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WDDTY

WHAT DOCTORS DONT TELL YOU

Chronic pain
Your guide to beating it naturally
New discoveries
2 Pain: killing it safely

Common conditions
7 Chronic back pain
10 Migraine misery
13 Fibromyalgia
15 Chronic fatigue syndrome
18 Irritable bowel syndrome

Tested treatments
21 Healing magnets
22 Serrapeptase
24 Cetylated fatty acids
26 SCENAR
28 Exercise for a better back

Your questions answered


29 Lumbago
30 Period pain
31 Endometriosis
32 Phantom-limb pain
33 Carpal tunnel syndrome
34 Ulcerative colitis
35 Osteoarthritis

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New discoveries

Pain: killing it safely


Statistics show that more Opioids such as morphine, oxyco-
people than ever are done, buprenorphine and fentanyl
living with chronic, have long been regarded as among the
persistent pain, and the most effective drugs for the treatment
of pain, but even these have proved
usual treatments just useless in many cases. In a review of
arent working. Yet, the 15 trials of opioids for chronic non-
latest research suggests a malignant pain (CNMP), the average
wealth of effective reduction in pain intensity was only
alternative optionsfrom around 30 per cent, and the dropout
mindbody techniques to rate was 56 per cent after two years.
Moreover, only three of eight studies
something as simple as that assessed functional disturbance
vitamin D. (such as being unable to work because
of pain) found any improvement with
hronic pain is a devastating opioid agents (Pain, 2004; 112: 37280).

C health problem that affects


millions of people around
the world. In the UK alone,
nearly eight million people are living
with moderate-to-severe pain lasting
A number of other reviews of the
use of opioids for chronic pain have
similarly reported only modest
evidence of efficacy with these drugs.
Whats more, although the medical
for more than six monthsand the use of opioids has increased over the
figures are on the rise. In his annual years, there is no evidence that this
report published in March 2009, has resulted in a lower prevalence of
Professor Sir Liam Donaldson, the UK chronic pain.
governments Chief Medical Officer, In Denmark, for example, the use
revealed that chronic pain is two to of opioids for CNMP has risen by more
three times more common now than than 600 per cent over the past two
it was 40 years ago. Currently, over a decades. Yet, in a national survey, 90
third of UK households have someone sometimes no known cause at allyet per cent of opioid users continued
in pain at any given time. conventional medicines answer is to complain of moderate to very-
Unlike acute pain, which warns us of generally the same: to treat it with severe pain compared with 46 per
actual or potential harm to the body, pain-relieving drugs. cent of non-opioid users (Exp Clin
chronic pain serves no useful purpose Paracetamol (acetaminophen) is Psychopharmacol, 2008; 16: 40516).
and, yet, has a major impact on thought to reduce pain by inter- Worse, in addition to being largely
peoples lives. Indeed, 65 per cent of rupting or suppressing pain signals inadequate, another problem with
sufferers report difficulty sleeping, and carried along the nerves, while conventional painkillers is their side-
nearly 50 per cent report having opioidswhich are much stronger effects (see box, page 3). Clearly,
problems with social activities, walk- drugsaffect the way in which pain is these drugs are not the answer to the
ing, driving or having a normal sex life. processed in the brain and spinal cord problem of pain.
Depression is also common, affecting to reduce the sensation of pain. Anti- The good news for pain sufferers,
about half of all chronic-pain patients. inflammatory drugs tackle pain by however, is that the failings of mod-
For some sufferers, suicide appears to reducing inflammation. ern medicine have encouraged studies
be the only solution. But while these drugs may work in into alternative methods for treating
But it doesnt have to be that way. theory, in practice, theyre failing to pain. Now, theres a wide variety of
New evidence suggests that chronic hit the spot. According to a study of non-drug therapies that offer new
pain may simply be due to an un- UK nursing homes, cited in Sir Liam hope to sufferers.
recognized nutritional deficiency or Donaldsons annual report, most
some other sort of imbalance in the residents experienced constant or The vitamin D approach
body. An holistic approach that views frequent moderate-to-severe pain, So far, some of the most compelling
pain in a very different way from despite the fact that 99 per cent were evidence suggests that the solution to
conventional medicine may be the on pain medication. In another study chronic pain could be something as
closest weve come to a cure. of chronic-pain patients of all ages, simple as vitamin D.
over one-third reported inadequate In a nationwide UK study of nearly
Conventional pain treatment pain control, and more than two- 7000 adults, scientists at the Institute
Chronic pain is a complex condition thirds admitted that, at times, their of Child Health in London found a link
with many different causesand medication failed completely. between low levels of vitamin D and

