Complementary Therapy: What can you do to reduce your pain?

Uploaded by swedishseattle on 03.08.2012

Hi, I'm Gordon Irving, Medical Director of the Swedish Pain and Headache Center. Let's
talk about complementary medicine, or CAM, and pain.
You probably use CAM all the time if you suffer from chronic pain. If fact, anything you do
to decrease your pain that is not by prescribed pill can be called complementary therapy.
That includes stretching, walking, herbal medications and acupuncture. So, what has
been shown to work and what are the problems?
I like to divide CAM therapies into two main categories. One, active -- what you can do,
like exercise, what foods to eat and how to decrease your stress. And then passive -- what
you have done to you, like acupuncture, sticking little needles in, or chiropractic.
Let's look at active therapies. Exercise is probably one of the most effective treatments
there is to decrease chronic pain. It's been shown in multiple studies to decrease
everything from lower back pain to fibromyalgia and headaches. Yet, it's very hard to adhere
to an exercise program long enough to get beneficial results. The exercise may also
have to be modified because of physical problems with joints, etcetera, yet everyone can do
Exercise also has an added benefit of expending calories and decreasing obesity. You may not
know it but if you are overweight, obesity itself may be causing pain. Also, every step
you take up to five times your body weight goes through the hip, knee and ankle joints
-- se even losing a few pounds can make a difference if you've got pain in these joints.
As I said, obesity itself causes changes in the brain and can cause generalized pain so
a major treatment to get in control of pain is to decrease your weight if you're obese,
and exercise.
What about food stuffs and nutraceuticals? Many patients can't tolerate anti-inflammatories,
such as Aleve or Advil, or they don't do it very well. Food stuffs and herbal remedies
have in fact been shown to have an important role in managing pain. And the so-called "anti-inflammatory
diets," which include food stuffs such as grapes, extra-virgin oil may be beneficial.
There are numerous studies looking at remedies such as feverfew for headaches, tumeric as
an anti-inflammatory. I tell patients to go onto the web and do some research on these
nutraceuticals and if possible go to a reputable store that sells herbal remedies to discuss
the type of pain problem you have, maybe arthritis, and what the people who are in the shop would
recommend as a single preparation. Now, the single preparation is important. Although
the individual parts of the preparation sold for arthritis pain, for example, may be shown
to work at certain doses and levels, if several are put together in a pill, they're usually
put together in very small and probably ineffective doses. Plus, the efficacy studies where they've
actually been combined have not been done.
So, you've collected some possibilities, you go onto a website that is objective and
has reviewed the published literature. One search is at Memorial Sloan-Kettering Cancer
Center in New York, and that's got an NIH grant to run a site called "About Herbs."
The next problem, one you've decided what you're going to take, is to find the company
that sells the nutraceutical at the correct dosage. And the dosage on the label is in
fact the dosage that's on the pill. Unfortunately, these preparations are not monitored closely
by the government for accuracy.
What about stress management? We know that the brain changes with pain -- parts of it
actually shrink. We know that the brain changes with stress -- again, shrinking. So pain
causes stress, stress increases pain. We've known for a long time that learning to decrease
stress will decrease pain. But only in the last few years have we been able to look at
the brain of living individuals, using things like functional MRI, and actually see the
results of both stress and the therapies such as mindfulness techniques which reduce stress.
Mindfulness is a being in the moment type meditation technique. You may find it difficult
bringing into your daily living, but if you can, it has a profound effect on stress and
pain and actually has been shown to increase brain size.
So, those are active therapies. What about passive therapies -- things that are done
to you? There's physical therapy, massage therapy, chiropractic -- all have roles in
chronic pain. But they're passive -- they should always be accompanied by a home exercise
program, advice on things like how not to let the area stiffen up again. Significant
improvement, which begins to last longer than a few hours after any treatment session, should
be felt within the first four sessions. It doesn't matter whether it's physical therapy
or chiropractic. Otherwise, it's probably not the therapy for you.
Devices giving off electrical currents -- there are lots of these. There are devices that
you put on the skin, and the idea is to confuse or neuromodulate the pain impulses. The skin
device is called a tens machine. We even have devices you can thread up the epidural space
of the spine -- that's called a spinal cord stimulator. And they both have evidence
that they can work in certain patients.
Acupuncture has a lot of research showing efficacy and a lot showing no results. However,
it does appear to be safe as long as disposable needles are used. Again, active exercise and
relaxation techniques are important to make any of these techniques more likely to work.
So, CAM should be seen as an important addition to any chronic pain therapy. But beware -- there
are always people and companies who target those in chronic pain claiming cures with
this device or the other, or that pill or the other. If you can find no good studies
on the web verifying these claims, buyer beware. If they sound too good to be true, it is probably
because it does not work.