The Bowen Technique, developed by Australian Tom Bowen in the 1950s,
is a gentle, hands-on therapy that addresses all types of musculoskeletal
pains, including fibromyalgia and TMJ. The technique uses precise,
light-pressured, rolling moves on muscle and connective tissue. This
gentle technique resets and balances the autonomic nervous system,
improves lymphatic flow, softens scar tissue, loosens adhesions,
encourages the correction of misalignments, and increases relaxation
and a sense of well-being. It can also encourage psycho-emotional
shifts. The Australian government released a report on Tom Bowen
and his work in 1975. The report found that Bowen, who saw about
13,000 patients each year, had an 80 to 90% success rate, usually
in one or two sessions.
Before his death in 1982, Tom Bowen passed his techniques on to Oswald
and Elaine Rentsch during a two-and-a-half year apprenticeship and
asked them to teach others. During the first Bowen treatment, the practitioner
performs sets of core Bowen movements, designed to balance the body.
After each set of moves, the client is left to rest for at least two
minutes, giving the body time to respond. A second treatment, one week
after the first, is usually recommended. Except for the coccal procedure,
which may induce labor in pregnant women, Bowen has no contraindications.
Joanne Whitaker, MD, however, has observed changes in some patients' blood
chemistry using microscopic live cell analysis that correspond to flu-like,
detox symptoms, lasting up to five days after a session.
The Bowen technique (aka Bowtech®) has been the subject of several
studies. In one study, people with fibromyalgia experienced varying
degrees of improvement, lasting a few days to several weeks. In another,
the technique was used on people with a frozen shoulder. Seventy percent
regained full range of motion that equalled the non-affected side,
and others experienced increased mobility. The technique has also benefitted
people with TMJ, back and hip pain, and anxiety.
Bowen, Carol. Animal Bowen® www.animalconnectionnetwork.com/205394/pages.htm (July
2005: Dead link.)
Rousselot, Patrik. Bowen Therapy Technique. www.bowentherapytechnique.com
Stiles, KG. The Bowen Technique. Massage Therapy
Journal, Summer 2003
Cancer Pain Management
Cancer pain management requires a dual approach, according to an article
by Pam Kedziera, RN, MSN, clinical manager of the pain management
center at Philadelphia's Fox Chase Cancer Center. People with
severe pain, including those with cancer, often experience two different
kinds of pain. Persistent pain is the continuous, long-term discomfort
that requires around-the-clock (ATC) medication. Frequently, however,
a moderate-to-severe flare-up, known as breakthrough pain, also occurs.
Breakthrough pain is episodic and usually lasts about 30 minutes.
Some doctors increase the dose of ATC medication in the hope of preventing
these breakthrough flare-ups; but higher doses also increase the likelihood
of adverse effects, such as sedation, nausea, and constipation. Instead,
Kedziera suggests using a long-acting opioid (e.g., controlled-release
oral morphine, fentanyl patch) at a regular, sufficient dose to manage
the persistent pain and a second prescription for short-acting opioids
like morphine or hydromorphone to take as-needed for the breakthrough
pain. Without the short-acting opioids to use as a back-up, patients
may limit their activity because they fear bringing on a flare-up of
Kedziera, Pam, RN, MSN, AOCN. The two faces of pain. RN February 1998
Ergonomics and Pain
Many times, the structural aches and pains that people experience are
caused by lifestyle habits and poor ergonomics. Inadequate arch supports
or unevenly-worn shoes can lead to an aching back or painful knees.
Sleeping on an old, flimsy mattress can make a person feel tired
and sore. Low back pain can also be caused by sleeping on the stomach.
Dr. Lynn Kelly (www.icdc.com/~drkelly/painpreventionbyposturing803.htm)
recommends sleeping on one's side using a regular-size pillow made
from fiberfill or buckwheat
hulls to support the head and neck.
In addition to the pillow under
the head and neck, using a long pillow to separate the knees and
ankles is very important, especially to low back pain sufferers.
