Many people are uncomfortable with the idea of taking a pill regularly for pain relief. Here are some alternatives.
By Dulce Zamora
Reviewed By Charlotte Grayson
Merck & Co.'s decision to discontinue the pain relief drug Vioxx has left millions of people scrambling for an alternative for pain management. According to the American Pain Foundation, there are more than 50 million Americans suffering from chronic pain, or 25 million experiencing acute pain as a result of injury or surgery. Worldwide, 2 million people were taking Vioxx at the time of the recall.
If you're a pain sufferer, here's some good news: Plenty of options exist to ease aches, and many of them don't come in pill form. After all, Vioxx only entered the market in 1999, and arthritis, menstrual cramps, post-surgery pain, and other aches and pains soothed by the drug have been around and managed for a much longer time period.
Only a few common alternatives are discussed in this article. There are dozens, if not hundreds, more pain relief approaches out there. Many of them may be snake oil in various shapes and sizes, and we know that has been around for ages.
Before trying any pain relief approaches, it is important to talk with your doctor. Some therapies may not be safe or appropriate for you, even if they are of the nonpharmaceutical kind. Different factors need to be considered before undergoing any treatment, including your medical condition and history.
Also keep in mind that none of the resources available are perfect pain remedies. They may not provide complete pain relief. They do not work the same for everyone. You may have to try a number of different strategies and combine some of them before finding an acceptable level of pain relief. As with any treatment, there may also be risks and side effects.
A benefit of trying out alternative therapies is that you may find a pain relief option that works for you. We all know how priceless pain relief can be. So don't give up on finding respite for your suffering.
Take an active part in your rehabilitation, advises Penney Cowan, executive director and founder of the American Chronic Pain Association. She says people need to ask themselves, "What's my role in regaining control of my life and actually living with this pain?"
"A big part of pain management is feeling like you have to regain control of your life, because the pain has taken over," says Cowan.
Pain Relief With Physical Therapy
There is no one solution to pain, but at least one expert says physical therapy is highly effective. "I recommend it to almost all of my patients," says Hayes Wilson, MD, chief rheumatologist at Piedmont Hospital in Atlanta, and national medical adviser to the Arthritis Foundation.
Physical therapists teach people how to take care of themselves. "If you give a man a fish, he eats for a day. If you teach him how to fish, he eats for the rest of his life," says Wilson, noting physical therapists are like fishing instructors.
He is not far off. According to the American Physical Therapy Association, physical therapists teach patients self-management skills. In the case of arthritis, therapists show people how to deal with pain in day-to-day life. They show people how to build up strength and improve range of motion, and how to make sensible decisions about activities to prevent arthritic flare-ups.
Yet physical therapy is far from a panacea. In patients with severe rheumatoid arthritis, a condition that can shave 10 to 15 years off life, Wilson sees immune-modulating drugs as a first choice of treatment, and physical therapy as an adjunct.
In patients with osteoarthritis, the condition could worsen if swelling isn't fully addressed. "I think physical therapy does decrease inflammation to a certain extent, but I think the most dramatic changes to inflammation are made pharmacologically (with medicine)," says Wilson.
In looking for a physical therapist, it is important to first find out whether your health care plan covers visits. Next, look for a trained professional, someone who is licensed to practice in your state. It is also helpful to find a therapist who has experience in dealing with your particular condition.
Next: Pain Relief With Acupuncture
Pain Relief With Acupuncture
Easing pain with needles may sound agonizing, but acupuncture is an ancient form of pain relief. In fact, according to the Mayo Clinic, preliminary evidence suggests acupuncture may provide pain relief for osteoarthritis, back and neck ache, depression, menstrual cramps, pain after oral surgery, and chemotherapy-induced vomiting.
Acupuncture originated in China thousands of years ago. In traditional practice, needles are pierced through the skin in specific areas to improve the flow of energy throughout the body. Western scientists suspect the practice may stimulate the release of chemicals, which can either soothe pain, or prompt the body's natural healing systems.
The National Institutes of Health has sponsored a number of studies on acupuncture, including its affect on arthritis, inflammation, and chronic pain. Until researchers can better pinpoint how acupuncture works in pain relief, physicians such as Wilson say the patient's faith in the procedure has a lot to do with its success.
