Turning to alternatives, not drugs, for pain relief
NEW YORK — Many years ago I was plagued with debilitating headaches associated with a number of seemingly unrelated activities that included cooking and sewing. I thought I might be allergic to natural gas or certain fabrics until one day, I realised that I tensed my facial muscles when I concentrated intently on a project.
The cure was surprisingly simple: I became aware of how my body was reacting and changed it through self-induced behaviour modification. I consciously relaxed my muscles when I focused on a task that could precipitate a tension-induced headache.
Fast forward about five decades: Now my back ached when I hurriedly cooked even a simple meal. Once again I realised I was transferring stress to the muscles of my back and had to learn to relax them and allow more time to complete a project to mitigate the stress. I recently prepared dinner for eight with nary an ache.
I do not mean to suggest that every ache and pain can be cured by self-awareness and changing one’s behaviour. But recent research has demonstrated that the mind — along with other non-pharmacological remedies — can be powerful medicine to relieve many kinds of chronic or recurrent pains, especially low back pain.
As Dr James Campbell, a neurosurgeon and pain specialist, put it: “The best treatment for pain is right under our noses.” He suggests not “catastrophising” — not assuming that the pain represents something disastrous.
Acute pain is nature’s warning signal that something is wrong and should be attended to. Chronic pain, however, is no longer a useful warning signal, yet it can lead to perpetual suffering if people stay afraid of it, the doctor said.
“If the pain is not an indication that something is seriously wrong, you can learn to live with it,” said Dr Campbell, an emeritus professor at Johns Hopkins Medical Institutions. Too often, he explained, “people with pain get caught in a vicious cycle of inactivity that results in lost muscle strength and further pain problems”.
Throwing powerful drugs at chronic pain problems may only add to the problem because ever higher doses are often needed. Knowing this, a growing cadre of specialists is exploring non-drug, non-invasive treatments, some of which have proved highly effective in relieving chronic pain.
The American College of Physicians recently issued new non-drug guidelines for treating chronic or recurrent back pain, a condition that afflicts about one-quarter of adults at a cost to America in excess of US$100 billion (S$135 billion) a year.
Noting that most patients with back pain improve with time “regardless of treatment”, the college recommends such remedies as superficial heat, massage, acupuncture or, in some cases, spinal manipulation (chiropractic or osteopathic). For chronic back pain, the suggestions include exercise, rehabilitation, acupuncture, tai chi, yoga, progressive relaxation, cognitive behavioural therapy and mindfulness-based stress reduction.
Drug-free pain management is now a top priority among researchers at the National Centre for Complementary and Integrative Health, a division of the National Institutes of Health. A comprehensive summary of the effectiveness of non-drug treatments for common pain — back pain, fibromyalgia, severe headache, knee arthritis and neck pain — was published last year in Mayo Clinic Proceedings by Dr Richard L Nahin and colleagues at the centre.
Based on evidence from well-designed clinical trials, the team reported that these complementary approaches “may help some patients manage their painful health conditions: Acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; massage therapy for neck pain with adequate doses and for short-term benefit; and relaxation techniques for severe headaches and migraine”.
Among the newest studies, conducted by Dr Daniel C Cherkin and colleagues at the Group Health Research Institute and the University of Washington in Seattle, both mindfulness-based stress reduction and cognitive behavioural therapy proved more effective than “usual care” in relieving chronic low back pain and improving patients’ function.
Cognitive behavioural therapy, or CBT, in essence teaches people to restructure how they think about problems. “Our study showed that cognitive behavioural therapy and mindfulness-based stress reduction were comparable in reducing dysfunction and pain severity,” said Dr Cherkin.
In a follow-up study done two years later, patients treated with mindfulness therapy or CBT remained more likely to improve than those who received the usual care, the team reported in February.
However, most health insurers do not cover the cost of many, if not all, complementary methods and the practitioners who administer them. When forced to pay out of pocket, many patients are likely to choose a drug remedy — despite its potential pitfalls — that insurance will cover.
There is another option: Physical therapy. Good physical therapy can often speed recovery and teach people how to avoid conditions, including inactivity, that can precipitate or exacerbate their pain. THE NEW YORK TIMES