Without this support for the upper leg and hip while lying on one's
weight of the upper leg can pull on upper hip and sacroiliac
joint, causing imbalances in the low back, resulting in sciatica
and other painful ailments.
To prevent sciatica (irritation of sciatic nerve which causes pain
down the back of the leg), Dr. Kelly cautions people to avoid
sitting unevenly. Sitting on a wallet held in a back pocket can
misalignment of the sacroiliac joint, resulting in sciatica.
Driving for long
periods with the right foot pointed outward on the gas pedal
can also irritate the sciatic nerve.
In an article on ergonomics at www.spine-health.com, Nancy C.
Selby, BS, and John J. Triano, DC, PhD, warn about more general
that can lead to pain. The first is maintaining the same posture
for over 20 minutes, which "slowly stretches the elasticity out of
the tissues" and leads to discomfort. Moving heavy loads is another
opportunity for strained muscles and trauma. Joints can also be stressed
by awkward, angled positions and by "frequent or repetitive stretching
to the end range of motion." Changing positions and doing
gentle stretches can go a long way toward reducing daily muscle
strain. For those who must spend long periods standing, the authors
suggest taking pressure off the back muscles by propping one foot
on a rail or box and changing position every 20 minutes. Standing
rubber mat and wearing shoes with cushioning and good support may
also lessen the strain of standing on a concrete floor for hours.
Hours spent before a computer—whether for work, study, or fun—can
break many of the basics for good ergonomics. A user-friendly workstation
with a chair that lets the user sit 'elbow high' to the
table surface is a necessity. In addition, knees should be level to
the hips. (A footrest or telephone book can help.) A Gannett News Service
article reports that "back and neck strain may actually be a
result of eye problems, since people will often put themselves through
weird contortions trying to see through the wrong kind of correction
lenses for computers." The article recommends positioning the
computer screen about 20 inches from the eyes at a height that is easy
to read. Some experts advise placing the screen so that eye level hits
about two inches from the top of the screen. Others say the gaze should
fall on the screen's center. The aim is to be able to sit comfortably
and read the screen, without slumping or cricking the neck. The American
Optometric Association recommends taking frequent breaks—"about
15 minutes for every 45 minutes on a computer"—and blinking
more often. Keeping the computer screen clean with a damp cloth,
eliminating glare, and increasing the font size also reduce eyestrain
Bruzzese, Anita. Beware of ailments linked to computers. The
Greenville News 15 September 2004
Kelly, Dr. Lynn. Ergonomics & Pain Prevention. www.icdc.com/~drkelly/painpreventionbyposturing803.htm
Selby, Nancy C. BS & Triano, John J., DC, PhD. Basic ergonomics.
15 May 2001, www.spine-health.com
For people who do not have cold sensitivity, ice therapy is a simple
at-home remedy for reducing pain caused by muscle strain. Whether
in the form of an ice pack wrapped in a towel to prevent ice burn
or in the form of an ice massage, ice therapy slows nerve impulses
and the pain-spasm reaction. It also slows inflammation and swelling
that often accompany muscle injury and decreases tissue damage. Ice
therapy is most effective if applied shortly after the injury. People
with rheumatoid arthritis, Raynaud's Syndrome, cold allergic
conditions, impaired sensation, or paralysis should not use ice therapy.
Ice massage therapy, according to www.spine-health.com, involves
the gentle, circular application of ice over a six-inch area. Because
ice doesn't stay in one spot for long (unlike an unwrapped ice
pack), ice burn is less of a concern. Although a regular ice cube can
be used for massage, a large piece is more effective. The web site
suggests using water frozen in a paper cup that has been peeled back
to expose the ice surface. Ice massage should not be performed on the
spinal column itself, just on the muscle. The goal is to numb the injured
area without burning the skin.
Ahh . . . Ice massage therapy for back pain relief. www.spine-health.com
Magnetic Pain Relief Device
Scientists at Lawson Health Research Institute (London, Ontario) have
invented a small device that uses a specific, pulsed, extremely low
frequency (ELF) magnetic field to reduce pain perception. They began
their research in 1995, by placing snails on a hot surface (40 degrees
C/ ˜100 degrees F). Snails prefer cool surfaces and consistently
reacted about five seconds after contact with the heat. The researchers
then gave the snails morphine before placing them on the hot surface.