"I think it can work for anybody, but it's going to work for the people who believe in it," Wilson says, adding that many treatment strategies are effective in part because of the patients' belief in them. "People who don't believe they're going to get better, I think, are less likely to get through."
Acupuncture is not recommended for people who are taking blood thinners, or for those with a bleeding disorder. Risks of the procedure involve dangers inherent in needle use, including spread of an infectious disease, piercing of organs, minor bleeding, and broken or forgotten needles.
Pain Relief With Stress Management
"The reign of pain falls mainly in the brain," jokes Dennis Turk, professor of anesthesiology and pain research at the University of Washington School of Medicine.
Yet there is a truth to Turk's joke. "You can never have pain without a conscious organism to interpret it," he says, referring to the brain. With this organ, people make sense out of noxious sensations and determine how bothersome they really are. A host of factors, including psychological ones, can affect how people perceive sensations, what they decide to do about them, and how they interact with their world.
Stress is a big psychological factor that can intensify the perception of pain. When people are distressed, their muscles tend to become tense and may arouse already tender tissues. On an emotional level, the pressure may amplify their perception of pain. "Emotional arousal or stress may lead them to interpret their situation as being more difficult, and may make them avoid certain types of activities, because they're afraid it's going to make their pain worse," says Turk.
To alleviate the pressure, Turk recommends trying to change the source of stress. For instance, if you find yourself always arguing with your spouse, it may help to find a way to communicate with him or her instead.
If it is not possible to change the source of tension, try distracting yourself with enjoyable activities such as spending time with friends, watching a movie, or listening to music. Participating in something pleasurable may shift focus away from pain.
Another strategy is to unwind. Relaxation techniques include deep breathing, progressive muscle relaxation, meditation, visualization, massage, yoga, and Tai Chi. These practices have been proven to be effective.
Some people have found stress relief by joining support groups or by getting individual counseling on how to best cope with their stress or ailment.
For the most part, many of these stress-management strategies have been proven to be effective. Yet not everyone can benefit from each of the techniques. Different methods work for different people. For instance, there is good evidence that people who go to support groups experience pain reduction and dramatic improvements in their physical and emotional functioning. Nonetheless, a person who doesn't want to talk about their ailment would not be a good candidate for a support group.
Next: Pain Relief With Exercise and Diet
Pain Relief With Exercise
Many people in pain often avoid exercise because movement hurts too much. Yet their inactivity may actually worsen their condition.
"The human body was designed to be in motion no matter what state of health you're in," says Sal Fichera, an exercise physiologist, certified personal trainer, and owner of ForzaFitness.com in New York City. "If you let your body become inactive, then you will let your body degenerate."
Muscle degeneration can lead to other problems such as diminishing bone density, depression, and a weakened heart. In contrast, regular exercise can help keep joints flexible and strong, and better able to deal with arthritic pain. Plus, physical activity promotes the release of mood-enhancing chemicals in the body that can help diminish the perception of pain.
There are three types of exercise recommended for arthritis patients. The first, flexibility workouts, involve stretches that can help enhance range of motion. The second, cardiovascular or aerobic workouts, includes walking, water exercises, and cycling. The third, strength conditioning, includes isometric or isotonic workouts.
Isometric workouts are static exercises that involve applying resistance without moving the joint. For example, if you stand up against the wall and press your hands against it, you are working out your chest muscle. On the other hand, isotonic workouts use the full range of motion. They include bicep curls and leg extensions.
To decrease pain and prevent further injury, it is important to apply appropriate effort in proper form. Not all exercises are right for everyone. If one type of exercise does not work for you, there are always other options. Before starting a fitness program, make sure to consult with your doctor and with a trained fitness professional.
Pain Relief With Diet
Here's extra incentive if you've been thinking about losing weight: Shedding excess pounds could help reduce the risk of pain.
"If you're overweight and de-conditioned, your joints take a major hit, because of the increased poundage that your joints have to carry," says Elton Strauss, MD, chief of orthopaedic trauma and adult reconstruction at Mount Sinai Hospital in New York City.
