Pain

HEALTH TOPICS Pain

Pain

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Treatment Goals

Magnetic Field Treatment

Specific Devices

Nutrition

References

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 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.

There is acute pain and there is 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 themsleves 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, 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 senstive 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.

However, the chronic abdominal pain of a Crohn’s Disease sufferer, irritable bowel syndrome, 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 conditions is not curative, and only maybe 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 of pain signals. However, magnetic fields probably won’t make a dead nerve function. 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 in reducing your pain. Good nutrition is foundational. Exercise often helps, unless it’s in places that movement makes 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. They can certainly reduce the secondary problems caused by the pain itself. 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 musculoskeltal system. Naturally, treating or removing the underlying cause is required but often not possible. Changing behavior 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 vs a single episode. Flare-ups often worsen 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

Other treatments can be tried: acupuncture, massage and physical therapy, cranial electrical stimulation using the Liss machine, relaxation response training, meditation and movement therapy, training in coping skills and/or chiropractic. 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. Also, the magnetic therapies can be used in your home. You 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.

Treatment Goals

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· Maintaining good health is basic.

· Whole body balancing is key 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 dependance on medications for the long haul.

Magnetic Field Treatment for Pain

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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

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 over the head, in addition to placement over any other painful part of the body, they may be additive to the benefits of pain medications.

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 directly work 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 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 in the legs, called intermittent claudication.

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 then secondarily by reflex action 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

What will determine what actions happen in the body is dependant 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 time it is for and

· how often it is used for.

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 can help the overall body as well, from the treatment of any local problem. But, this whole body reflex action is incidental and not as effective for pain 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, the only goal is pain control and the pain is very local then small local magnetic fields can be used, static or PEMF.

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.

Remember not to use these 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. People with Pain, Chronic Fatigue and Chemical Sensitivity tend to also have electrical sensitivity. Electrosmog is important to control in these individuals.

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 throw off 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.

Devices that offer 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 (see www.mybiopro.com/drpawluk) 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.”

Specific Devices

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I recommend PEMF devices over static magnetic devices, if a choice is available. These include: Quantron Resonance System (QRS) and the Magnopro.

Because of the elctrosmog issue, I also suggest counteractive measures using the BioPro - electrosmog counter-active device.

If there is a strong component of anxiety or depressive symptoms, I also suggest considering the Liss Machine for cranial electrical stimulation.

Review Devices ►

■ Magnopro System

■ QRS System

■ BioPro

■ Liss Machine

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 supplements 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.

· Wear and/or use your BioPro (www.mybiopro.com/drpawluk)

daily to counteract the effects of electrosmog, so that the fatigue effects of this electro pollution won’t wear you down and create additional stress.

· 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 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 setting and gradually- typically every 3-4 days - increase the settings until the strongest setting is reached.

· If not sensitive, typically start the mid-range and increase the settings, by one or two every day until the strongest setting is reached.

· Once the highest setting is reached 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 setting is preferred.

· In the evening:

· Always use the lowest setting for at least 20 minutes just before bedtime. This is always the last setting to use for the day. It is the “finishing” treatment – the “finishing” touch.

· You can combine any other settings in a separate treatment session if you want just before ending the day with the finishing treatment.

Nutrition

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No specific diet has been shown to be effective. An anti-inflammatory diet may be helpful. Chlorella pyrenoidosa, a freshwater green alga, 10 g daily, can be used for a 3-month trial.

A number of supplements can be used to help with pain and sleep. These should include:

q A good daily multi,

q Vitamin E (mixed tocopherols only – not the cheaper dl-alpha tocopherol) 400 to 1600 IU daily

q Vitamin C 500-1000 mg twice per day

q Selenium intake as nuts or supplements: at least 100 μg daily; not to exceed 400 μg daily

q Calcium 1.5 g daily;

q Magnesium 600 to 750 mg daily

q Vitamin D 400 IU per day

Botanical sedatives can be used to promote sleep or treat anxiety:

q St. John’s wort 300 mg up to 3 times daily

q Kava: as dried root, 450 mg 1 or 2 capsules up to twice per day

q Valerian: as extract, 400 to 900 mg 2 hours before bedtime

q German chamomile: as tea, steep 3 g of dried flower heads in 150 ml boiling water for 5 to 10 minutes and strain; take 1 cup up to 3 times daily

q 5-HTP capsules, 50-200 mg with meals or at bedtime (do not mix with SSRI anti-depressants or anti-parkinson drugs)

q Melatonin 3-12 mg at bedtime (some suggest taking on edose at about 4 pm and therest at bedtime)

For analgesic effects:

q Ginger: As dried root, 1 g 2 to 3 times per day to start, increased up to 4 g daily

q Turmeric: As powdered root, 0.5 to 1 g 2 to 3 times daily

q Salozisin

For increased energy.

q Siberian ginseng: As powdered root, 0.6 to 3 g 1 to 3 times per day, or ethanolic extract, 0.5 to 6 mL 1 to 3 times a day; use for 2 to 8 weeks, then abstain for 2 weeks

q Gotu kola: As dried leaves, 600 mg 3 times per day; as tea, 600 mg dried leaves steeped in 150 mL of boiling water for 5 to 10 minutes and strain; take 1 cup 3 times per day

q or an adaptogen combination – Vital Adapt

Recommended Nutrition

■ Daily Multi Vitamin

■ Vitamin E

■ Vitamin C

■ Selenium

■ Calcium

■ Magnesium Malate

■ Vitamin D

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■ St. John's Wort

■ Kava Root

■ Valerian

■ Chamomile Tea

■ HTP

■ Melatonin

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■ Ginger

■ Turmeric

■ Salozisin

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■ Siberian Ginseng

■ Gotu Kola

■ Adaptogen

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 be used together.

References & Resources

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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.

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· 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.

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