With the pain killer, it took the creatures about 15 seconds to react.
Next the researchers exposed the snails to specific magnetic fields
and found one that produced the same delayed reaction as the morphine.
Having identified a pain-reducing magnetic impulse, the scientists
moved on to humans. The Lawson researchers developed a headset to deliver
ELF impulses and began testing the device on patients with either fibromyalgia
or with rheumatoid arthritis. Patients wore the headsets for 40 minutes,
at least twice a day, for one week. The scientists found "a significant
reduction of pain in fibromyalgia and a very significant reduction
of pain in arthritis patients." Alex Thomas, a bioelectromagnetics
scientist with Lawson, says that it may take ten years before the device
reaches the marketplace because of scientific controls. The magnetic
field produced by this device is weaker than the field produced by
an electric hair dryer. The device has no known side effects.
Miner, John. Small device gets rid of pain. Sun
Media 14 May 2004.
Shupak, N. et al. Effects of exposure to a specific pulsed magnetic
field on pain ratings in fibromyalgia patients: A double-blinded, randomized
control design. www.ampainsoc.org/abstract/2004/data/798/
Mind-Body Pain Management
Biofeedback teaches people to consciously alter bodily functions that
are usually involuntarily controlled, such as blood pressure, heart
rate, and brain activity. It can also help people reduce their perception
of pain. An important part of biofeedback training involves teaching
people to relax. Relaxation counteracts tension that feeds the pain
cycle. The Chronic Pain Haven web site says, "Many clinicians
believe that some of their patients and clients have forgotten how
to relax. Feedback of physical responses such as skin temperature
and muscle tension provides information to help patients recognize
a relaxed state." Biofeedback is being used to ease the pain
of many chronic or recurring conditions, such as migraine or tension
headaches. It is also used to treat digestive disorders, high/low
blood pressure, cardiac arrhythmias, Raynaud's disease, epilepsy,
and movement disorders. Because biofeedback does not address the
underlying causes of pain, responsible biofeedback therapists ask
clients to have a thorough physical exam before teaching them to
use the technique.
Biofeedback is not the only mind-body technique used to alleviate
pain and stress. Woodson Merrell, MD, Executive Director of the Continuum
Center for Health & Healing at Beth Israel Medical Center, says
that other techniques such as imagery and hypnosis are also helpful.
He believes that meditation, which disengages conscious thought and
leads to deep relaxation, is "the most effective of all." Dr.
Merrell also advocates the use of acupuncture, which he feels is underutilized. "Acupuncture
forces the nervous system to relax," he said in an interview
for the American Pain Foundation. "It raises endorphins and mitigates
the pain." Nevertheless, Dr. Merrell believes that mind-body
techniques "are the most powerful way to reduce stress in the
long-term" because they can be used at any time or place for
The American Pain Foundation. Physician Looks to Safest, Gentlest,
Most Effective Methods to Treat Pain and Stress: An Interview with
Woodson Merrell, MD. April 2002. www.painfoundation.org
The Chronic Pain Haven. Biofeedback for chronic pain control. www.chronic-pain-haven.com
Frequent pain assessment is a necessary part of any pain management
program. Because of the subjective nature of pain and the varied
responses that sufferers have to it, pain assessment takes skill.
Some patients respond to pain overtly with vocalization (moaning,
crying, screaming, gasping, and grunting) or by grimacing, clenching
their teeth, or tightly closing their eyes, and wrinkling their brow.
Others look calm and may respond to pain merely by avoiding conversation
and social contact and/or by immobilizing or being protective of
hurting body parts. Restlessness and pacing, muscle tension, rhythmic
or rubbing motions, reduced attention span, crabbiness or irritation,
and elevated blood pressure or heart rate may also indicate pain.