There are plenty of weight loss programs available, but keep in mind that regular physical activity and a nutritious, well-balanced diet are proven methods for weight loss.
On the other extreme, being underweight or weight loss with a poor diet and inactivity can exacerbate pain. "Your hormone levels are off," explains Lisa Dorfman, MSRD, a sports nutritionist and spokeswoman for the American Dietetic Association (ADA). Normal flow of hormones can help the body combat aches, and activate the body's own healing systems.
Research shows vegan and vegetarian diets, and diets low in animal protein can help reduce pain, says Dorfman. These diets are usually rich in B vitamins (B6, B12, folic acid, and iron), which have been shown to reduce osteoarthritis. They are also usually rich in omega-3 fats (flaxseed, walnuts, soy, and fish), which have been shown to create anti-inflammatory compounds.
Dorfman says people need not become vegetarians for pain relief. She suggests limiting intake of animal protein and saturated fat, and beefing up on foods rich in omega-3 fatty acids, antioxidants, vitamins, and minerals.
Christine Gerbstadt, MD, RD, another spokesperson for the ADA, agrees. She also suggests eating more whole grains and organically produced foods. She says steroid hormones and preservatives may negatively stimulate the autoimmune system.
Pain Relief With Dietary Supplements
There is promising evidence that two types of dietary supplements -- Chondroitin sulfate and glucosamine -- may help relieve pain associated with osteoarthritis. Yet more research needs to be done on their long-term safety and effectiveness.
Side effects of chondroitin are rare, but could include headache, motor uneasiness, euphoria, hives, rash, photosensitivity, hair loss, and breathing difficulties. People with bleeding disorders or those talking blood thinners should consult with their doctor before taking the supplement.
Side effects of glucosamine include upset stomach, drowsiness, insomnia, headache, skin reactions, sun sensitivity, and nail toughening. Some glucosamine products may be made with shellfish, and may cause adverse reaction in people with shellfish allergies.
Some arthritis patients may find some pain relief with bioelectric therapy. "The people who benefit from bioelectric therapy are people who tend to have mild muscle pain," says Wilson, noting that people with joint inflammation, such as those with rheumatoid arthritis, may not get as much benefit.
In bioelectric therapy, a dose of electric current is applied to the skin to help distract the brain from sensing pain. The therapy tries to overload the brain with sensations to divert its focus on the original source of pain.
There may be skin irritation and redness as a result of bioelectric therapy. This strategy is not recommended for people who have a pacemaker, are pregnant, have blood clots in the arms and legs, and have a bacterial infection.
Strauss at Mount Sinai Hospital in New York City, warns against its use. "I don't think there are studies out there that show it works," he says.
Live a Healthy Life
In some cases, your physician may suggest combining nonmedicinal options with drug therapy. Try not to rule out medication altogether. The ideal goal of pain relief treatment, after all, is not just to alleviate suffering, but also to keep you alive and healthy.
Remember: The simplest -- yet often the most challenging -- strategy for pain relief involves eating right, sleeping enough, exercising, and managing stress. "If you look at pain management skills, they are nothing more than good living skills," says Cowan. "If we don't live our life and really pay attention, the pain overcomes us."
Published October 2004.
SOURCES: American Pain Foundation Web site. Penney Cowan, executive director and founder of the American Chronic Pain Association. Hayes Wilson, MD, chief rheumatologist at Piedmont Hospital in Atlanta, and national medical adviser to the Arthritis Foundation. American Physical Therapy Association. Mayo Clinic web site. National Center for Complementary and Alternative Medicine web site. Dennis Turk, professor of anesthesiology and pain research, University of Washington School of Medicine. Sal Fichera, exercise physiologist; and certified personal trainer; and owner of ForzaFitness.com, New York City. Elton Strauss, MD, chief of orthopaedic trauma and adult reconstruction, Mount Sinai Hospital. New York City. Lisa Dorfman, MSRD, sports nutritionist; and spokeswoman for the American Dietetic Association (ADA). Christine Gerbstadt, MD, RD, spokeswoman, American Dietetic Association. Medline Plus web site: Rofecoxib (Vioxx). WebMD Medical Reference in collaboration with The Cleveland Clinic: "Bioelectric Therapy."
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