What role do injections play?

Injections can mechanically disrupt "knots" or "scar tissue" within muscles or ligaments. They can block nerve pathways which cause pain, or reduce inflammation from structures in which inflammation is a strong component of the pain. Sometimes it is the mechanical effect of the injection which is mainly helpful;" sometimes it is mainly the medication which is helpful. Often it is a combination of both factors. Some conditions require only one or two injections and others require a "series of injections". Often injections can be done as a "local procedure" into the site of the pain; sometimes the injection is more helpful when it is injected some distance from the pain, e.g. into the fluid which surrounds the spinal roots.

Are acupuncture and hypnosis actually scientific ways to treat pain?

Acupuncture, although an ancient art, has actually been studied and continues to be studied extensively. It is most definitely more effective than "placebo". It has characteristics in common with TENS, with massage, with injections, and with certain electrical treatments; it has characteristics which are unique and stand on their own right. It does not cure any condition, but it is a valuable adjunct for treating symptoms of pain.

Hypnosis has many properties in common with cognitive behavioral therapy; other properties in common with biofeedback. It is also being scrutinized and is being proven effective as a supplementary tool for managing pain.

Who treats chronic pain?

Before assuming pain is chronic, one should have a sufficient diagnostic evaluation under the care of a physician. Although often not curable, once more serious conditions can be ruled out, many things can be done along the lines of the multi-disciplinary approach described above, to reduce symptoms, improve function, and return to a normal way of life. Those centers which offer accurate diagnosis and a more eclectic variety of options for treatment seem to have greater success in management of this problem. The multi-disciplinary approach, where different specialists communicate with one another, improves the overall success rate. Chronic pain affects 20 million Americans. The magnitude of this problem and consequences and management continue to be a source of interest.