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Complementary Treatments

Complementary Treatments (2)

02 Nov

When it comes to controlling pain symptoms, many sufferers opt out of prescription pills and instead gravitate toward a more natural solution: herbal supplements. And it makes sense, since plants have been used for centuries as go-to remedies for a plethora of conditions. But not all supplements are as effective as touted – and some come with serious side effects.

Drawbacks to Herbal Supplements

Herbal supplements aren’t held to the same rigorous standards as that of traditional medications.[1] That means that, according to the journal Surgical Neurology International, “some manufacturers inflate products’ claims and may not cite possible side effects and potential drug interactions.” And while they are still inspected by government agencies, since they are considered a food item, their preparation is not standardized, meaning the true concentration of the drug may vary between brands – and even sometimes within a brand.

This lack of regulation and standardization has made it difficult for researchers to study the true effectiveness and potential side effects of these natural remedies. However, there is initial, promising research for various supplements, although more research is needed.

Commonly Used Supplements

Chronic inflammation is at the core of many pain-causing conditions. Certain herbs can help control and reduce this inflammation, aiding with both pain relief and healing. Below are a few commonly used plant-based pain remedies. Before starting any supplement, always consult your healthcare provider.

  • White willow bark: As early as 400 BC, people were utilizing willow bark to reduce pain and inflammation.[2] Its use has continued throughout the centuries and it’s now used commonly to treat such conditions as back pain, joint pain, osteoarthritis, headaches and tendinitis. Willow bark works similarly to aspirin in reducing inflammation, but it isn’t accompanied by aspirin’s dangerous gastric side effects.[1] Current research on the plant has been promising, with various randomized trials demonstrating an efficacy similar to aspirin. 1[3][4] The supplement can cost more than aspirin, however, and shouldn’t be used in any situation in which taking aspirin would be dangerous.

  • Omega-3: Omega-3s (fish oil) have been used as a form of treatment since the late 18th[1] And for good reason. Omega-3 polyunsaturated fatty acids have since been shown to be incredibly effective in terms of decreasing inflammation. Currently, it‘s recommended by the American Heart Association to decrease vascular inflammation and thus help in the prevention of coronary artery disease.[1] Currently research suggests omega-3s may help moderately improve such conditions as arthritis,[5][6] non-surgical back and neck pain and cervical and lumbar disc disease,[7] allowing people to rely less on NSAIDs. Unfortunately, most of the studies on omega-3s and pain are small and the topic warrants further investigation.

  • Frankincense (bowswellia serrate): Boswellia is a species of tree and the resin, more commonly known as frankincense, has been shown to have anti-inflammatory and anti-arthritic properties. It was traditionally used as a component in folk medicine to treat chronic inflammatory diseases. In more recent years, small studies have shown boswellia’s positive effects on such conditions as osteoarthritis and rheumatoid arthritis.[8]

Supplements and Integrative Care

Some natural supplements on their own may provide noticeable relief of pain and inflammation. But to achieve optimal pain relief, natural supplements should ideally be paired with more conventional treatments, like physical therapy and a balanced diet, as well as interventional treatments, like injections and nerve blocks. An integrative model like this addresses pain and inflammation through a variety of channels, thereby ensuring optimal pain relief.

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[1] Bost, JeffreyW, Adara Maroon, and Joseph C. Maroon. “Natural Anti-Inflammatory Agents for Pain Relief.” Surgical Neurology International 1 (December 13, 2010): 80.

[2] University of Maryland Medical Center. “Willow Bark.” August 05, 2015. Accessed February 9, 2017. http://umm.edu/health/medical/altmed/herb/willow-bark.

[3] Schmid, B, R Lüdtke, H-K Selbmann, I Kötter, B Tschirdewahn, W Schaffner, and L Heide. “Efficacy and Tolerability of a Standardized Willow Bark Extract in Patients with Osteoarthritis: Randomized Placebo-Controlled, Double Blind Clinical Trial.” Phytotherapy Research 15, no. 4 (June 2001): 344–50.

[4] Shara, Mohd and Sidney J. Stohs. “Efficacy and Safety of White Willow Bark ( Salix Alba ) Extracts.” Phytotherapy Research 29, no. 8 (May 22, 2015): 1112–16.

[5] The Natural Standard Research Collaboration. “Omega-3 Fatty Acids, Fish Oil, Alpha-Linolenic Acid.” November 01, 2013. Accessed February 9, 2017. http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-acids-fish-oil-alpha-linolenic-acid/evidence/hrb-20059372.

[6] University of Maryland Medical Center. “Omega-3 Fatty Acids.” Accessed February 9, 2017. http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids.

