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Overcoming Pain with Alternative Therapies
We've all heard the stories: a friend whose backaches were cured by acupuncture, another who swears by herbs for relief of aching joints. But in a world where everything from emu oil to WD40 is touted as a cure for disabling aches and pains, who are we to believe? Well-designed studies of alternative therapies are lacking, and most doctors haven't been well trained to help their patients cope with chronic pain. Fortunately, at places like the University of Maryland School of Medicine, all that is changing.

One of a dozen medical centers funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM), the school is conducting rigorous trials on alternative approaches to pain relief and more. Among the therapies under investigation are acupuncture for osteoarthritis mind-body medicine for fibromyalgia, and herbal remedies for rheumatoid arthritis.

At the university's Center for Healing, a team of doctors trained in conventional medicine and alternative therapies are also putting research into practice. The Center joins a growing number of clinics across the country that complement traditional treatments with acupuncture, massage, herbs, and other nonconventional therapies. When football players for the Baltimore Ravens suffer a sprained ankle or pulled hamstring, it is no longer uncommon for their doctors to refer them to the Maryland clinic. Other people come for relief of migraines, stiff joints, muscle aches, neck and back pain, tennis elbow, menstrual cramps and more.

"Show Me the Studies"
Alternative medicine was once commonly referred to in mainstream medical circles as "unproven therapies," but now often goes by the name of integrative care, or complementary and alternative medicine (CAM). The emphasis is on using holistic therapies that look at the whole person and either complement traditional treatments or offer alternative options, with a push for more and better research.

"A lot more evidence is coming on board," says Brian Berman, M.D., a professor of family medicine and director of the University's complementary medicine program. "We want to build a mosaic. Each study itself doesn't have 'the answer.' But we're putting the different building blocks together and getting a sense of what works and what doesn't in the move toward integrated care."

In the largest acupuncture study of its kind to date, Dr. Berman and colleagues are assessing the effects of this ancient Chinese healing art in nearly 600 men and women over age 50 with the familiar ache of arthritic knees. The trial has been designed to assess the effectiveness of traditional acupuncture, in which super-fine needles are inserted into specific pain-relieving points to stimulate the flow of healing energy, or qi. These points will be compared with "sham" acupuncture, in which the patient is "needled" at random locations.

Pain Relief through Needles
Results of earlier studies suggest that acupuncture may indeed relieve arthritis pain in the shoulders, hips, and knees, as well as headaches and other types of lingering pain. Other studies are under way to assess whether the needles ease discomfort after dental surgery or relieve the nausea and vomiting caused by cancer chemotherapy drugs.

"Acupuncture is a safe approach, with no side effects," says Lixing Lao, Ph.D., a licensed acupuncturist and director of traditional Chinese medicine research at the Maryland program. "It can enhance the effects of conventional medicines." In addition to acupuncture, Dr. Lao employs Chinese herbs and tuina, a form of therapeutic massage that he says is especially effective for relieving frozen shoulder.

"I have seen improvements in many patients who were not receiving relief with conventional arthritis medicines, such as Vioxx and Celebrex," says Marcos Hsu, N.D., a naturopathic physician at the Maryland center who regularly employs acupuncture to relieve joint pain. "Many have even opted to postpone their joint replacements."

Mind-Body and Herbal Remedies
Researchers at the University of Maryland are examining other therapies as well. Herbs, for example, are being studied for relief of lupus, rheumatoid arthritis, and other immune-mediated diseases. And mind-body therapies, such as meditation and behavioral therapies, are being assessed for the disabling muscle aches of fibromyalgia.

All these studies should go a long way in moving worthwhile alternative therapies into the mainstream. At Maryland and similar programs across the country, a new generation of doctors is being exposed to complementary techniques and seeing the results of testing, breaking down barriers of acceptance. "Certainly over the past 11 years, since we started our program, there's been a huge change in acceptance and people willing to look at these therapies," says Dr. Berman.

Proving that a particular treatment works has implications for insurance coverage as well. Although some programs reimburse for such treatments as acupuncture, biofeedback, chiropractic, and nutritional counseling, many complementary therapies are currently considered experimental and thus not covered. Determining which are truly effective could set the stage for broader reimbursement.

And proven or no, alternative therapies remain hugely popular with patients. Nearly half of American adults now use at least one CAM treatment. "Word of mouth is a powerful inducement," observes Dr. Lao. "Patients see others coming to our clinic and feeling better, and this convinces them to come in."

 If you are using or considering alternative therapies, work closely with your doctor and other health-care providers to discuss treatment options, both conventional and alternative. Choose a practitioner whom you trust and can talk with openly. In addition to your doctor, other professionals--nurses, physical therapists, nutritionists, counselors, and other specialists--can also play important roles.

 If you are interested in joining a clinical trial, discuss it with your doctor. Dozens of CAM studies are under way, looking at everything from magnets for Parkinson's and craniosacral therapy for earaches to qigong for heart disease and soy for brittle bones. For more information, contact the National Institutes of Health NCCAM Clearinghouse at 1-888-644-6226, or on the Web at http://nccam.nih.gov/clinicaltrials/.
Date Published: 03/29/2003
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