Running Head: PAIN MANAGEMENT 1

MANAGEMENT OF CHRONIC PAIN: ALTERNATIVE THERAPIES

Loral Lee Portenier

Saybrook University
Running Head: PAIN MANAGEMENT 2

Abstract

Pain is a multifaceted part of the human experience and as such, has spawned a plethora

of techniques designed to ease or erase all related suffering. Chronic pain effects not

only one’s physical well-being, but also one’s mental, emotional, social, and spiritual

well-being. While allopathic medicine is catching up with this concept, complementary

and alternative medicine has offered a banquet of options from which to choose that

already tend to acknowledge the holistic effects of pain. This paper reviews the field of

pain management, focusing on non-allopathic interventions, and briefly highlights two of

these options: Healing Touch and Qigong.

Keywords: pain management, alternative therapies, CAM, Healing Touch, Qigong

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Management of Chronic Pain: Alternative Therapies

Pain seems to be part of the human condition. It is a gift in that it can help

prevent serious injury or death. For example, the memory of the pain we experienced

from a cut in the past makes us more careful around knives, saw blades, and glass now.

The pain of a burn makes us careful around fires, chemicals, and hot liquids. And the

pain of a gall bladder attack or a ruptured spleen can send us to the doctor for lifesaving

treatment.

Not everyone has this self-protective gift, however. Myers (2010) describes a

little girl who has a genetic disorder that precludes the sensation of pain. And leprosy,

which can affect the skin, mucous membranes, eyes, and peripheral nerves, can have a

similar effect (Leprosy, 2011).

Clearly, then, acute pain is useful for survival and even quality of life.

Unfortunately, some people develop chronic pain which can negatively impact their

overall functioning and quality of life. “More than 50 million Americans endure chronic

pain . . . and approximately 4 out of every 10 patients with moderate to severe pain report

little relief” (Sutherland, Ritenbaugh, Kiley, Vuckovic, & Elder, 2009, p. 819). Chronic

pain may not have a source that is visible (e.g., back pain), or even a definable source

(e.g., phantom limb pain). This can negatively impact people’s relationships with others,

from friends and family to health care providers (Pavlek, 2008), simply because it tends

to be easier for humans to treat as real something we can see and understand, and to

dismiss that which is not obvious.

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Pain, especially chronic pain, can be multifaceted. For instance, Cochran (2007)

lists numerous symptoms that can accompany the physical sensation of pain and stiffness,

including fatigue and insomnia, withdrawal from activity, weakened immune system,

mood changes (e.g., hopelessness, fear, irritability, depression, anxiety, stress, anger), and

disability. Similarly, Sutherland, et al. (2009) emphasize that chronic pain can affect

one’s emotional, social, and spiritual well-being. Accordingly, techniques for

management of chronic pain need to incorporate more than just the attenuation of

subjective, self-reported physical sensations of pain.

Pain management has been evolving over the past decades. In the mid-20th

century, according to Dannenbaum (2005), the ruling theory was the Specificity Theory

of Pain, which “proposed that the intensity of pain is directly related to the amount of

associated tissue damage” (p. 46). Fortunately, this restrictive theory has been

discredited and replaced with the contemporary Gate Theory (e.g., Dannenbaum, 2005;

Myers, 2010), which takes a multi-faceted, biopsychosocial approach to pain.

Dannenbaum (2005) states that people “frequently experience psychological distress in

response to their injury, which can severely impede their physical recovery and actually

increase their subjective experience of pain” (p. 46). He makes the argument that the

most effective treatment incorporates both physical and psychosocial interventions.

And the American public recognizes this fact. To wit, by 1990, a third of all

Americans had utilized some form of complementary and alternative medicine (CAM),

and that number nearly doubled in the next decade (McMillen, 2011). CAM studies have

included a smorgasbord of such topics as “herbs, vitamins, spiritual healing, relaxation,

massage, acupuncture, energy healing, hypnosis, biofeedback, mistletoe therapy,

PAIN MANAGEMENT 5

therapeutic spas, yoga, lifestyle diets, audio or videotapes, medication wraps, and

osteopathic, homeopathic, and chiropractic treatment” (Wong-Kim, & Merighi, 2007, p.

119). Other options in this CAM smorgasbord include aromatherapy (Potts, 2009),

acupressure (Forem & Shimer, 1999), meditation, expressive arts therapies, naturopathic

medicine, Ayurveda, various biofield therapies (e.g., qigong, Reiki, therapeutic touch)

and bioelectromagnetic-based therapies (e.g., pulsed fields, magnets, alternating or direct

currents) (Lawrence, Rosch, & Plowden, 1998).

“The depth and complexity of chronic pain and the frequent resistance to

conventional medical interventions make it a good candidate for CAM” (Sutherland, et

al., 2009, p. 820). Wadman (2009) reported that in 2007, “38% of Americans said they

had turned to alternative treatments at least once over the previous 12 months, spending

US$33.9 billion on a gamut of therapies from acupuncture to herbal remedies to yoga” (p.

711). Each of these therapies could comprise a lengthy treatise in its own right.

However, because this paper cannot cover the scope of alternative therapies that are

currently available, it will focus on two options that draw heavily on the mind-body-spirit

connection, namely, Healing Touch and Qigong. Each therapy will be discussed briefly,

as well as its potential for addressing chronic pain.

