tissues

Taken together, all these actions of magnetic fields help the body stay well and rebalance problems before they will ever become noticeable by you at the cellular level, the physiologic level and the emotional level. Magnetic fields have been found, in animals and humans to be equivalent to about 10 mgs of morphine in terms of the amount of pain able to be reduced. They help the pain problem at a number of different levels – at the local level, region of the body and from there, even the whole body. Used on the head and/or the spine , in addition to placement over any other painful part of the body, they may be additive to the benefits of pain medications. They usually allow less medication to be needed.

Several studies have shown that magnetic fields actually decrease the firing of nerves. An irritated nerve is constantly firing and giving the pain signal.

Often the magnetic fields don’t work directly on the pain fibers, to reduce pain. They may be working on reducing swelling (edema). Swelling may cause a build-up of natural chemicals that irritate the nerves, such as lactic acid and cytokines, and increase local acidity. Reducing swelling by improving circulation through the area of the swelling and reducing the chemical mediators of swelling, will “clear the swamp” so to speak.  They may reduce the pain caused by a local lack of oxygen resulting from poor blood flow from tense muscles or constricted blood vessels. Improving circulation would help with this. We see evidence of improvement of this from magnetic fields with the pain from blocked blood vessels (ischemia) in the legs, called intermittent claudication, and the heart with angina.

Because magnetic fields act on acupuncture meridians, they will have many of the benefits that acupuncture does in stimulating endorphins and producing other hormone changes.  Magnetic fields don’t typically act as strongly as acupuncture needles, especially needles with some electrical stimulation. I have used static magnets on acupuncture points with some good results. PEMFs will act on the acupuncture points and meridians under the magnetic field and also by reflex reactions through the rest of the body.

Balancing actions of magnetic fields
All the effects of magnetic fields on tissues happen at the same time. The ones that get “turned on” depend on what the body needs at the time. They are not specifically “tunable.”  That means you can’t decide which actions will be activated at any given time. They are all potentially active all the time. If the body is healthy and balanced for any given action, these actions will not likely be involved. That means you won’t notice that particular physical effect. The body will decide what it needs. This is the beauty of magnetic therapies – they will work with the body’s own systems, naturally. In this respect they act like acupuncture therapy. They only act to stimulate the body’s own systems. They will not create actions the body isn’t capable of.

Actions depend on field characteristics
Part of the extent of what actions happen in the body depends on the characteristics of the magnetic system used. These include:

• the types of frequencies
• the strength/s of the field
• size of the magnetic field
• the length time it is used for and
• how often it is used.

For pain the best effects would happen with:

• local and whole body exposures,
• daily use
• low frequency and various intensity ELFs

Small area ELF devices used for the treatment of any local problem can help the overall body as well, to some extent. But, this whole body reflex action is incidental and not as effective for pain control as whole body treatment. Whole body treatment, even with local pain problems, helps the rest of the body to “be well.” Anything that decreases the total burden on the body’s ability to cope with whatever it might be dealing with, helps reduce the pain. If cost is an important consideration, and the only goal is pain control and the pain is very local, then small area local magnetic fields can be used, whther static magnets or PEMFs. Static magnets will usually only be useful for problems near the skin surface.

Static Magnets
Small permanent magnets, used on acupuncture points or painful/tender/trigger points are also helpful but you have to know where to put them. These can sometimes be useful to wear during the day over the worst painful areas. Using them over acupressure points is one way to start. An acupressure book that could be helpful to locate and use these points is Acupressure’s Potent Points: A Guide to Self-Care for Common Ailments. Even so, whole body balancing, by using whole body treatments takes away the guesswork of which points to use at any given time. Some of these points may be helpful for stress, anxiety or depressive symptoms too.  The Large Intestine 4 point, Spleen 6 or Stomach 36 can help especially.  Pressure massage over GV 24.5 and GV 20 are very helpful and a handheld TENS/acupoint stimulator can be used to stimulate several ear acupoints (zero point and shen men) as well as GV24.5 and GV20.

Various kinds of magnets may be combined depending on where the pain/tender/trigger points are. The size of the magnet, will depend on the area needing treatment.

