Complementary Treatments for Pain

Terrence Auyeung wasn’t prepared for the unexpected during the morning commute to his Redwood City, California, office. But suddenly his Subaru began to fishtail on a winding mountain road, and he narrowly avoided skidding off a steep hill. It was a close call, and Auyeung counted his blessings. Three days later, however, he began feeling excruciating shoulder pain, probably from slamming into the side of his car during the accident.

But Auyeung wanted to avoid taking medications for pain, and although he had never seen an acupuncturist before, he decided it was time to try something other than drugs. Two times a week for three weeks, the acupuncturist inserted thin needles in his shoulder to relieve the pain. When it was over, Auyeung noticed a big difference in his ability to move his shoulder.

“The pain was all gone,” the 31-year-old engineer said. “It worked.”

Many people who suffer from chronic pain eventually look beyond prescription medicines for relief. Some worry about the cost or side effects of drugs, some feel that mainstream treatments aren’t effective enough to handle their pain, and some merely want to explore all their options.

There’s certainly no shortage of alternatives. Over the centuries, hucksters have proposed countless “remedies” for pain relief, including bee stings and snake oil. Before trying an alternative remedy for pain, talk with your doctor. Doctors may not be experts in alternative medicine, but some have incorporated complementary medicine into their practices. Even if they haven’t, most can help you find the information you need to make a decision about what treatment may be best for you. Your physician can investigate the source of your pain, ruling out a disease such as cancer, and help you find alternative remedies that can bring relief without risking your health.

Some alternative remedies really do ease pain and can be valuable additions to medical therapy, hence the term “complementary therapies.” Others may even substitute for it, in which case their use is known as “alternative medicine.” More and more, pain centers are integrating acupuncture, biofeedback, therapeutic massage, and hypnosis into their practices, and many physicians trained in pain management are referring patients suffering from chronic pain to these therapies.

Here’s a brief look at some of the most popular — and scientifically proven — complementary remedies for pain.

Common alternative therapies

Acupuncture. A 5,000-year-old practice that originated in China, acupuncture involves stimulating certain points of the body with hair-thin needles to promote healing. Scientists are just beginning to understand how acupuncture works, but many studies are under way to discover more.

Although no one has been able to fully explain how acupuncture works within the framework of Western medicine, the National Center for Complementary and Alternative Medicine (NCCAM) proposes that acupuncture helps by stimulating the activity of pain-killing chemicals such as endorphins and immune-system cells. The NCCAM also cites studies showing that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones, affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes that regulate a person’s blood pressure, blood flow, and body temperature.

As reported in the Annals of Internal Medicine in 2006, more than half of all patients who underwent acupuncture reported significant relief six months later compared with just 29 percent of the patients who had typical treatments consisting of prescription pain relievers and regular doctor visits.

Another German study of 298 patients with lower back pain found similar results: As reported in a 2006 issue of the Archives of Internal Medicine, 12 sessions of acupuncture brought pain relief that was still evident one year later. By design, some of the acupuncture patients received a shortened version of the usual procedure. Surprisingly, these patients reported just as much relief as the patients who underwent the full course.

Biofeedback. This technique helps patients reduce their pain by giving them more control over their own bodies. Biofeedback users learn how to harness brainpower to increase their circulation or relax their muscles. Around the country, pain centers are incorporating biofeedback into their treatments, often in concert with other relaxation therapies such as meditation.

Biofeedback is most useful for stress-related pain, especially migraines and tension headaches. A meta-analysis published in the journal Pain found that a combination of biofeedback and relaxation cut migraine pain by 43 percent. Biofeedback can also ease the pain of chronically sore backs, necks, and shoulders.

The method helps relieve some of the most serious and vexing forms of pain. A report from the American Cancer Society notes that biofeedback may be able to ease pain and “improve the quality of life” for some cancer patients. The therapy has not been shown to be helpful for sudden, severe lower-back pain and other aches caused by temporary injuries, which are best addressed by your physician.

Relief with herbs

Herbal remedies. Not every herbal product lives up to its claims, but some really do seem to ease pain. For example, some studies have shown that peppermint — the common ingredient found in gums and teas — may be effective in treating tension headaches and irritable bowel syndrome.