In the early 1980s, the nursing profession began to offer a biofield- or energy-

based therapy called Healing Touch (HT) (MacIntyre, Hamilton, Fricke, Wenium, Mehie,

& Michel, 2008). HT works gently to promote balance and well-being in all areas of

one’s life, including the physical, mental, emotional, and spiritual realms (Healing Touch

International, Inc, 2008c). HT assumes that people are “a multidimensional energy

system (including consciousness) that can be affected by another to promote well-being”

PAIN MANAGEMENT 6

(MacIntyre, et al, 2008, p. 24). During an HT session, the client typically lies fully

clothed on a massage table while the practitioner uses his or her hands to clear, energize,

and balance the energy field around the body. The practitioner may or may not

physically touch the client’s body during the session (Healing Touch Program, 2011).

Certification can be acquired after successfully completing five levels of training,

and is suitable for use by professionals such as nurses and other health care providers,

body-oriented therapists, and psychotherapists (Healing Touch International, Inc, 2008a).

Sutherland, et al. (2009) insist that it is important that practitioners of HT be “deeply

engaged in a personal spiritual practice” of their own (p. 820).

Healing Touch International, Inc (2008b) states that pain management is the

newest area of research, and lists 16 studies that have had varying results. Sutherland, et

al. (2009) reported a study that was done with people suffering from chronic headaches.

They received three sessions of HT from a trained practitioner and reported a decrease in

their pain, as well as “potentially transformative shifts and whole-person outcomes” of a

type and magnitude that were unexpected by both the researchers and the participants.

Meanwhile, Wardell and Weymouth (2004) reviewed the existing literature, with a

similar conclusion to that reported by Healing Touch International, Inc (2008b), namely,

that there were mixed results when utilizing HT to reduce chronic pain. Sutherland, et al.

(2009) bemoan the fact that there currently exist few adequate measurement tools for this

type of experience, and urge other researchers to investigate this area further. The

amount of variables in an area of study such as chronic pain (e.g., type and history of

pain, rapport, setting) could help explain the varieties in overall effectiveness of HT as a

complementary treatment. Interestingly, similar to HT is external Qigong, or Qi-therapy.

PAIN MANAGEMENT 7

Qigong is a Chinese system that increases health by the use of physical postures,

breathing techniques, and intention that is focused on cultivating and vitalizing Qi (chi),

or one’s life force (The National Qigong Association, n.d.). Qigong involves the entire

body holistically, regulating and regenerating “the cardiovascular/circulatory, lymphatic,

digestive, and nervous systems as well as the body's internal organs” (Cohen, 1997).

“Medical Qigong is a traditional complementary intervention used to prevent and

cure disease, to improve health, and to strengthen the vital energy through practice or by

receiving it from practitioners” (Yang, Kim, & Lee, 2005, p. 950). Consequently,

medical Qigong is divided into two forms, external and internal. The former is called Qi-

therapy and involves a trained practitioner using his or her hands to feel for and

manipulate the qi of the patient, which makes it similar, then, to HT.

On the other hand, “[i]nternal Qi-training refers to . . . the cultivation of oneself to

achieve optimal health in both mind and body” (Yang, et al., 2005, pp. 950-951). “Slow,

graceful movements combined with mental concentration and relaxed breathing are used

to increase and balance a person's . . . qi. When mind intent and breathing technique is

added to physical movement, the benefits of exercise increase exponentially” (Cohen,

1997).

According to Yang, et al. (2005), “[i]n classical Chinese thought, chronic pain is

considered to reflect a disturbance of the circulation of Qi, or disharmony and depletion

in the supply of Qi (p. 950). Following a pilot study, they conducted a randomized trial

to study the effects of Qi-therapy on 43 residents at senior centers in Korea. Their results

demonstrated that mood improved and pain decreased in the group that received Qi-

therapy, but not in the control group.

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Conclusion

Complementary and alternative medicine is no more a panacea than is allopathic

medicine. Chen (2004) admits that no single healer, regardless of how competent, can be

100 percent effective 100 percent of the time. And Barrett (2011) has much less

complimentary things to say about CAM. I find it particularly interesting, however, to

note the different stances these two authors take. Chen (2004) reports that the current

research may not have as rigid standards as they could, and care should be taken in future

studies to do higher quality research. But he also mentions that part of the problem might

be that we are asking the wrong questions and trying to measure the answers with tools

that we have not yet even developed. Barrett (2011), on the other hand, implies that

because some of the research has been poorly designed and reported, and that no

intervention is replicable in all circumstances, it clearly is quackery, hence the name of

his website “QuackWatch.” Never mind that allopathic medicine is guilty of the same

shortcomings.

In short, then, as long as people exist, there will be pain, and no single pain

intervention will be effective with all people all of the time. One cannot disregard CAM

simply because contemporary science does not yet understand it, nor can one expect to

find a magic wand in any particular intervention. Personally, I see pain management

tools as being similar to other tools. If this saw blade does not work, try this one. If this

pair of vise grips is too large or too small for the job, try a different size. Sometimes a

belt sander is the best for the task, while sometimes a piece of fine grit sandpaper is

needed. In other words, flexibility, an open mind, a gratifying collection of tools, and the

skills to use them are what is key in the effective management of chronic pain.
PAIN MANAGEMENT 9

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