As Sonia R. Strevy, RN, MS, writes in her article "Myths and
Facts about Pain" (RN, February 1998), "Since only the
patient knows how much pain he's experiencing, you need to
ask him about it—at regular intervals."
A complete pain assessment includes questions about factors that
make pain worse or better, about pain quality (dull, sharp, stinging),
whether the pain is localized or radiates, about timing (constant or
intermittent), and about pain intensity. Several pain intensity scales
are available. These scales can be descriptive (no pain, mild pain,
moderate pain, severe pain, very severe pain, worst possible pain)
or be numeric (a 0–10 scale, with 0 meaning no pain and 10 equaling
worst possible pain). For children or people with diminished mental
capacity, a picture scale can be used. This scale consists of 6 faces
that correspond to the descriptive pain scale with the 'no pain' face
smiling broadly. The smile gradually turns into a frown as the series
of pictures progress to the right, until the last frowning face weeps
with "the worst possible pain."
A new pain scale for children was developed by two-and-a-half year
old Amanda Woodward and her mother Beverly Hillstrom. In February 1998,
Amanda was diagnosed with an inoperative brain tumor. Her mother told
Amanda that a ball, which wasn't supposed to be there, was in
her head. One day Amanda told her mom that the ball was green. This
specific shade of green meant that "the pain was so bad that
it made her cry very, very hard." According to Amanda, "orange
meant it still hurt a lot but not as much as green; yellow was for
less pain; purple meant it hurt just a little, and pink was for when
there was no pain at all." Amanda's doctors found that
she used the same five colors to describe her pain throughout her illness.
Amanda's mother began questioning other seriously-ill children
and found that each child had their own five-color scale that described
how much they hurt. Children who have never felt severe pain do not
identify with the color scale and begin guessing at colors.
Amanda's mother has published a book called Amanda's
Rainbow in memory of her daughter who died in October 1998. The book shows
the rainbows that Amanda and three other children used to describe
their pain levels. It also includes a pullout chart so that a child
can create her own pain intensity-rainbow that can be displayed for
caregivers. Dr. Zenon Cieslak, one of Amanda's pediatricians,
points out that colors are among the first words that a child learns.
He says that the rainbow concept "is especially appealing for
children who have lost the ability to speak, as Amanda had before she
Bains, Camille. Describing pain by colour could help kids. Canadian
Press 30 October 2002. http://chealth.canoe.ca/
Strevy, Sonia R., RN, MS. Myths & facts about pain. RN February
In its 2000–2001 standards manual for accredited healthcare facilities
and agencies, the Joint Commission on Accreditation of Healthcare Organization
(JCAHO) included pain control requirements. In order to receive accreditation,
facilities must have policies and procedures that encourage "the
appropriate use of analgesics and other pain control therapies." As
part of an accredited pain care management program, health care providers
must employ regular pain assessment and reassessment and patient education
about the importance of effective pain management.
Fears about possible addiction to pain-relieving drugs and the difficulty
of assessing pain severity has resulted in under-treatment. Professor
Harald Breivik, president of the European Federation of IASP whose
organization co-sponsored the 1st Global Day Against Pain, says that
chronic pain is a highly underestimated healthcare problem, "causing
major consequences for the quality of life of the sufferer and a major
burden on the healthcare system in the Western world." Pain causes
more than discomfort. "Acute pain may contribute to wound dehiscence
[a splitting open]," Sonia Strevy, RN, MS explains in her article "Myths & facts
about pain," or cause guarding and decreased mobility. "The
latter may contribute to pneumonia and embolism. Chronic pain diminishes
quality of life and may also bring on anxiety, depression, and a sense
The World Health Organization has outlined a three-step approach for
controlling pain. For the least severe pain, WHO recommends oral analgesics
such as acetaminophen and ibuprofen. The next step includes mild opioids
like codeine that can be used in combination with the oral analgesics
if necessary. When pain refuses to subside, WHO advises moving to the
third category: strong opioids like morphine or fentanyl (Duragesic,
Sublimaze). The goal of pain management is to keep the patients as
comfortable as possible and improve the quality of their lives.