In addition, a 2006 scientific review found “strong evidence” that the herb devil’s claw can offer short-term relief of back pain. As reported in the Cochrane Database of Systematic Reviews, the herb was as effective as 12.5 milligrams of the prescription medicine rofecoxib (Vioxx) — now off the market due to safety concerns. The same review found “moderate evidence” that white willow bark can bring temporary relief from pain. Likewise, a review published in the Clinical Journal of Pain found that devil’s claw, capsaicin (an extract from hot peppers), and a mix of oils from avocados and soybeans may appear to reduce pain from osteoarthritis. None of these studies were definitive, but together they do suggest that some herbal remedies may safely relieve pain in certain circumstances.

You’ll definitely want to talk to your doctor and do some of your own research before trying an herbal remedy. If the product really does help, your doctor may be able to cut back on your other treatments. He or she can also warn you about potential conflicts with your medications. Remember, these herbs have effects just like any drug, but they have not been tested as rigorously for safety and efficacy. The Food and Drug Administration doesn’t regulate herbs and supplements to ensure that what is in the bottle matches the ingredients stated on the label, and tests of different brands of herbs vary widely on how much of the key ingredients they contain. Buyers definitely have to beware.

Massage. Massage is an “alternative” therapy that is quickly going mainstream. As reported in the journal Rheumatology, 71 percent of doctors say they have referred patients to massage therapists. A good massage can increase blood flow and warm muscles, and, yes, ease pain, especially back pain and arthritis.

Massage is generally very safe, but the National Center for Complementary and Alternative Medicine says it should be avoided by anyone with bleeding disorders, people taking blood thinning medication like warfarin, anyone with low blood platelet counts, people with blood clots, fractures, open or healing wounds, skin infections, weakened bones (from osteoporosis or cancer), or someone who has had a recent surgery; pregnant women or people with chronic conditions should also consult their doctor before seeking massage. (If you’re pregnant, it’s also important to seek out a massage therapist with a specialty in prenatal massage; if you have cancer, look for a specialist in oncology massage.) The University of Washington Department of Orthopaedics and Sports Medicine also warns against massaging joints that are swollen or extremely painful. The university offers this succinct advice: If massage causes pain, stop.

Controversy over chiropractic

Chiropractic. Chiropractic is a 100-year-old practice that uses noninvasive means to restore and improve health. Its tools include manipulation of the joints and surrounding tissue — including muscles, tendons, and nerves — to treat neck and back pain, joint pain, headache, muscle aches, and other health problems.

Although it’s a widely used complementary treatment for pain, there’s no medical consensus on its value. While some studies have found that spinal manipulation can relieve low-back pain, many other studies have found no such benefits. Most studies have focused on back pain, and the overall results are not that impressive.

A survey of scientific studies published between 1996 and 2003 led the National Center for Complementary and Alternative Medicine to this conclusion: “Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain.”

Recent medical research has also linked, in extremely rare cases, a particular chiropractic treatment with stroke. A number of peer-reviewed neurology journals and the Stanford University Medical Center’s stroke center have reviewed reports of strokes in patients who have received spinal manipulation for the treatment of neck pain.

A study published in a peer-reviewed chiropractic journal, the Journal of Manipulative Physiological Therapy, found that the incidence of stroke following manipulation of the neck was low, but concluded that “there seems to be sufficient evidence to justify a firm policy statement cautioning against upper cervical rotation as a technique of first choice.” Neurologists warn that any patients with an increase in neck pain after spinal manipulation should see a physician immediately.

In the context of health care procedures, however, chiropractic treatments have a good safety record. About 20 million people see a chiropractor each year, and only a handful report serious injuries. If you do opt to try chiropractic, find a practitioner who has extensive experience treating patients with your type of pain.

As for Auyeung, he’s returned to the acupuncturist — this time to relieve pain from a knee injury he got from playing basketball.

“You don’t see any side effects, like when you take medicine,” Auyeung said.


Interview with Terrence Auyeung, an engineer and pain sufferer

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