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    Pain Management: Exploring the Alternatives


    Pain Management: Exploring the Alternatives

    If you suffer from chronic pain, there may come a time when you feel that conventional medical treatments aren't doing enough -- or, in the case of harsh side effects, that the treatments are doing too much.

    Alternative approaches typically promise greater relief with fewer side effects, but they're not as well-studied as conventional treatments, and the array of choices can be bewildering.

    Because many alternative treatments aren't subject to the same rigorous testing and approval processes of conventional medicine, you should evaluate their risks.

    A Growing Trend
    According to the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, Americans spent more than $27 billion on alternative therapies in 1997, including herbal medicine, massage, megavitamins, folk remedies, energy healing and homeopathy. According to NCCAM, complementary and alternative therapies are generally holistic in nature, encompassing psychological and spiritual aspects in addition to physical aspects, and this contributes to their growing appeal.

    Yet many of the people embracing alternative treatments aren't telling their doctors, and this creates a risky situation. Despite the fact that vitamins, herbal remedies and nutritional supplements can interact dangerously with certain prescription drugs, a 1999 Arthritis Foundation survey found that only 40 percent of respondents had told their doctors that they were using alternative treatments. The survey indicated that reasons for this silence ranged from fear of the doctor's disapproval to a belief that the doctor wouldn't know enough about alternative medicine to offer guidance.

    Bridging the Gap
    The good news is that many doctors aren't as disapproving as their patients seem to think. The same Arthritis Foundation survey revealed that 85 percent of the doctors surveyed believe that some alternative therapies may be effective, and nearly half the doctors recommend some of them to their patients. Perhaps more surprising was the overwhelming response (84 percent) in favor of increasing funding for research on alternative treatments.

    Any alternative therapy should be discussed with your doctor, even if you think he or she will respond negatively. And herbal treatments or dietary supplements should also be discussed with your pharmacist. "I need to see all the medications a person is taking," said Houston pharmacist Consuelo Worley. "Many medications and conditions are contraindicated, and someone buying over-the-counter remedies may not know that."

    The Arthritis Foundation recommends that you first ask your doctor what he or she knows about the alternative treatment you're considering, and listen to the response. Do your homework ahead of time so you can share information with your doctor if he or she isn't familiar with the therapy. Established sources such as medical journals will probably bring the best response. If your doctor approves (or at least doesn't disapprove) of the treatment, ask for a prescription or referral, and see if your health insurance covers the therapy.

    William R. Work, M.D., a board-certified family practitioner and medical director of the Community Hospice of Fresno, said, "The physician should be approached in a non-confrontational way. For example, if a patient were to come in and demand to know why I wasn't offering him reflexology treatments and accuse me of just wanting to pump him full of pills, then he or she will lose the therapeutic relationship that they had with me, and it will take a lot to regain what was lost. But if this same patient comes in and shows me something on an alternative treatment and asks what I think, then I am more willing to 'go outside the box.'" Work pointed out, however, that patients must understand that what they are requesting is not the normal treatment, and that a delay in standard treatment could cause serious damage.

    What's Out There?
    Alternative and complementary medicine encompasses a wide range of treatments. The following is a list of some techniques that people have used, along with a brief description of how they work from the Arthritis Foundation's book Guide to Alternative Therapies.
    Acupuncture -- Originating in China more than 3,000 years ago, acupuncture uses the insertion of thin, sterile needles along specific pathways called meridians. According to licensed acupuncturist Patti McCormick, the traditional view of acupuncture holds that this improves the circulation of life force energy, or "qi" (pronounced "chee"), throughout the body. From a Western point of view, she adds, the needles stimulate the circulation of blood, endorphins and cortisol, which is the body's natural painkiller.
    Ayurveda -- From the Indian term for "science of life," this comprehensive system involves a vegetarian diet, meditation, yoga, massage and more. Ayurveda is more of a lifestyle than a simple therapy.
    Body learning and awareness -- Three popular mind/body techniques are Alexander, Feldenkrais and Trager. Each focuses on posture, breathing, balance and movement, but with subtle differences in technique. Yoga and tai chi are more advanced mind/body therapies.
    Chinese medicine -- Based on the premise that life stems from the balance of yin and yang energies, Chinese medicine seeks to balance these properties in the body through acupuncture, herbs, and, sometimes, dietary changes or meditation.
    Chiropractic -- Chiropractors manually adjust the spine to correct the alignment of vertebrae. Some also use ancillary treatments such as massage, nutritional counseling and ultrasound therapy.
    Osteopathy -- Like chiropractic, osteopathy seeks to correct the alignment of the spine and joints, but osteopathy also focuses on soft tissue, blood circulation and various natural medicine techniques.

    Get Informed to Get Healthy
    Whichever remedy you consider, be sure to gather as much information as possible before committing to it. Work recommends using reputable sources such as medical journals and the National Library of Medicine's MEDLINE search system to find studies and scientific evidence for -- and against -- the treatment.

    NCCAM warns that words like "cure," " miracle" and "secret formula" should be red flags. Once you have done the appropriate research on an alternative or complementary treatment that interests you, take that information to your doctor. The two of you can work together to better manage your pain.


    The Risks of Herbal Remedies

    If you opened up a box of bran flakes and found cookies instead, you would know immediately that something was amiss. But what if your ginseng supplements had significantly less ginseng than the label stated? Or what if your herbal remedy was contaminated with digitalis, a drug that can dangerously alter your heart rate? How would you know?

    You wouldn't. Worse yet, Marcia Angell, M.D., and Jerome P. Kassirer, M.D., wrote in the Sept. 17, 1998, New England Journal of Medicine that these and other anomalies are occurring, and they are putting Americans at risk every day.

    Richard J. Ko, Pharm.D., Ph.D., writes in the same issue that a California Department of Health Services test of 260 Asian patent medicines found disturbing inconsistencies. At least 83 of the remedies contained undeclared pharmaceutical ingredients, such as ephedrine, chlorpheniramine and methyltestosterone, or heavy metals, including lead, arsenic and mercury.

    According to Angell and Kassirer, the problem lies in the lack of regulation of herbal remedies and nutritional supplements. The Dietary Supplement Health and Education Act of 1994 allows dietary supplements to be sold without approval by the U.S. Food and Drug Administration. For conventional medicines, FDA approval is a critical step before reaching consumers.

    What should consumers do? Angell, Kassirer and Ko argue that the government should take a more active role in screening and regulating herbal remedies and nutritional supplements, but in the meantime, consumers must educate themselves about the possible risks -- as well as the benefits -- of herbal treatments. Even a safe herbal remedy can interact dangerously with a prescription drug or another herb, so it is critical to consult your doctor or pharmacist before taking anything new, even over-the-counter vitamins. And if you have a bad reaction to an herbal remedy or supplement, stop using it and contact your doctor immediately.


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