2 WDDTY Chronic pain


chronic wide-spread pain (CWP). an important role for this vitamin in mialow levels of circulating
Although the findings were not pain control. Indeed, according to an calciumwhich sets in motion a
significant in men, in women, CWP extensive review of the research so cascade of biochemical reactions
prevalence varied according to farpublished online at Pain Treat- negatively affecting bone metabolism
vitamin D concentrations. Those with ment Topics (http://paintopics.org/ and health. One of these reactions is
levels of 7599 nmol/Lthe range pdf/vitamind-report.pdf)having not an increase in parathyroid hormone
deemed necessary for bone health enough vitamin D is linked to a raft (PTH), which impairs bone mineraliz-
had the lowest rates of CWP, which of painful maladies, including bone ation, causing a spongy bone matrix
were just over 8 per cent. In contrast, and joint pain, muscle aches, fibro- to form. As this matrix absorbs fluid,
in women with levels less than 25 myalgia, rheumatic disorders, osteo- the resultant expanding pressure
nmol/L, CWP rates were nearly arthritis and other complaints. triggers pain in the tissues overlying
doubled at 14.4 per cent (Ann Rheum Much of the research has focused the bones that are abundant in
Dis, 2009; 68: 81722). on chronic musculoskeletal-related sensory pain fibres.
Similar results were reported last pain. Indeed, the reports author, Dr In addition, vitamin D deficiency
year in an American study. Mayo Stewart Leavitt, identified 22 clinical might contribute to pain in other
Clinic researchers found a connection studies investigating vitamin D status ways. Several studies cited in Leavitts
between inadequate vitamin D levels in patients with this sort of pain. report found that vitamin D may be
and the amount of opioid medication Across these studies, an average of involved in non-musculoskeletal pain
taken by patients suffering from around 70 per cent of patients with syndromes, including neuropathy,
chronic pain. Those with low vitamin chronic musculoskeletal pain were migraine headaches and inflamma-
D levels were taking much higher found to be deficient in vitamin D. tory autoimmune conditions such as
doses of medicationnearly twice as The evidence also shows that inflammatory bowel disease.
muchas those with adequate levels. supplementing with vitamin D can Whatever the mechanism involved,
Moreover, the low-vitamin-D opioid dramatically improve pain. In 324 the data suggest that checking for
users reported poorer physical women with chronic back pain, vitamin D deficiencyand correcting
functioning and a worse overall vitamin D eased symptoms in 95 per it (see box, page 4)may be a key
perception of health (Pain Med, 2008; 9: centand in 100-per-cent of those factor in chronic-pain management.
97984). with the most severe D deficiency
Although these two studies arent (Spine [Phila Pa 1976], 2003; 28: 1779). Mindbody techniques
proof that a lack of vitamin D causes According to Leavitt, vitamin D Observing soldiers during World War
chronic pain, they do contribute to a deficiency might lead to musculo- II proved that the mind plays a huge
growing body of evidence suggesting skeletal pain by causing hypocalcae- part in the perception of pain. Among
soldiers with equally devastating
wounds, some asked for less morphine
Dangerous drug side-effects than others. Their perception of the
wound and what it meant in their lives
Opioids are known to cause constipation, nausea and vomiting, sedation, appeared to be crucial. To one, the
cognitive impairment and respiratory depression. Worse, patients can wound meant surviving the battle and
develop a tolerance to the drug effects, resulting in physical dependence going home; to another, it meant
and withdrawal symptoms on stopping the medication. Estimated addiction major surgery and a lower income,
rates among patients with non-cancer-related pain range from 3 per cent to fewer activities and other negative
almost 20 per cent (Drugs, 2003; 63: 1732). consequences (Purves D et al., eds.
Neuroscience, 2nd edn. Sunderland, MA:
Another class of drugs with a worrying safety profile are the non-steroidal
Sinauer Associates, 2001).
anti-inflammatory drugs, or NSAIDs, which are commonly prescribed for
arthritis, headache and other inflammatory conditions. In the US alone, Nowadays, when considering treat-
some 60 million NSAID prescriptions are written each year. ment for chronic pain, its accepted
The main concern is the risk of gastrointestinal (GI) complications such that the emotional reaction to pain is
as ulceration, perforation and bleeding. Indeed, the US drugs regulator, the almost as important as the sensation
Food and Drug Administration (FDA), has estimated that 24 per cent of itself in determining how well the
the Americans who take these drugs for a year will develop one of these patient will cope. This means that
complications, leading to 107,000 hospitalizations and at least 16,500 therapies that take this mindbody
deaths annually among arthritis patients alone (Am J Med, 1998; 105: 31S8S; connection into account are partic-
Geriatr Nurs, 2001; 22: 1189).
ularly useful for managing pain.
Recent evidence has also linked NSAIDs to serious cardiovascular One such therapy is hypnosis, a
events, including heart attack, angina and transient ischaemic attacks (TIAs, technique that introduces instruc-
or mini-strokes) (Am J Cardiol, 2009; 103: 122737; Clin Ther, 2006; 28: 182736). tions or suggestions to bring about
Even good old aspirinone of the less potent NSAIDshas been changes in subjective experience,
associated with major risks of bleeding such as haemorrhagic stroke, a type perception, sensation, emotion,
of stroke caused by ruptured blood vessels leaking blood into the brain thoughts and behaviour. In the case
(Lancet, 2009; 373: 184960) of chronic pain, hypnosis enables
patients to control the intensity of

