Complementary Pain Management Techniques

 

Acupuncture

In an extensive review of 69 papers on acupuncture for chronic pain, it was concluded in Pain 2000 Jun;86(3):217-25 that there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care.

Following spinal cord injuries, 50% of those receiving acupuncture will improve and 27% will become worse after the treatment. (Arch Phys Med Rehabil 2001 Nov;82(11):1578-86). Acupuncture appears to work partially by specific areas of brain activation, particularly the left Anterior Cingulus, the Insulae bilaterally, the Cerebellum bilaterally, the left Superior Frontal Gyrus, and the right Medial and Inferior Frontal Gyri. Most of the activated areas are shared with areas activated in acute and chronic pain states as described in the literature. (Neuroimage 2001 Jul;14(1 Pt 1):60-6).

Overall, our experience with acupuncture is that it will help half to two thirds of all patients, but the effect is short term requiring repeated acupuncture treatments. Generally acupuncture is not covered by insurance.

Magnetic Therapy

There are many who sell repackaged refrigerator magnets for an enormous markup as inserts for shoes, wrist bands, magnet embedded mattresses, or in pads that are placed on the back or forehead.

One study, Altern Ther Health Med 2001 Sep-Oct;7(5):92-5, found significantly lower magnetic properties of commercially available magnets than that claimed by 5 different manufacturers. The flux density of magnets is related to their penetration depth into the skin and muscle. Lower flux densities as measured in the above study creates significant doubt as to the validity of the manufacturers claims and makes study of magnetic therapy with controlled studies impossible.

Do magnets work in chronic pain therapy: In a 6 month magnet study in patients with fibromyalgia, the pain intensity level was marginally significantly lowered while the functional status, , tender point count, and tender point intensity after 6 months of treatment did not differ significantly from changes in the Sham group or in the Usual Care group. J Altern Complement Med 2001 Feb;7(1):53-64

A rheumatology review of low back pain treatments concluded magnets have marginal benefit. Curr Opin Rheumatol 2001 Mar;13(2):128-34

In a pilot study published in JAMA, there was no difference in back pain after magnet treatment vs. sham magnet treatment. JAMA 2000 Mar 8;283(10):1322-5

Some of the more astute marketeers have touted the use of quadrupole magnets in an array to enhance pain reduction. However a study comparing a single regular magnet vs. magnetic array failed to find any differences in pain reduction. Arch Phys Med Rehabil 2001 Oct;82(10):1453-60

With a paucity of information demonstrating any beneficial effect at all, it appears based on currently available data, Americans are being duped into purchasing expensive static magnets which have little or no demonstrable effect. On the other hand, pulsed electromagnetic therapy, not available in the US, has a long history of demonstrable pain reduction. The field strength in this therapy is much higher than the simple refrigerator magnets sold for medical uses. One study demonstrated 76% of patients treated for migraines and other headaches, had significant improvement whereas only 2.5% of placebo patients felt significant relief. Adv Ther 2001 May-Jun;18(3):101-9

Massage Therapy

Pain has been effectively managed for thousands of years with massage. However, not all massage is of the same type, and certain types of massage such as Rolfing, should never be permitted since this therapy has in more than one case, caused rupture of the liver. Vigorous neck massage, such as Shiatsu, has resulted in retinal and cerebral artery embolism (Stroke. 2001 Oct;32(10):2441). Occasionally, other side effects are noted such as cardiac arrest with neck massage or migration of a urinary stent (WMJ. 1997 Dec;96(12):57-8.) Massage does not always produce a positive pain benefit as was suggested in a study of foot reflexology in cancer patients which did not produce a significant difference in pain, but did reduce anxiety. (Oncol Nurs Forum 2000 Jan-Feb;27(1):67-72). Most interestingly was a study published in Spine which revealed the persons attitude towards treatment may have more influence than the treatment itself. In this case, patients with a positive attitude towards massage had better outcomes than they did when undergoing acupuncture, whereas the same was true for those with better attitudes towards acupuncture vs. massage. Overall, however, for patients in chronic pain, the outcomes depend on attitude and on the willingness to utilize the benefits of massage to improvement movement. Massage therapy is a method of connecting to even the most obtuse patient and does appear to have some benefit in pain management.

Biofeedback

In the realm of chronic pain, biofeedback has been found to be useful in the treatment of headaches and moderately useful in other aspects of chronic pain. The actual reduction in pain is often less than the increase in function and integration with work and activities of daily living. Other uses of biofeedback, such as treatment of phantom limb pain, neuropathic pain, and cancer pain are investigational at this time.

Herbal Products

Many herbal products are touted as being effective for pain management including MSM (methylsulfonylmethane) which is an oxidized product of the old standard DMSO. At levels of 1-5 grams per day, in small series this has been effective. Germanium (the mineral, not the flower geranium) at doses of up to 2,000mg a day are touted as being as effective as narcotics for cancer pain and for chronic non-malignant pain. Melatonin has been proven to help regulate sleep and thereby decrease chronic pain in fibromyalgia patients. Yan Hu Suo is a pain relieving mixture of drugs derived from the Chinese herb Fumewort which is touted to be as strong as morphine. It is given in doses of around 10g per day in divided doses. 5-HTP is a precursor to serotonin and may be useful in doses of 150-900mg per day in the treatment of obesity, depression, and fibromyalgia pain. Most herbal cures have not been tested in any scientific manner with much of the hype as merely anecdotal in nature. Caveat emptor.

Homeopathy

The administration of a parts-per-million mixture of toxins and drugs which are meant to stimulate certain cleansing defenses has been used for decades. The therapy is to be individualized by a homeopath. Unfortunately, there is little clinical evidence for any efficacy at all and the homeopathic drugs sold in nutritional centers have been found to contain (very high and unreported on the label) doses of ephedrine, steroids, etc. rather than the product which was touted. The entire "science" of homeopathy should be avoided at this time since it appears to rest on case reports without evidence of safety or efficacy.

Chiropractic

Although the science behind chiropractic is suspect, the results appear to be equal to that of allopathic medicine with respect to patient pain relief and better with respect to overall satisfaction in the treatment of low back pain. Unless the patient has an unstable or severely osteoporotic spine, chiropractic for low back pain can be useful. Combining anesthesia with chiropractic can also be useful in a technique known as MUA, or manipulation under anesthesia. At this time, we do not recommend most patients have chiropractic in the neck due to the much finer structures which are easier to dislocate or fracture than the lumbar spine. But there are reputable practitioners who can perform cervical chiropractic. Ask us if you have questions regarding which chiropractors are recommended.

Mind-Body Techniques

There are several non-invasive spiritual or mind control techniques which are very useful in pain management. Self hypnosis, progressive relaxation, meditation, focal imagery, religious worship, craniosacral therapy, energy field therapy have all been demonstrated to have some potential benefit in controlling the symptoms of pain. We encourage patients to explore these and other such techniques on their own based on their religious and social values.

Mild yoga and Tai Chi are methods of focus and distraction from pain which can be very useful.

 

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