• Back of head: acupuncture magnets, large neodymiums, magnetic collars, head band or necklace
• Neck: acupuncture magnets, large neodymiums, flexible wraps or discs, magnetic, head band or necklace
• Shoulders: acupuncture magnets, large neodymiums, flexible wraps or discs, magnetic head band or necklace
• Ribs: acupuncture magnets, large neodymiums, flexible wraps or discs
• Elbow: acupuncture magnets, large neodymiums, flexible elbow wraps or discs, magnetic band or bracelet
• Buttocks: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes
• Hips: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes, or belts
• Knees: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain or in the shoes
• Head: acupuncture magnets, large neodymiums, flexible wraps or discs, magnetic head band or necklace
• Foot/feet: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used at the painful area or in the shoes
• Muscles/tendons/ligaments: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the pain area/s
• Abdomen: acupuncture magnets, large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the painful area/s
• Skin: large neodymiums, flexible wraps, discs or boards, even shoe inserts used over the painful area/s

If you don’t get adequate relief from the above local applications, try adding strong larger magnets over the neck for pain in the arms/hands or either the neck or low back for pain problems in the legs/feet and over the spine at the level of the problem if it’s in the chest. Treatment over the spine controls the nerve traffic conducting the pain signals from the body to the brain.

Remember not to use static magnets all day long every day. I suggest giving the body a break for 8 or more hours each day to avoid tolerance happening. Of course, pain anywhere else can be treated with these as well. Permanent magnets can be used along with the PEMF systems. Remember also that permanent magnets can harm credit cards, tapes and should not be used with pacemakers, etc. See the contraindications section.

Static Magnetic Mattresses
Research has shown benefit from using these for pain. They may be used in combination with PEMF systems, so don’t throw away your magnetic mattress if you already like to use one. The two together should help even more. It may be worth experimenting to see how they work together or not, since every body is unique in it’s reactions. The pulsed fields tend to be more flexible and offer multiple uses for the same cost. They may cost more initially but are a better health investment in the long run and would be better if other health conditions amenable to magnetic fields are also present.

Electrosmog

Electrosmog is a powerful energy drainer and strong stress inducer. Electrosmog is pervasive and insidious. It is all around us – and goes right through us, all day, every day. Computer terminals, hair dryers, TVs, electric stoves, the wiring in the house and our cars, stereos, microwave antennas, wireless systems, all strongly act on our bodies. They can’t be blocked – anywhere on the planet. We can only decrease them or add frequencies to the body that balance the body. They stress body systems continually – day and night. Cell phones are the newest “societal need.” They deliver very powerful effects to the brain and are like sticking your head in a microwave oven. As the brain goes, so goes the rest of the body. So, using hands free cell phone systems decreases, but does not elminate these risks. Keeping healthy and practicing holistic health is the best protection.

Devices that are offered to keep the body from being thrown out of balance by harmful “electro-smog” may be useful to wear throughout out the day, whether in our own homes where we have a lot of wiring and TVs, stereos or radios playing, driving/riding in a car, sitting in front of computer terminals, using cell phones in office settings with a lot of electronics, in stores or in urban areas. These devices don’t specifically block out magnetic fields – it’s unlikely that anything can significantly – but probably stimulate the body to maintain frequencies that will make the body more resistant to the effects of the “electro-smog.”

You should strongly consider testing your home and workplace for electrosmog and then using filters to counteract this additional electrosmog effect. Home and workplace electrosmog is potent and pervasive. See the section on this ((((dirty electricity ))))).

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Specific Devices

I recommend PEMF devices over static magnetic devices, if a choice is available.  In general I prefer whole body PEMF systems, since they offer treatment to the whole body as well as any local pain management needs. Helping the whole body helps any local need.

If there is a strong component of anxiety or depressive symptoms, I also suggest considering the Fisher Wallace machine for cranial electrical stimulation, although it can be useful for any chronic pain.

How to use PEMF devices for Pain

Since the recommended devices can have complicated set-ups and treatment regimens and often do not come with explicit directions, consultation is the best way to get individually tailored protocols, specific to any given individual’s unique overall health issues or needs.  Otherwise, the manufacturer’s directions can be a starting place.

Always check for sensitivity when you start. If you think you may be sensitive, or know you are, start low and go slow in advancing the settings.

