Other Techniques
Other nonpharmacologic techniques, such as transcutaneous electrical
nerve stimulation (TENS), acupuncture, and psychological approaches, can be used
in an attempt to alleviate postoperative pain. The mechanism by which TENS produces
analgesia is unclear and may be related to the modulation of nociceptive impulses
in the spinal cord, release of endogenous enkephalins, or a combination of these
and other mechanisms.[353]
Although the analgesic
efficacy of these techniques is controversial, TENS and acupuncture may provide postoperative
analgesia, decrease postoperative opioid requirements, reduce opioid-related side
effects, and attenuate sympathoadrenal system activation.[353]
[354]
[355]
[356]
In general, both of these approaches to postoperative pain are relatively safe,
noninvasive, and devoid of systemic side effects seen with other analgesic treatment
options.[353]
[357]
However, there are methodologic issues with many of the available trials, and the
precise role of these treatments in postoperative pain management is not clear.[358]
[359]
It is possible that TENS and acupuncture
may
be useful adjuncts to more traditional pharmacologic analgesic drugs, but these techniques
may not be effective as the sole drug for severe postoperative or labor pain.[354]
[360]
Although this chapter has focused on the neurobiology of nociception
and pharmacologic treatments available for the treatment of postoperative pain, the
experience of pain is complex, multifaceted, and "an unpleasant sensory and emotional
experience," as defined in part by the International Association for the Study of
Pain. The differential behavior response to surgical incision may be related to
global (i.e., personality, gender, age, and culture) and specific (i.e., fear, depression,
anger, and coping) psychological factors.[361]
Cognitive behavior and behavior therapies may be efficacious in reducing pain and
alleviating psychological factors associated with pain.[362]
[363]
Identifying and addressing psychological
factors
can reduce pain, improve the efficacy of pharmacologic analgesics, and diminish patients'
distress, in part through enhancement of the placebo effect.[361]
[364]
Although the placebo effect traditionally
has been thought to have a psychological origin,[364]
the placebo response may exert part of its effects through activation of endogenous
opioids[365]
and be useful in reducing the intensity
of pain.[366]
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