3) Anti-depressant medications: These drugs, used in dosages much less than those used by people who are depressed, are effective in modulating certain chemical substances known as neurotransmitters. The result of this is that pain signals coming from muscle and nerve are reduced in frequency and intensity. These medications can also have a beneficial effect on the sleep _e. Not actually sleeping pills on the sense that they do not induce sleep), these medications increase the percent of Stage 4 sleep (deep sleep) and, therefore, allow recovery and healthier functioning of muscle tissue. These are, therefore, very effective medications for chronic pain syndromes in which there is a strong component of pain emanating from muscles and nerves.

What is chronic pain?

4) Others: There are new drugs being developed all the time, including medications which act as nerve "anesthetics" or creams which can block certain types of nerve signals. Dilantin, Klonopin, Tegretol, Mexitil and Zostrix are just some of the medications now being studied. Originally developed for other purposes, these drugs are finding themselves as part of the armamen. tarium against specific chronic pain conditions.

What medications are discouraged?

In general, narcotics and tranquilizers are not helpful. They result in sedation and loss of control, with some risk of addiction. There are other medications which can often be substituted without significant side effects.

Factors in Chronic Pain

What role can physical therapy modalities play?

Physical therapy modalities, when carefully chosen for their specific qualities, can be helpful.

For example:

1) Ultrasound-when used in a continuous fashion, this can heat up deep tissues and improve metabolism and promote circulation through injured tissue. When used in a pulsed fashion, ultrasound can promote increased elasticity and allow for stretching and regaining, range of motion.

2) Electricity-depending upon the exact form of usage, electricity can reduce edema, decrease inflammation, block pain signals (TENS), improve muscle strength, and reduce muscle spasm.

3) Moist heat and ice-these are good modalities for reducing muscle spasm or pain temporarily so that the therapist can work on the painful part of the body and help the patient to make better progress.

4) Manual therapy-this includes many variations of massage, stretching techniques, and mobilization techniques to regain motion and flexibility in joints of the spine and the extremities.

5) Traction-this can be done manually or mechanically and is a modality, for stretching ligaments, as well as separating vertebrae to relieve pressure on nerves, discs, and joints.

What role does exercise serve?

Exercise promotes fitness despite pain. Different forms of exercise promote a variety of benefits.

Specifically:

1) Flexibility --stretching exercises promote increased motion and allow for better function before "pain signals" are triggered. In many chronic pain conditions, inactivity results in decreased flexibility, which, in turn, becomes its own source of pain. Regaining flexibility in and of itself may result in a decrease in symptoms of pain.