In addition:

• Always treat your day’s water ration on the system with you in the morning – preferably in a glass container without a metal lid.
• Take your morning supplments before you get on the system. There are no supplements I know of no supplements that have to be avoided with these treatments.
• Have a drink of water – at least 10-16 ounces before you get on the system.
• Have your breakfast first to stimulate digestion.
• Let your body tell you what it needs in terms of settings, length of treatments and/or placements of applicators.
• Do what you can to to counteract the effects of electrosmog, so that the fatigue effects of this electro pollution won’t wear you down and create additional stress.
• You should strongly consider testing your home and workplace for electrosmog and then using filters to counteract this additional electrosmog effect. Home and workplace electrosmog is potent and pervasive. See the section on this ((((dirty electricity ))))).
• It doesn’t matter when supplements are taken relative to magnetic field therapy. In the ideal circumstance they should be taken about half an hour to one hour before the magnetics treatment.
• Key to success is daily use – twice a day if you can. In the morning to wake up the cells. In the evening to clean out the effects of the day’s stresses on the body. You can still use the system mid-day if needed for any other given problem/s. Health Maintenance settings may be combined at any given treatment session with treatment settings and pillow/pad placements as needed.

In the morning: If sensitive, start at the lowest intensity setting and gradually- typically   every 3-4 days -  increase the intensity until the strongest setting is reached. If not sensitive, typically start the mid-range and increase the intensity, by one or two levels day by day until the strongest intensity is reached. Once the strongest intensity is reached, you can stay at that level or whatever level seems to produce the best results from then on, unless you have a reaction or your intuition tells you another intensity is preferred.

In the evening: you may need to use a lower intensity just before bedtime in case the body may become over stimulated and interfere with sleep. However this will be an individual consideration and you may have to try different intensities to find what works best for you, balancing symptom reduction and achieving sleep. You may also find that you may use stronger intensities before bedtime for a short period of time for arthritis symptom management followed by other frequency or intensity settings that may enhance sleep.

Go to my Product Reviews for more information on specific magnetic field devices.

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Nutritional recommendation

Conventional Treatment of Chronic Pain

Treatment is by trial and error. Pain killers are typically prescribed, with increasing degrees of strength. If the underlying cause is not removed, low-dose antidepressant therapy can help for the short term. Magnetic fields can be additive to the benefits of analgesics. They can even be used together for the greatest benefit. The goal is to avoid invasive procedures such as injections, ablative procedures, implanted pain devices or surgery. Most doctors who deal with chronic pain are not aware of or rarelyuse electromagnetic approaches. Their approaches are always an option. PEMF treatment does not interfere with any other approaches or remove those options from consideration if PEMFs are not successful. Since PEMF treatments are not invasive and have no side effects, there is nothing lost in trying them first before invasive approaches are used. Unfortunately, many people don’t consider or learn about the PEMF approach until after they have failed or gotten worse with conventional approaches. Even in this last ditch situation PEMFs can be dramatically helpful.

For more Nutritional, supplement and lifestyle recommendations….

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References & Resources

Pain Resources

Most resources are very conservative because of their medical advisors and do not recommend complementary approaches as much as they should. Cranial electrical stimulation and magnetic therapies are mostly unknown by them. They are given here for completeness.

The Pain Network
P.O. Box 31760
Tucson , AZ 85751
Telephone: 1-800-853-2929
Web address: www.fmnetnews.com

Reviews that can help:

