Andrea Petersen, Feb. 1, 2005

With Vioxx Off the Market,
Herbs and Yoga Gain Favor,
But Caution Is Necessary

By ANDREA PETERSEN
Staff Reporter of THE WALL STREET JOURNAL
February 1, 2005; Page D4

With Vioxx off the market and Celebrex and Aleve caught up in news of side effects, some patients are shutting their medicine-cabinet doors and turning to alternative pain-relief treatments.

Meanwhile, manufacturers are trying to woo those searching for other options. “Looking for a safe alternative to Vioxx?” say online promotional materials for Linimax, a supplement that contains glucosamine, a nutritional supplement shown in some studies to ease joint pain. “The Natural Answer to the Vioxx Debacle” says online promotions for Inflacain, another nutritional supplement.

Word of mouth is boosting sales for other manufacturers. New Chapter Inc., a nutritional-supplement maker in Vermont, says sales of its Zyflamend herbal product (which contains ginger and tumeric) have doubled in the past few months. The company says sales have risen because health-food store employees are recommending the product to people looking for an alternative pain reliever.

There are a host of potential alternatives to prescription pain relievers. They range from methods backed by clinical trials and supported by many physicians, such as acupuncture, to more-fringe treatments such as magnets and some herbal remedies. Some of the more off-beat therapies have little science behind them to prove they work. And alternative treatments can have side effects, too. People on blood thinners, for example, shouldn’t get acupuncture. Some herbal products have been found to be contaminated with toxic substances such as lead and mercury.

A number of patients have tried wearing magnets next to their skin in an attempt to reduce chronic pain.

A number of patients have tried wearing magnets next to their skin in an attempt to reduce chronic pain.

Here are some of the most popular nonprescription pain treatments:

Supplements and Herbs

There are multitudes of supplements and herbs that are sold to patients seeking pain relief. The most rigorously studied is glucosamine, an amino acid that plays a role in the formation of cartilage. Several clinical trials have shown that glucosamine may help with hip and knee osteoarthritis. Side effects are minimal, but some may experience heartburn or diarrhea. It may increase insulin resistance, so those with diabetes or who are obese need to be carefully monitored.

There are a variety of herbs that act as muscle relaxants, such as kava, cramp bark and passion flower. Kava, however, has been linked to liver problems and kava products have been banned in several countries. Pregnant women shouldn’t take cramp bark.

Other herbs act as anti-inflammatories, such as willow bark, tumeric and ginger root. Ginger shouldn’t be used by anyone with gallstones, bleeding disorders or anyone who is taking blood thinners. In high doses, ginger could damage the stomach lining. Traditional Chinese medicine and Ayurvedic medicine have their own herbal treatments. Ayurveda is the traditional medicine of India, which aims to promote health through nutrition, exercise and herbal remedies.

Acupuncture

Acupuncture involves placing very thin needles in specific points on the body. It has been used for thousands of years in China to treat a medley of illnesses. The procedure usually is either performed by licensed practitioners who have completed several years of training or by doctors who have taken acupuncture courses. In recent years it has been the subject of a number of studies showing its efficacy at treating pain.

In a study in the Annals of Internal Medicine in December, patients with osteoarthritis of the knee who were treated with acupuncture over 26 weeks showed a 40% to 45% improvement in both joint function and pain, compared with patients who received a sham acupuncture therapy, whereby patients were pricked with needles in nontherapeutic points. Two additional studies published last year showed that acupuncture is effective in alleviating shoulder and neck pain.

People with bleeding disorders or who are on blood thinners should avoid acupuncture. Also, people should be sure to seek out a licensed acupuncturist since there is a risk of injury if the practitioner isn’t well trained. As with any invasive therapy, there is a risk of infection.

Trigger-point therapy also uses needles, which are pushed into knots of muscle that cause pain (the so-called trigger points). The points are located by the doctor through a physical exam. When the needle is put in place, the muscle contracts, twitches and then relaxes. The risks and side effects are similar to those of acupuncture.

Yoga, Physical Therapy

The cure for some back pain may not be found at the drugstore, but at the gym. Many doctors agree that strengthening abdominal muscles is critical to protect strained backs from incurring further damage. Physical therapists also work with patients with painful joints to strengthen the surrounding muscles, which can ease pressure on joints. Losing weight can diminish muscle strain and joint stress and alleviate pain.

In some recent studies, yoga, the 5,000-year-old Indian tradition, has been shown to help with pain. In one 1998 study published in the Journal of the American Medical Association, patients with carpal-tunnel syndrome who did yoga postures for eight weeks had decreased pain and improved strength compared with those who didn’t do yoga.

Various Relaxation Techniques

Pain specialists often use so-called mind-body techniques such as meditation and other relaxation therapies, either alone or along with medication. The upside is that there are almost no side effects. One 2003 study in the Journal of Rheumatology showed that meditation and Qigong, a Chinese breathing and movement practice, was no more helpful than a support group in reducing pain for patients with fibromyalgia, an autoimmune disorder. Other small studies have shown pain relief.

Magnets

Dozens of Web sites hawk magnets to treat pain and they often promise miraculous relief. While the treatment may sound hokey and doctors are unclear as to why and how magnets would relieve pain, researchers are interested. A study published in the Journal of the American Medical Association last year showed that magnets in shoes didn’t help with foot pain. A 2002 study in the American Journal of Obstetrics and Gynecology showed that magnets did reduce chronic pelvic pain when worn on the abdomen continuously for four weeks.