WDDTY Chronic pain 3


New discoveries

the pain, to manage the pain and the Nutrients for chronic pain
emotions accompanying it, and to
find suitable resources to deal with it, u Vitamin D. Sunlight is the best source of this vitamin but, as most of us
thereby allowing them to be involved dont get enough of it this way, pain expert Stewart Leavitt recommends
in their own treatment (Rev Med Suisse, (with the supervision of a qualified practitioner) a daily supplement of
2009; 5: 13802, 13845). 2000 IU of vitamin D3 (cholecalciferol), along with a daily multivitamin
Scientific reviewscalled meta- that includes calcium and 400800 IU of vitamin D. It may take up to nine
analyses, as they analyze all of the months to experience the maximum effects of this regimen.
findings and assess them altogether u Glucosamine and chrondroitin sulphate. This combination is known to
have found hypnosis to be effective be effective for inflammatory conditions such as osteoarthritis of the knee
for chronic pain. On combining 18 (J Rehabil Res Dev, 2007; 44: 195222).
studies of laboratory-induced and u Proteolytic enzymes, such as bromelain, have various pain-relieving
patients pain, the findings were that properties that have proved useful in the treatment of rheumatic diseases
hypnosis obtained greater pain relief (Wien Med Wochenschr, 1999; 149: 57780).
than in 75 per cent of those given u Amino acids, such as D-phenylalanine and L-tryptophan, appear to
either the usual care or no treatment increase pain tolerance in animals as well as in humans (Prog Clin Biol Res,
at all (Int J Clin Exp Hypn, 2000; 48: 13853). 1985; 192: 36370; J Psychiatr Res, 19821983; 17: 1816).
In yet another meta-analysis of the
efficacy of hypnosis for headache,
lower-back, temporomandibular joint tion that is causing the pain, and then the energy fields that are thought to
(TMJ), cancer-related and sickle-cell- helps the patient to recognize when surround and penetrate the human
disease pain, as well as the pain this dysfunction is occurring and to body (J Rehabil Res Dev, 2007; 44: 195222).
related to fibromyalgia, osteoarthritis correct it using various strategies. Both types of energy medicine have
and disability, hypnotherapy resulted This means of getting to the root of proved to be beneficial for chronic
in greater pain reduction than either the pain may be why a number of pain, but one of the most popular
standard care or no treatment. The studies have found biofeedback to be therapieswhich falls into the first
authors concluded that . . . hypnotic more effective than conventional energy-medicine categoryis
treatment for chronic pain results in treatments for chronic pain (J Rehabil transcutaneous electrical nerve
significant reductions in perceived Res Dev, 2007; 44: 195222). stimulation, or TENS. This technique
pain that maintain for at least several Other techniques that integrate transmits electrical impulses into the
months, and possibly longer (J Rehabil the body and mind have also proved body through electrodes that are
Res Dev, 2007; 44: 195222). useful for chronic pain. Yoga and placed on or near the painful area.
As well as working, a further bonus mindfulness meditation are especially Although it doesnt address the
of hypnosis is that it is almost always effective for treating chronic lower- underlying cause of pain, these
a benign treatment with little risk of back pain (J Altern Complement Med, 2008; electrical impulses produce a tingling
negative side-effects. Indeed, what 14: 63744; J Pain, 2008; 9: 8418), while sensation that reduces the pain itself.
side-effects do occur are overwhelm- guided imagerywhich uses mental Indeed, numerous studies have shown
ingly positive, including a greater images to imagine and create the that TENS works for a range of
sense of control over pain, greater desired physical outcomehas shown chronic-pain conditionsfrom
overall feelings of wellbeing, and less promise in alleviating the pain of musculoskeletal pain, such as back
tension, stress and anxiety (J Rehabil osteoarthritis and fibromyalgia (Fam and neck pain, to the persistent pain
Res Dev, 2007; 44: 195222). Community Health, 2008; 31: 20412; Pain that often follows surgery (Pain, 2007;
Another mindbody technique with Med, 2007; 8: 35975). 130: 15765; Curr Opin Anaesthesiol, 2009; Jul
a good track record for pain control 9: Epub ahead of print).
is biofeedback, a process of recording Energy medicine Of the other bioelectromagnetic-
and feeding back real-time informa- Besides mindbody techniques, based therapies that are currently
tion on how the body is functioning another drug-free approach thats available, pulsed electromagnetic field
to allow the patient to learn how to proved to be successful among pain (PEMF) generators and cranial
actively control these functions. patients is the use of so-called energy electrotherapy stimulation (CES)
Numerous studies have established medicine. hold particular promise for patients
that biofeedback is an effective According to the US National Cen- who suffer from chronic pain.
treatment for a wide range of chronic ter for Complementary and Alterna- PEMF generatorswhich include
pain problems, including migraine tive Medicine (NCCAM), this comes in low-power, wearable devices designed
and tension-type headaches, muscle- two types: the first includes bio- for virtually continuous use as well as
related orofacial pain, lower-back electromagnetic-based therapies that high-power machines meant to be
pain, phantom-limb pain and fibro- involve electromagnetic fields (EMFs) used several times a dayare able to
myalgia. such as pulsed fields, magnetic fields help osteoarthritis sufferers, and can
The technique generally works and alternating-/direct-current fields; reduce chronic migraine headache
because it first identifies the patients while the second includes biofield activity by around 80 per cent (J
own, individual physiological dysfunc- therapies that are intended to affect Rehabil Res Dev, 2007; 44: 195222).