Many clinicians use too low a dose of these strong opioids or avoid
prescribing them because they fear that patients will become addicted
to the drugs. Strevy's article marks the difference between physical
dependence and psychological dependence (aka addiction). Patients using
opioids can become physically dependent on the drugs after two or three
weeks of use, depending on the dose. Physical dependence means that
patients will experience withdrawal symptoms, if the drug is abruptly
discontinued. Patients who are physically dependent on drugs with a
short half-life (e.g. codeine, morphine) experience anxiety, chills,
irritability, hot flashes, joint pain, sweating, and/or vomiting six
to twelve hours after the last dose. Discontinuing opioid drugs with
a longer half-life (e.g. levorphanol and transdermal fentanyl) usually
results in less severe effects. Psychological dependence is a different
phenomenon. An article by R. C. Rinaldi, E.M. Steindler et al [JAMA,
259(4), 555] defines psychological dependence as the "compulsive
use of a substance resulting in physical, psychological, or social
harm to the user and continued use despite that harm." Studies
with cancer patients who have taken strong opioids for long periods
show that very few become psychologically dependent on the drugs.
Effective doses of pain medication given at regular intervals (which
avoids a see-saw effect) is just one part of pain management. Strevy's
article mentions several non-drug approaches that can reduce the need
for medication: massage, transcutaneous electrical nerve stimulation
(TENS), exercise, heat/cold applications, progressive muscle relaxation,
guided imagery, and therapeutic touch. By including these therapies
in a pain management treatment program, drug reactions and medical
Patient education is essential for good pain management. "Many
patients in pain don't ask for medication," Sonia Strevy
explains, "and many of those who do don't ask early enough
to obtain adequate pain control." Patients have diverse reasons
for not requesting pain medication. They may not want to 'bother' the
nurse. They may fear side effects from the drugs. The use of pain medication
may conflict with a cultural or religious belief, or they may believe
that their pain is "inevitable and untreatable." Explaining
the risks and benefits of pain medication will help. Patients need
to understand that forestalling pain before it takes hold and becomes
unmanageable (i.e., taking medication before a painful procedure or
increased activity) is more effective than waiting until they are in
agony before asking for help. Pain management begins by letting patients
know that "most pain can be controlled."
Acello, Barbara, RN, MS. Meeting JCAHO Standards for Pain Control.
Nursing 2000, Vol 30, No. 1.
Australian Broadcasting Corporation. Pain relief a human right: WHO.
11 October 2004. www.abc.net.au/news/newsitems/200410/s1217682.htm
Strevy, Sonia R., RN, MS. Myths & facts about pain. RN February
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) originated under
the guidance of Dr. Norm Shealy in 1967. It involves sending electrical
impulses through electrodes placed on or near a painful area. Although
it does not address the underlying cause of pain, these electrical
impulses produce a tingling sensation that reduces the pain itself.
A TENS unit is commonly used in conjunction with other pain management
therapies and can only be obtained with a prescription from a MD,
DO, or DC. TENS can ease chronic and acute pain. It is effective
in the treatment of neck and back pain, headache, migraine, arthritis,
post-herpetic neuralgia, sciatica, lumbago, fractures, tennis elbow,
muscle strains, post-operative pain, and childbirth. People using
pacemakers need approval from their cardiologist before using TENS
as the electrical impulses may prevent the pacemaker from working
correctly. Also, electrical stimulation on the front of the neck,
especially over the carotid sinus, may be hazardous.
In January 2003, Norm Shealy's SheLi TENS™ became available.
According to the Shealy Health Net web site, the SheLi TENS™ has
been "extensively tested" and "offers a superior
result." Its price of $695 includes shipping and 3 electrodes.
The SheLi TENS™ is available from Self-Health Systems, 5607 South
222nd Road, Fair Grove, Missouri 65648; phone 888–242–6105
(8am-5pm CT); fax 417–267–3102.
Masters Medical. What is TENS? TENS—Transcutaneous Electrical
Nerve Stimulation. www.masters.com.au
Shealy Health Net. The SheLi TENS™. 9 January 2003