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January 24, 2005
Warnings about three common pain relievers prompt interest in nontraditional treatments.
BY JANUARY PAYNE
Washington Post
Gwenn Herman knows chronic pain -- the regular backaches, the stiffness of her neck after her 1995 car accident, the pain that didn't respond, or responded inconsistently, to prescription and nonprescription painkillers.
That's why she learned, long before the recent rash of safety alerts about three commonly used pain medications, to explore alternative treatments such as meditation, guided imagery and breathing exercises.
That view is likely to find more adherents following reports linking the prescription pain drugs Vioxx and Celebrex and, more recently, the popular over-the-counter painkiller Aleve (naproxen) to potentially life-threatening side effects.
Experts advise patients not to stop pain medications without consulting their doctor. The drugs now subject to so much publicity may remain the best choices for some patients. Nonetheless, the reports have focused more attention on alternative pain relief.
Palliative effects for some techniques, such as meditation, have been shown in several studies. Other methods, such as guided imagery, so far tend to rest on more anecdotal evidence.
Even non-drug treatments can be dangerous. Some treatments can interact with prescription and over-the-counter medications. Excessive doses of supplements may cause harmful side effects. And pursuing alternative treatments in place of necessary conventional care can create additional dangers.
Don't stop or start any therapy -- traditional or alternative -- without consulting your doctor. But if you're looking for relief, here are some possibilities to consider:
Mind-body therapies
Meditation -- Meditation has been shown to increase activity in parts of the brain associated with positive emotional states. Some studies suggest meditation may relieve pain from arthritis and other conditions, but the pain relief could also have resulted from other therapies participants were receiving. Clinical trials are investigating the pain-relieving effects of meditation on patients with rheumatoid arthritis and other chronic conditions.
Biofeedback -- This technique teaches patients to control functions such as heart rate, muscle tension, breathing, skin temperature and blood pressure to relieve stress and chronic pain.
Biofeedback has been shown to be helpful in treating about 150 medical conditions, including migraines, arthritis and fibromyalgia.
Hypnosis -- A clinical trial is exploring whether hypnosis and other nontraditional therapies can ease muscle tension in children with spastic cerebral palsy. Studies suggest a benefit from hypnosis for patients with many different types of pain, including low back, tension headache, osteoarthritis and chronic pain. But larger, better-designed studies are needed.
Cognitive behavioral therapy -- Cognitive behavioral therapy -- a kind of talk therapy that helps people recognize and change negative behaviors -- may help relieve the depression, stress and chronic pain that can accompany disabling diseases. Duke University researchers have developed a talk therapy program for arthritis patients and their spouses. They are exploring whether patients' aerobic fitness or coping abilities decrease their pain or disability.
Hands-on treatments
Exercise and movement therapy -- A regular program of physical movement is sometimes helpful in relieving pain. But patients should use care when selecting a workout regimen, as overexertion can cause additional pain. Light exercise, physical therapy, pool exercise and "movement therapies" such as tai chi are recommended as good starting points.
Osteopathic manipulation -- Manipulation of the joints restores the normal range of motion of a particular joint and can restore the normal blood flow, said Martin Levine, a member of the board of trustees for the American Osteopathic Association. Growing evidence suggests that osteopathic manipulation may ease low back pain and be useful for a variety of other conditions, including depression, fibromyalgia, menstrual pain and neck pain.
Chiropractic treatments -- Spinal manipulations, focusing on the relationship between the body's structure (primarily of the spine) and function, are mainly used to treat musculoskeletal conditions. Evidence of benefits from chiropractic treatments varies with the condition being treated.
Massage -- The stroking or kneading of sore muscles by a therapist can increase blood flow to painful areas, sometimes providing relief. But arthritic joints are sensitive, so patients should go to a therapist trained in handling the disease. Preliminary research shows that massage may help relieve chronic pain from musculoskeletal conditions. But more studies are needed.
Herbs and supplements
Glucosamine and chondroitin sulfate -- Some experts think glucosamine may help cartilage form and repair itself; chondroitin sulfate is part of a large protein molecule that gives cartilage elasticity. A study is exploring whether this combination treatment is more effective than placebo in treating osteoarthritis of the knee. The study will also look at whether either supplement alone is more effective than the combination.
Omega-3 oils -- There is some evidence that capsules containing these oils may reduce pain, inflammation and stiffness associated with rheumatoid arthritis, but not osteoarthritis. A study is investigating whether a combination of fish oil and borage seed oil may work better for rheumatoid arthritis than either oil alone.
Turmeric and ginger -- The combination, available as a supplement, is being studied to see whether it can reduce inflammation associated with arthritis and asthma.
Other alternatives
Heat/cold therapy -- Applying heating pads or cold packs to sore joints and muscles may ease pain temporarily. But arthritis patients should consult their doctors or physical therapists because the recommendation for cold or heat varies with arthritis type. Moist or dry heat or an ice pack can be placed on the sore area for about 15 minutes to relieve pain. Patients with poor circulation should not use cold packs.
Transcutaneous electrical nerve stimulation (TENS) -- The wearing of a small, portable electric stimulation unit may help ease pain temporarily by blocking pain messages to the brain and modifying pain perception.
Copyright 2004 Knight Ridder. All Rights Reserved.
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