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judge the effectiveness of sessions over time. Develop a resource list that includes books, pain clinics, local support groups, mental health professionals, and referrals to other health-care providers like acupuncturists, chiropractors, naturopathic physicians, orthopedic surgeons, and physical therapists who may provide useful services. PAIN MANAGEMENT AND MASSAGE Research has shown that massage effectively reduces pain. Although the mechanism by which pain is reduced is not always clear, certain techniques have proven reliable. Promote Relaxation. Any type of pain information received by the brain signals a threat to survival, and so triggers the fight-or-flight response of the sympathetic nervous system. The increase in blood pressure, heart rate, breathing rate, and blood flow to voluntary muscles, the heart, and lungs is often accompanied by mental and emotional anxiety, anger, and fear. Norepinephrine, one of the neurotransmitters that mediate the fight-or-flight response, enhances transmission of nerve impulses, increasing the intensity of pain. Stress increases the sensation of pain, and pain increases stress. Massage can help reduce the stress through the parasympathetic nervous system response. Break the Pain-Spasm-Pain Cycle. In this persistent cycle, pain triggers muscle spasms, muscle spasms cause decreased blood flow and a buildup of metabolic wastes in the tissue, leading to pain, which then triggers more muscle spasms and a recurrence of the cycle. Massage breaks the cycle by reducing muscle spasms, triggering the parasympathetic nervous system response to reduce sympathetic firing, and increasing circulation to the local area, which removes metabolic wastes, thereby reducing pain. Use the Spinal Cord's Gating Mechanism to Reduce Pain. Because the spinal cord has a limited ability to attend to multiple sources of sensory stimuli at one time, pain stimuli traveling on the slower C-fiber axons can be locked out when lots of sensory stimuli (such as that caused by massage) are traveling to the brain. Dull, aching, or throbbing pain, the type often associated with chronic conditions, can be blocked by somatic stimuli like massage. Use Thermal Applications. Cold applications like ice packs or ice massage are most appropriate for acute pain, as they cause vasoconstriction of blood vessels and slow the metabolic process of cells, allowing them to survive a period of hypoxia, which reduces the zone of secondary injury. Cold applications have a numbing effect on the tissue and reduce the velocity of pain stimuli transmissions. Heat is most often used for chronic conditions because it increases circulation to the local tissue, improving the condition of the tissue through enhanced oxygen, nutrient, and waste exchange to decrease muscle spasm. Heat lowers pain perception because it slows the conduction of pain stimuli to the brain and sedates the central nervous system to aid relaxation. Reduce Trigger Points. Trigger points are hypersensitive spots that usually occur within a taut band of muscle or fascia and cause the affected muscle to be shortened. Trigger points have a predictable pain referral pattern. They are related to tissue ischemia (vasoconstriction and decreased circulation) FACTORS THAT DECREASE PAIN FACTORS THAT INCREASE PAIN Counseling from a mental health specialist Positive internal dialogue Program of strengthening and conditioning, based on physical therapist recommendations, to maintain available activity levels Relaxation techniques (e.g., massage, meditation, hypnosis, etc.) Thermal therapies (e.g., hot baths, hot packs, ice, etc.) Distraction methods to remove focus from pain Conflict Depression Faulty body mechanics/ poor posture Inactivity Increased focus on pain Increased stress levels Negative internal dialogue Pain avoidance behaviors Progression of a pain- causing disease Overactivity Sleep disturbances 36 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4