User:Speka3/Pain management

Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that focuses on behavior change rather than symptom change, includes methods designed to alter the context around psychological experiences rather than to alter the makeup of the experiences, and emphasizes the use of experiential behavior change methods. The central process in ACT revolves around psychological flexibility, which int turn includes processes of acceptance, awareness, a present-oriented quality in interacting with experiences, an ability to persist or change behavior, and an ability to be guided by one's values. ACT has an increased evidence base for range of health and behavior problems, including chronic pain. ACT influences patients to adopt a tandem process fo acceptance and change, which allows for a greater flexibility in the focus of treatment.

Recent research has applied ACT successfully to chronic pain in older adults due to in part of its direction from individual values and being highly customizable to any stage of life. In line with the therapeutic model of ACT, significant increases in process variables, pain acceptance, and mindfulness were also observed in a study applying ACT to chronic pain in older adults. In addition, these primarily results suggested that an ACT based treatment may significantly improve levels of physical disability, psychosocial disability, and depression post-treatment and at a three month follow-up for older adults with chronic pain.

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) encourages patients to change behaviors, thoughts, and feelings to help in reducing their distress. CBT helps patients with chronic pain to conceptualize pain as manageable, transition to an active role in pain control, and to adapt behavioral and cognitive repossess to pain. Research has suggested that therapists should include a combination of treatment modalities such as relaxation to promote successful coping with chronic pain. Although there has been limited research done examining integrating physical exercise and CBT for people with chronic pain, results indicated a significant reduction in pain intensity as well as significant improvement in quality of life and overall health.

TMS
Transcranial magnetic stimulation (rTMS) is a non-invasive technique of brain stimulation that can modulate activity in specific brain cortex regions, and it involves the use of a rapidly changing magnetic field applied at the scalp to electromagnetically induce current in a focal volume of brain cortex.

Previous research has indicated that patients with chronic pain have changes in cortical and corticospinal reactivity as evidenced by a single pulse and pair pulse TMS techniques. TMS has been documented as a useful tool for brain mapping and able to modulate cortical activity when applied repetitively.

TENS
Transcutaneous electrical nerve stimulation (TENS) is a self-operated portable device intended to help regulate and create chronic pain via electrical impulses. Limited research has explored the effectiveness of TENS in relation to pain management of Multiple Sclerosis (MS). MS is a chronic autoimmune neurological disorder, which consists of the demyelination of the nerve axons and disruption of nerve conduction velocity and efficiency. In one study, electrodes were placed over the lumbar spins and participants received treatment twice a day and at any time when they experienced a painful episode. This study found that TENS would be beneficial to MS patients who reported localized or limited symptoms to one limp. The research is mixed with whether or not TENS helps manage pain in MS patients.

tDCS
Transcranial direct current stimulation (tDCS) is a non-invasive technique of brain stimulation that can modulate activity in specific brain cortex regions, and it involves the application of low-intensity (up to 2 mA) constant direct current to the scalp through electrodes in order to modulate excitability of large cortical areas. tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience. Zaghi and colleagues (2011) found that the motor cortex, when stimulated with tDCS, increases the threshold for both the perception of non-painful and painful stimuli. Although there is a greater need for research examining the mechanism of electrical stimulation in relation to pain treatment, one theory suggests that the changes in thalamic activity may be due the influence of motor cortex stimulation on the decrease in pain sensations.

In relation to MS, a study found that after daily tDCS sessions resulted in an individual's subjective report of pain to decrease when compared to a sham condition. In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.

Fibromyalgia is a disorder in which an individual experiences dysfunctional brain activity, musculoskeletal pain, fatigue, and tenderness in localized areas. Research examining tDCS for pain treatment in Fibromyalgia has found initial evidence for pain decreases. Specifically, the stimulation of the primary motor cortex resulted in significantly greater pain improvement in comparison to the control group (e.g., sham stimulation, stimulation of the DLPFC). However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.