Stress review paper

Pain review paper

Pain References

• Alfano, AP, Taylor , AG, Foresman , PA ,Dunkl, PR, McConnell, GG, Conaway, MR, Gillies, GT.
• Static magnetic fields for treatment of pain:  a randomized controlled trial. J Altern Complement Med 7(1):53-64, 2001.
• Brown, C.; Ling, F.; Wan, J.; Pilla, A. Non-invasive static magnetic field therapy reduces chronic pelvic pain:  a double-blind pilot clinical study. Bioelectromagnetics Society, 24th Annual Meeting, 23-27 June, Quebec City, QC, Canada, Abstract No. 8-3, p. 49-50, 2002.
• Colbert, A P, Taylor, AG, Foresman , PA , Conaway, MR, Alfano, AP. Magnetic-field studies encouraging – discussion of magnetic sleep pad study (letter and reply).  J Altern Complement Med 7(5):393-399, 2001.
• Colbert, AP, Markov , MS , Banerji, M, Pilla, AA. Magnetic mattress pad use in patients with pain:  a randomized double-blind pilot study. J Back Musculoskeletal Rehabil 13(1):19-31, 1999.
• Goldenberg DL. Pain, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1995 Mar;7(2):127-35.
• Hausotter, W. Modern illnesses from the critical viewpoint. Versicherungsmedizin 53(4):177-181, 2001.
• Janssens LA. Trigger point therapy. Probl Vet Med. 1992 Mar;4(1):117-24.
• Khramov, RN, Vorobiov, VV, Yarkov, AV. Difference in the effects of millimeter radiation by rats in norm and after a pain stress caused by electric stimulation.  Fundamental and Applied Aspects of the Use of Millimeter Electromagnetic Radiation in Medicine.  Abstracts of the 1st All-Union Symposium with International Participation.  10-13 May, 1989, Kiev , Ukraine , p. 155, 1989.
• Lautenbacher, S. The role of pain perception in the etiology of chronic pain and the causation of sex differences. Bioelectromagnetics Society, 24th Annual Meeting, 23-27 June, Quebec City , QC , Canada , p. 39, 2002.
• McCray, RE, Patton , NJ . Pain relief at trigger points:  a comparison of moist heat and shortwave diathermy. J Orthop Sports Phys Ther 5(4):175-178, 1984.
• Miriutova NF, Levitskii EF, Abdulkina NG. Electromagnetic and mechanical vibrations in the therapy of myofascial pains. Vopr Kurortol Fizioter Lech Fiz Kult. 2000 Jan-Feb;(1):14-6.
• Panagos A, Jensen M, Cardenas DD. Treatment of myofascial shoulder pain in the spinal cord injured population using static magnetic fields: a case series. J Spinal Cord Med. 2004;27(2):138-42.
• Pilla, AA. Static magnetic field therapeutics:  state of the art. Bioelectromagnetics Society, 23rd Annual Meeting, 11-14 June, St. Paul , MN , Abstract No. P-71, p. 159-160, 2001.
• Rauscher, E, Van Bise, WL. Pulsed magnetic field treatment of chronic back pain. Bioelectromagnetics Society, 23rd Annual Meeting, 11-14 June, St. Paul, MN, Abstract No. 10-3, p. 56-57, 2001.
• Sandstrom, M, Hansson Mild, K, Lyskov, K, Wilen, J, Bergdah, J, Eriksson, N, Hoog, J, Marqvardsen, I,  Marqvardsen, O, Stenberg, B, Widman, L. Electrical hypersensitivity – a multidisciplinary study.
• European Bioelectromagnetics Assoc. (EBEA), 4th International Congress, 19-21 November, Zagreb , Croatia , 1998.
• Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Therapeutic effects of peripheral repetitive magnetic stimulation on myofascial pain syndrome. Clin Neurophysiol. 2003 Feb;114(2):350-8.
• Thomas, AW, White, KP, Drost, DJ, Cook, CM, Prato , FS. A comparison of rheumatoid arthritis and pain patients and healthy controls exposed to a pulsed (200 ut) magnetic field:  effects on norma l standing balance. Neurosci Lett 309(1):17-20, 2001.
• Vallbona, C, Hazlewood, CF, Jurida, G. Response of pain to static magnetic fields in postpolio patients:  a double-blind pilot study. Arch Phys Med Rehabil 78(11):1200-1203, 1997.
• Vallbona C, Richards T. Evolution of magnetic therapy from alternative to traditional medicine.  Phys Med Rehabil Clin N Am. 1999 Aug;10(3):729-54.
• Weintraub, MI, Vallbona, C, Hazlewood, CF. Magnetotherapy:  a new intervention? (letter and reply).
• Arch Phys Med Rehabil 79(4):469-470, 1998.

No abstracts provided

• Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of pain? J Fam Pract 1999;48:213-8.
• Blunt KL, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of pain patients: a pilot study. J Manipulative Physiol Ther 1997;20:389-99.
• Haanen HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP, et al. Controlled trial of hypnotherapy in the treatment of refractory pain. J Rheumatol 1991;18:72-5.
• Harding SM. Sleep in pain patients: subjective and objective findings. Am J Med Sci 1998; 315:367-76.
• Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for pain. Clin J Pain 1998;14:232-8.
• Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am 1989;15(1):91-103.
• Pillemer SR, Bradley LA, Crofford LJ, Moldofsky H, Chrousos GP. The neuroscience and endocrinology of pain. Arthritis Rheum 1997;40:1928-39.
• Sandstrom MJ, Keefe FJ. Self-management of pain: the role of formal coping skills training and physical exercise training programs. Arthritis Care Res 1998;11:432-47.
• Schneider MJ. Tender points/pain vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J Manipulative Physiol Ther 1995;18:398-406.
• Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot study of cognitive behavioral therapy in pain. Altern Ther Health Med 1998;4:67-70.
• Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in pain. A 4.5 year prospective study. Scand J Rheumatol 1996;25:77-86.
• Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Pain. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.