View Full Version : Painkiller alerts give alternatives a boost

01-18-05, 01:57 PM

January 11, 2005

Gwenn Herman knows chronic pain - the backaches, 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 last month's 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 to support groups sponsored by the Pain Connection, a Potomac, Md.-based nonprofit she runs.
"What works for one person doesn't work for another," Herman said. "The more alternatives, the better."

That view is likely to find more adherents after last month's 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 last month.

See a doctor

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.

Palliative effects of some of these techniques, like meditation, have been shown in several studies. Other methods, like guided imagery, so far tend to rest on anecdotal evidence.

Debate on effectiveness

Still 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 last month from a study funded by two branches of the National Institutes of Health: the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Center for Complementary and Alternative Medicine. That study found that acupuncture - a 2,000-year-old Eastern practice that involves insertion of thin needles at specific points on the body - appeared to help relieve pain and improve function for knee osteoarthritis.

The large study, in the Annals of Internal Medicine, assigned about 190 of 570 patients ages 50 and older to receive acupuncture. By Week 8, 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, at a slightly lower level.

Researchers plan to analyze data to see whether pain relief with acupuncture was reduced or eliminated need for pain medications. "From clinical experience, that's what we do think is happening," said study author Brian Berman, director of the University of Maryland School of Medicine's Center for Integrative Medicine. "They may need less of the medication, which may mean less side effects."

There are other basic steps that doctors and experts say may help ease pain. Weight loss, for example, can help relieve the pressure on arthritic joints, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Several non-drug approaches besides acupuncture that some doctors regard as helpful - or at least promising - are listed below. But 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 consulting a physician.

Mind-body therapies

Meditation: Some studies suggest that meditation may relieve pain from arthritis and other conditions, but the pain relief reported by participants also could 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 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," said Andrew Weil, professor of internal medicine and director of the Program in Integrative Medicine at the University of Arizona. A clinical trial funded by the National Center for Complementary and Alternative Medicine is exploring whether hypnosis and other nontraditional therapies can ease muscle tension in children with spastic cerebral palsy. Studies suggest hypnosis helps 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 whether this helps patients cope with the disease. They are exploring whether aerobic fitness or coping abilities decrease pain or disability.

Hands-on treatments

Exercise and movement therapy: A regular program of physical movement sometimes helps in relieving pain. But patients should use care when selecting a workout regimen, as overexertion can cause additional pain, according to the Institute of Arthritis and Musculoskeletal and Skin Diseases. Light exercise, physical therapy, pool exercise and "movement therapies" such as t'ai 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 and drainage to an area," said Dr. Martin Levine, an osteopath 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 aid various 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.

Harvard counts at least 150 published studies or case reports on chiropractic manipulation therapy for low back pain, but many are poorly designed, and results are mixed.

Several studies also have shown pain relief for patients with tension or migraine headaches, but most of these studies also were 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 the Institute of Arthritis and Musculoskeletal and Skin Diseases. But the therapist should be trained in handling arthritis.

For more information

Find more information about alternative and non-drug pain relief therapies:

National Center for Complementary and Alternative Medicine,

Offers treatments, research findings, safety advice for choosing herbal supplements and tips for selecting a practitioner. The NCCAM Clearinghouse (888-644- 6226) will answer general questions but not provide medical advice or physician referrals.

Office of Dietary Supplements, www.ods.od

An arm of the National Institutes of Health, ODS has fact sheets on dietary supplements. The office does not have a public information clearinghouse and advises patients to consult their doctors for advice.

Mayo Clinic's Complementary & Alternative Medicine Center, www (Under "Health Centers" heading on left side of screen, scroll down and select "Complementary & Alternative Medicine").

Provides information on a variety of therapies as well as advice on herbs and supplements. Addresses safety concerns and which therapies are commonly used for specific conditions.,0,3153707.story?coll=ny-health-headlines