Appendix: Complementary and Alternative Treatments for Pain Relief

Increasingly, North Americans are looking beyond traditional health care for relief from chronic pain, turning to a host of products and practices that have been grouped together under the umbrella term complementary and alternative medicine (CAM). Middle-aged and older Americans are even more likely to make use of natural products such as herbal supplements and mind-body practices such as chiropractic care, massage, and acupuncture. In all, about 40 percent of North American adults use some form of CAM.

Before you engage in any treatment, become informed about the treatment and the practitioner, ask family and friends for personal references, and get information about treatment costs (preferably in writing). Not all jurisdictions license or regulate practitioners of the different therapies. In those that do, seek out licensed ones, or members of the professional body. Always ask for your provider’s credentials and clear the treatment with your primary-medical-care providers. In the United States, check out the National Center for Complementary and Alternative Medicine (http://www.nccam.nih.gov). In Canada, where health care is largely regulated by the provinces, check with your local department of health. Limited information is also available on the Health Canada website (http://www.hc-sc.gc.ca). The following are brief summaries of some common CAM treatments that have been promoted for pain management.

Acupuncture

Acupuncture is an ancient therapy and one of the planks of traditional Chinese medicine. It involves the insertion and manipulation of very fine needles in the body at designated points along invisible pathways, called meridians, just below the skin.

The operating theory is that the benefits of acupuncture come from releasing blocked energy, from opening up the flow of a vital life energy called qi (pronounced “chee”). Once the proper flow of energy is restored, the body’s natural healing mechanisms can get to work. As we discussed in chapter 2, groundbreaking research suggests that qi may also be related to intracellular communication within the connective tissue, especially the fascia.

Research indicates that acupuncture may relieve pain from osteoarthritis, especially knee pain. It was also found to be effective for neck pain. Some randomized, controlled studies have shown that acupuncture is an effective adjunctive treatment for hypertension, chronic pain, headaches, and back pain.

According to a 1997 consensus statement released by the National Institutes of Health, acupuncture is most helpful when used as part of a multidisciplinary approach to treating osteoarthritis, low-back pain, carpal tunnel syndrome, tennis elbow, and myofascial pain. A 2006 Mayo Clinic study found that acupuncture significantly improved symptoms of fibromyalgia. Overall, acupuncture is one of the most widely used (and well-respected) forms of alternative therapy in the United States and Canada.

Acupuncture is generally considered a low-risk treatment, but adverse side effects can occur. I strongly advise contacting a national accrediting organization to locate a qualified acupuncturist. (See http://www.nccaom.org/ in the United States or https://www.acupuncturecanada.org/ in Canada to find a practitioner near you.)

Massage

Touch-based therapy is another of the ancient forms of medical treatment. Egyptian tomb paintings show people being massaged; in the fifth century BCE, Hippocrates, widely considered the father of Western medicine, wrote, “The physician must be experienced in many things, but assuredly in rubbing . . . for rubbing can bind a joint that is too loose, and loosen a joint that is too rigid.”

Over the millennia, many schools of massage have sprung up. The widely available and popular Swedish massage combines long strokes and kneading movements that primarily affect surface muscle tissues. Deep-tissue massage uses more pressure to reach deeper levels of muscles and stimulate lymphatic drainage. Acupressure massage, Chinese massage called tui na, and shiatsu, a form of Japanese body work, also use greater pressure than does Swedish massage, doing so according to the principles of acupuncture. (I have to imagine that these approaches have a similar stimulating effect on the cellular communication of the connective tissue.)

Other touch therapies that incorporate massage include reflexology, a form of foot message based on the premise that the whole body, including internal organs, is reflected in the foot, and rolfing, a structured technique of soft tissue massage that aims to intensely work the body’s connective tissue (fascia) and muscles.

Massage is commonly used to relieve muscular tension and to promote relaxation. It can decrease swelling and impaired joint mobility, ease muscle spasms, and increase circulation to promote healing. It can also reduce pain and improve muscle tone.

Massage therapy can be helpful for conditions such as neck and back pain, headaches, temporomandibular joint (TMJ) pain and dysfunction, muscle and joint pain, nerve pain, fibromyalgia, myofascial pain syndrome, sports injuries, and soft tissue injuries. Benefits can include reduced stress, anxiety, and pain along with improved circulation, enhanced sleep patterns, increased oxygen supply, and release of endorphins, the body’s natural painkillers. Massage can also reduce heart rate, lower blood pressure, and increase energy and immune system activity.

Be sure to seek out a credentialed massage therapist through the National Certification Board for Therapeutic Massage and Bodywork (http://www.ncbtmb.org/tools/find-a-certified-massage-therapist) or via a recommendation from your primary-care physician.

Chiropractic Medicine

Chiropractic medicine is one of the more common treatments people seek when they have back pain. Although spinal manipulation can be traced back thousands of years, the chiropractic care we know today was developed in the United States in the 1890s by the Canadian native Daniel D. Palmer.

Chiropractic has always been one of the most controversial of the alternative and complementary medicines. In the 1960s, the American Medical Association (AMA) condemned chiropractic as an “unscientific cult,” kicking off a legal battle that the AMA lost in 1987. Today, chiropractors are widely respected; they often work in treatment teams with conventional medical doctors, and their services are covered by some medical insurance plans in the United States and Canada. Most people seek chiropractic services especially for back pain, while many elite athletes have chiropractors at the ready. For example, the American Chiropractic Association claims that chiropractors are used by all thirty-two professional football teams in the country.

Currently, most chiropractors do hands-on adjustments called spinal manipulative therapy or spinal manipulation. According to chiropractic theory, misaligned vertebrae can restrict the spine’s range of motion and affect nerves that radiate from the spine. These restrictions lead to pain and poor function. Chiropractic adjustments seek to realign vertebrae, restore range of motion, and free nerve pathways. Chiropractors may also use massage or additional treatments such as ultrasound and electrical muscle stimulation.

You can find a certified chiropractor through the American Chiropractic Association website (http://www.acatoday.org/Find-a-Doctor) or via a recommendation from your primary-care physician.

Team of Healers

A well-chosen combination of Western and alternative medicine is often the best way to achieve full pain relief. You might find that the ideal program features help from doctors, chiropractors, acupuncturists, and massage therapists. You might seek out the help of physical therapists or osteopaths. You might likely benefit from a warm soak in an Epsom salt bath each night. And you should always include your correct daily fitness regime.

Each member of the team plays a different but essential role in returning the body to full health. None should be excluded as a potential option. We must fully explore and be open-minded to find the best treatment for our particular problem.

Fitness is the one form of soft medicine that requires work on the part of the person in pain. A therapist, machine, or medication cannot substitute for the benefits we gain from exercising. There is no machine, passive therapy, or medication that can strengthen our full 650 muscles while increasing our body’s flexibility. The exciting thing about correct fitness is that it can rapidly reverse pain with very little effort.

A pain-free life is entirely possible when we understand how to use the team of health-care professionals—and when we are also prepared to top off their work with correct regular exercise!