Drug-free pain relief gains new adherents

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Drug-free pain relief gains new adherents

Tuesday, March 8, 2005

By JANUARY W. PAYNE

THE WASHINGTON POST

Gwenn Herman knows chronic pain - the regular backaches, the stiffness

and freezing 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 like meditation, guided

imagery and breathing exercises. Today, she teaches the techniques, all

of which she uses daily, to members of support groups sponsored by the

Pain Connection, a Potomac, Md.-based nonprofit organization she runs.

" What works for one person doesn't work for another, " said Herman. " The

more alternatives, the better. "

That view is likely to find more adherents following the crush of

sometimes-conflicting reports linking the highly advertised pain drugs

Vioxx and Celebrex and, more recently, the popular over-the-counter

painkiller Aleve (naproxen) to potentially life-threatening side

effects. The safety concerns led to Vioxx's removal from the market at

the end of September and the halting of a major clinical trial for

Celebrex in December.

Experts advise patients not to stop pain medications without consulting

their doctor, noting that further analysis of the data is needed and

acceptable health risks must be evaluated individually. 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 treatments, particularly those that don't

involve drugs.

Palliative effects for some of these techniques, like meditation, have

been shown in several studies. Some other methods, like guided imagery,

so far tend to rest on more anecdotal evidence.

" I find (guided imagery) extremely helpful in controlling my pain, "

said Herman. " The images that I use help give an outlet to the pain and

a pathway out of my body. "

Still waiting to be established is to what extent any of the treatments

can effectively relieve the chronic, often daily pain of those with

such conditions as arthritis, severe headaches, lupus and fibromyalgia.

Pain sufferers confused or upset by recent painkiller news got a small

dose of hope in December from a study funded by two branches of the

National Institutes of Health: the National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS) and the National Center for

Complementary and Alternative Medicine (NCCAM). That study found that

acupuncture - a 2,000 year-old Eastern practice that involves the

insertion of thin needles at specific points on the body - appeared to

help relieve pain and improve function for patients with knee

osteoarthritis.

The large study, published in the ls of Internal Medicine, assigned

about 190 of 570 patients ages 50 and older to receive acupuncture. By

week eight, these participants functioned better than those receiving

sham acupuncture or educational therapy. By week 14, those who were

getting acupuncture reported less pain than the others, but the sham

treatment group also reported pain reduction, though at a slightly

lower level.

Researchers plan to analyze the data to see if the pain relief from

acupuncture was sufficient to reduce or eliminate the need for pain

medications.

" From clinical experience, that's what we do think is happening, " said

study author Berman, director of the University of land

School of Medicine's Center for Integrative Medicine. " They may need

less of the medication, which may mean less side effects. "

Beyond special pain treatments, there are other basic steps that

doctors and experts say may help ease patient pain. Weight loss, for

example, can help relieve the pressure on arthritic joints, according

to NIAMS. Weil, professor of internal medicine and director of

the Program in Integrative Medicine at the University of Arizona, tells

patients a diet low in " pro-inflammatory fats " such as margarine can

also help ease arthritis pain.

Several non-drug approaches besides acupuncture that some doctors

regard as helpful - or at least promising - are listed below. But

there's an important caveat: 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. Experts advise against

stopping or starting any therapy - traditional or alternative — without

first consulting a physician.

Mind-body therapies

Meditation - One of the most commonly used mind-body therapies,

meditation has been shown to increase activity in parts of the brain

associated with positive emotional states, according to NCCAM. Some

studies suggest meditation may relieve pain from arthritis and other

conditions, but the pain relief reported by participants could also

have resulted from other therapies they 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. Sensors track changes in

pulse, skin temperature and muscle tone, among others, and signal

patients. Biofeedback therapists teach patients how to recognize such

changes on their own. Biofeedback has been shown to be helpful in

treating about 150 medical conditions, including migraines, arthritis

and fibromyalgia, according to the Mayo Clinic.

Hypnosis - " You can learn to change the perceptions of pain, " Weil

said. An NCCAM-funded 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 to confirm early findings, according to Harvard

Medical School, through its online partner Aetna InteliHealth.

Cognitive behavioral therapy - " Thoughts and emotions can affect pain, "

Berman said, so 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 to see if this

helps patients cope with the disease. 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, according to NIAMS. Light exercise regimens, physical therapy,

pool exercise and " movement therapies " such as tai chi are recommended

as good starting points for many patients.

Osteopathic manipulation - Manipulation of the joints " restores the

normal range of motion of a particular joint, (and) can restore the

normal blood flow and drainage to an area, " said Levine, an

osteopathic physician in New Jersey and a member of the board of

trustees for the American Osteopathic Association. Growing evidence

suggests that osteopathic manipulation may ease low back pain and may

be useful for a variety of other conditions, including depression,

fibromyalgia, menstrual pain and neck pain, according to Harvard.

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. Harvard counts at least 150 published studies or case

reports on chiropractic manipulation therapy for patients with low back

pain, but many are poorly designed and results are mixed. Several

studies have also shown pain relief for patients with tension or

migraine headaches, but most of these studies were also poorly

designed, according to Harvard.

Massage - The stroking or kneading of sore muscles by a therapist can

increase blood flow to painful areas, sometimes providing relief,

according to NIAMS. But arthritic joints are sensitive, so patients

should go to a therapist trained in handling the disease. Some studies

suggest improvements in low back pain from massage techniques, though

most of the studies were not well designed, according to Harvard.

Preliminary research also shows that massage may help relieve chronic

pain from musculoskeletal conditions. But more studies are needed to

confirm the results.

Herbs and supplements

Glucosamine and chondroitin sulfate - " There's a fair amount of

evidence that shows that (supplements containing glucosamine and

chondroitin) can help, especially for arthritis pain and inflammation, "

Berman said. The cartilage building blocks - glucosamine is a glucose

derivative that some experts believe may help cartilage form and repair

itself; chondroitin sulfate is part of a large protein molecule that

gives cartilage elasticity - are made into supplements from shellfish

and other animal tissue. A study sponsored by NCCAM and the Department

of Veterans Affairs 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, according to Harvard. An

NCCAM-funded 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 - Weil calls the combination, available as a

supplement, a " very effective herbal anti-inflammatory (that) works as

well as NSAIDs (nonsteroidal anti-inflammatory drugs). " But the Mayo

Clinic finds little evidence to support an anti-inflammatory benefit.

NCCAM is funding a study to see if these botanicals reduce inflammation

associated with arthritis and asthma. It's also funding a center at the

University of Arizona to investigate their benefits.

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, according to NIAMS. 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, according to NIAMS.

Transcutaneous Electrical Nerve Stimulation (TENS) - The wearing of a

small, portable electric stimulation unit may help ease pain

temporarily, according to NIAMS, by blocking pain messages to the brain

and modifying pain perception. The unit sends mild electric pulses to

nerve endings under the skin in the painful area.