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Stopping the Hurt

For Some, Recent Safety Concerns About Pain Relievers Are Heightening Interest in Drug-Free Treatments, Many of Them Promising But Still Largely Unproven.

By January W. Payne
Washington Post Staff Writer
Tuesday, January 4, 2005; Page HE01

Gwenn Herman knows chronic pain -- the regular backaches, the stiffness and freezing of her neck after her 1995 car accident, the pain that didn't respond, or responded inconsistently, to prescription and nonprescription painkillers. That's why she learned, long before last month's rash of safety alerts about three commonly used pain medications, to explore alternative treatments like meditation, guided imagery and breathing exercises. Today, she teaches the techniques, all of which she uses daily, to members of support groups sponsored by the Pain Connection, a Potomac-based nonprofit organization she runs.

"What works for one person doesn't work for another," said Herman. "The more alternatives, the better."

The ancient Chinese practice of acupuncture proved modestly effective in reducing osteoarthritis pain in a recent government-funded study.

Investigating Alternative Treatments: More detailed information about alternative and nondrug pain relief therapies is available from a variety of authoritative sources.

That view is likely to find more adherents following last month's crush of sometimes-conflicting reports linking the highly advertised pain drugs Vioxx and Celebrex and, more recently, the popular over-the-counter painkiller Aleve (naproxen) to potentially life-threatening side effects. The safety concerns led to Vioxx's removal from the market at the end of September and the halting of a major clinical trial for Celebrex last month.

Experts advise patients not to stop pain medications without consulting their doctor, noting that further analysis of the data is needed and acceptable health risks must be evaluated individually. The drugs now subject to so much publicity may remain the best choices for some patients. Nonetheless, the reports have focused more attention on alternative pain relief treatments, particularly those that don't involve drugs.

Palliative effects for some of these techniques, like meditation, have been shown in several studies. Some other methods, like guided imagery, so far tend to rest on more anecdotal evidence.

"I find [guided imagery] extremely helpful in controlling my pain," said Herman. "The images that I use helps give an outlet to the pain and a pathway out of my body."

Still waiting to be established is to what extent any of the treatments can effectively relieve the chronic, often daily pain of those with such conditions as arthritis, severe headaches, lupus and fibromyalgia.

Pain sufferers confused or upset by recent painkiller news got a small dose of hope last month from a study funded by two branches of the National Institutes of Health: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM). That study found that acupuncture -- a 2,000 year-old Eastern practice that involves the insertion of thin needles at specific points on the body -- appeared to help relieve pain and improve function for patients with knee osteoarthritis.

The large study, published in the Annals of Internal Medicine, assigned about 190 of 570 patients ages 50 and older to receive acupuncture. By week eight, these participants functioned better than those receiving sham acupuncture or educational therapy. By week 14, those who were getting acupuncture reported less pain than the others, but the sham treatment group also reported pain reduction, though at a slightly lower level.

Researchers plan to analyze the data to see if the pain relief from acupuncture was sufficient to reduce or eliminate the need for pain medications.

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