[7] Maroon, Joseph Charles and Jeffrey W. Bost. “Ω-3 Fatty Acids (fish Oil) as an Anti-Inflammatory: An Alternative to Nonsteroidal Anti-Inflammatory Drugs for Discogenic Pain.” Surgical Neurology 65, no. 4 (April 2006): 326–31.

[8] Siddiqui, M. Z. “Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview.” Indian Journal of Pharmaceutical Sciences 73, no. 3 (May-June 2011): 255-261.

02 Nov

Pain comes in many forms – and alternative pain treatment options do, as well. So . Should you seek acupuncture for low back pain? What about for fibromyalgia? And when are massage, relaxation and yoga warranted? At the beginning of September, the National Center for Complementary and Integrative Health – part of the National Institutes of Health (NIH) – went a long way toward answering this question, reviewing five decades of research to find the answer.

Overview of Research

The NIH review was published in Mayo Clinic Proceedings in September and contained data from 105 U.S. randomized controlled trials that were conducted over the past 50 years.[1] The trials covered a range of pain conditions, including low back pain, fibromyalgia, neck pain, osteoarthritis of the knee and migraine pain. It also looked at a variety of complementary treatment approaches, including acupuncture, massage, yoga, tai chi and dietary supplements, among others.

Although the review was wide-ranging and included a plethora of studies, there were some limitations. In some trials, the number of participants was small (with fewer than 100 individuals) and not very diverse, which could explain some of the conflicting results seen across the trials. However, throughout all trials, there were no serious side effects reported and very few mild side effects (like muscle soreness), meaning that overall, complementary treatments are a reasonably safe option for pain sufferers.

Back Pain

As one of the most common pain conditions, back pain has been the subject of many studies regarding complementary treatments. It may have something to do with the fact that people in the U.S. spend roughly $8.7 billion out-of-pocket each year on complementary approaches to manage their back pain, an amount which far exceeds any other condition.[2]

This review looked at back pain studies on acupuncture, massage therapy, osteopathic manipulative therapy, spinal manipulation and yoga. The NIH found that acupuncture and yoga, in particular, may be the most beneficial for patients with low back pain. There is also weaker, but still moderately positive evidence for: massage therapy, which may provide short-term relief; spinal manipulation, which can provide modest pain relief if performed often enough; and osteopathic manipulation, which may help improve pain, but has limited effects on function/disability.

Neck Pain and Knee OA

In terms of neck pain, the review looked at studies involving massage and spinal manipulation. They found that although spinal manipulation demonstrated no significant improvements in terms of pain and function, massage therapy did provide some benefits. If done often enough – say an hour 2 or 3 times a week – massage was able to help reduce pain and improve function in the short-term.

For osteoarthritis of the knee, the team reviewed studies regarding various dietary supplements, in addition to more active therapies. They found mixed results for glucosamine and chondroitin, but ultimately concluded there was little evidence to suggest these supplements were any better than taking a placebo. Tai chi, on the other hand, resulted in significant improvements for individuals with knee OA, and acupuncture was proven useful, as well.

Migraine Pain and Fibromyalgia

Studies regarding alternative treatments for severe headache and migraine pain were rare, with only one included for acupuncture, one for massage and two for omega-3 fatty acids. According to these studies, there is no benefit of acupuncture or massage in terms of pain severity, and the data for omega-3s is contradictory. Relaxation techniques, however, have been the subject of more research and have been shown to reduce both the frequency of headaches and the level of disability they cause. Even better results were achieved when relaxation was combined with another form of treatment, like medication or cognitive behavioral therapy.

The studies regarding complementary approaches for fibromyalgia have often been small and inconclusive, yet, according to this review, there is some evidence to suggest that mindfulness-based stress reduction can reduce stress and sleep disturbances associated with fibromyalgia and that tai chi may help reduce symptoms.

Multidisciplinary Approach

As the review found, many complementary approaches can be useful for the treatment of pain, but oftentimes more improvement can be seen when complementary approaches are paired with interventional ones. The physicians at Advanced Pain Management are dedicated to working with other practitioners to provide individualized and comprehensive pain relief. To learn more, call (888) 901-7246.

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[1] Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.” Mayo Clinic Proceedings 91, no. 9 (September 2016): 1292–1306.

[2] Nahin, Richard L., Barbara J. Stussman, and Patricia M. Herman. “Out-of-Pocket Expenditures on Complementary Health Approaches Associated with Painful Health Conditions in a Nationally Representative Adult Sample.” The Journal of Pain 16, no. 11 (November 2015): 1147–62.


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