RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
NERVE
PAIN
September, 2006
Definition
of the Problem
There are three major
classifications of nerve pain: neuritis, neuralgia, and
neuropathy.
Neuritis is a term used to describe an inflammation of a
nerve that results in pain, sensory disturbance, or the
ability of the nerve to “react” properly. Among the many
types of neuritis are optic, interstitial, and brachial.
Neuralgia is characterized by shooting or sudden and
recurring pain involving a nerve or nerves. It usually does
not involve permanent damage or structural change to the
nerve. Some types of neuralgia are migranous,
cervico-occipital, post-herpetic, and ideopathic.
Trigeminal neuralgia in the face (formerly, tic douloureux)
is considered by many to be the worst possible pain anyone
can experience.
Neuropathy (also known as peripheral neuropathy, sensory
peripheral neuropathy, or peripheral neuritis) is a painful
condition that usually results from major or irreversible
damage to the nerves. This damage can be from disease,
injury, or a tumor. In the United States, diabetes is the
leading cause of neuropathy. Most people with neuropathy
experience periodic or constant muscle weakness, numbness,
and tingling. Many also experience severe burning or
electric-like shooting pain.
Scope
and Cost of the Problem
According to the Neuropathy
Association, neuropathy affects between 15-20 million
Americans (What Is Neuropathy, 2006).
Total disease-related costs of diabetic neuropathy alone
are estimated at $10.91 billion a year (Gordois, Schuffham,
et al, 2003). Approximately 43% of those with neuropathic
pain reported that their employment was affected by their
condition, with significant reduction in their quality of
life, and an increase in comorbid conditions such as sleep
deprivation, coronary heart disease, depression, and
anxiety (McCarburg and Billington, 2006).
Medical
Treatment
Treatment of nerve pain is
often geared toward relieving symptoms. No one therapy is
completely successful, and it is not uncommon for two and
three drugs to be used. Specific treatment is usually
determined by the exact condition. For example, neuritis is
treated with opiates, steroids, and NSAIDs. For neuralgia,
carbamazepine is a frequent first treatment choice.
Baclofen, clonazepam, gabapentin, and valproic acid have
also been known to be somewhat effective.
Most neuropathic pain is treated with any number of drug
types: tricyclic antidepressants (TCA’s); anticonvulsants
such as gabapentin; systemic local anesthetics; SSRI’s;
corticosteroids; substance P depletors; autonomic drugs;
NMDA receptor antagonists; and capsaicin cream. When these
treatments fail, other interventions include trigger-point
injections, pain “blocks,” epidural steroids, spinal cord
stimulators, TENS stimulation, and morphine pumps. Surgery
is rarely recommended.
Other
Treatments for Nerve Pain
In addition to medication,
physical therapy, weight loss, aerobic exercise, muscle
group strengthening, and nutritional supplements are
sometimes recommended. Psychological approaches, including
behavior modification and respondent treatment (hypnosis,
visualization, relaxation, and biofeedback) are frequently
recommended (Galper, Taylor, Cox, 2003; Irving, Goli,
Dunteman, 2004; Mackey, undated; Richeimer and Macres,
2000; Yung and Bruehl, 2003).
Mind-Body Approaches
Since stress can aggravate
pain, stress reduction is an indispensable part of any
nerve pain treatment plan. This is one of the areas where
mind-body techniques are particularly effective
(Blumenthal, Jiang, et al, 1997; Williams, Kolar, et al,
2001). There is also substantial evidence to support the
use of mind-body techniques in the management of many types
of pain. The effectiveness of guided imagery is well
documented (Ilacqua, 1994; Lambert, 1999; Mannix,
Chandukar, et al, 1999), as are hypnosis (Crasilneck,
1995; Haanen, Hoenderos, et al, 1991; Tusek, Church, et al,
1997), meditation (Kabat-Zinn,
Lipworth, and Burney, 1985), and biofeedback (Buckelew,
Conway, et al, 1989).
Conclusion
Guided imagery involving
relaxation and positive suggestion can help to lower
stress, improve coping skills, enhance an overall sense of
emotional well-being, and help with making lifestyle
changes.
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