4 WDDTY Chronic pain


CES, which delivers a low-level research so far, as 23 out of 5, which bones and joints, soft tissues, and the
electrical current through electrodes means that its possibly to probably circulatory and lymphatic systems.
attached to the skin surface (usually effective for the treatment of chronic They can be particularly effective for
on the ears), has proved to be better pain (J Rehabil Res Dev, 2007; 44: 195222). chronic pain, as practitioners of these
than a sham procedure for treating Like acupuncture, Qigong is a therapies generally tailor their
fibromyalgia pain as well as the pain traditional technique for enhancing treatments to the specific needs of
associated with spinal-cord injury (J the flow of qi in the body through each individual patient.
Clin Rheumatol, 2001; 7: 728; J Rehabil Res combining movement, meditation Chiropractic manipulationspecif-
Dev, 2006; 43: 46174). and breath regulation. ically, spinal manipulation therapy
Precisely how these two electrical For pain control, Qi therapy was (SMT)is the treatment of choice for
treatments work is still not fully particularly successful in reducing many chronic back-pain patients.
understood. PEMF generators appear negative psychological symptoms, Studies show that it has clinically and
to increase blood flow to the areas while boosting melatonin and statistically significant benefits com-
exposed to the EMFs, whereas CES is immune-system activityat least in pared with either sham manipulations
thought to bring about changes in younger subjects. Nevertheless, in a or treatments considered to be
certain chemicals of the brain, study of 94 elderly patients, those ineffective or even harmful, such as
including serotonin and norepineph- who received Qi therapy had less bed rest and traction (Cochrane Database
rine. Both mechanisms appear to have painand less anxiety, depression and Syst Rev, 2004; 1: CD000447).
a positive affect on pain (J Rehabil Res fatiguecompared with those given SMT has also been used in the
Dev, 2007; 44: 195222). sham therapy as a control (Complement treatment of a variety of other painful
As for biofield therapies, the other Ther Med, 2003; 11: 15964). conditions, including fibromyalgia,
type of energy medicine, acupuncture In a systematic review of all carpal tunnel syndrome, migraine and
is the one that is most extensively randomized clinical trials (up to dysmenorrhoea (menstrual pain), and
studied. As with other biofield January 2007) assessing Qi therapy was found to be more effective than
modalities, this traditional Chinese for chronic pain, Qigong produced conventional treatments in improving
medical technique is based on the greater reductions in pain than did pain and disability (J Rehabil Res Dev,
concept that all living things, the control treatments. Moreover, a 2007; 44: 195222).
including humans, are infused with a meta-analysis of two studies showed Massage therapy for chronic pain
subtle form of energy (qi), and that a significant effect of Qi therapy also has plenty of supporting
any disturbances to this energy result compared with general care for evidence. In a recent comprehensive
in illness. This means that acupunc- treating chronic pain (J Pain, 2007; 8: review by the prestigious Cochrane
ture treats pain and other conditions 82731). Collaboration, massage proved to be
by improving the quality, balance and superior to joint mobilization,
flow of energy within the body. Manipulation-based medicine relaxation therapy, physical therapy,
In fact, acupuncture appears to be Yet another approach to pain manage- acupuncture and self-care education
especially effective for back pain. In ment is the use of manipulative and for the treatment of lower-back pain.
a meta-analysis of 33 randomized, body-based techniques such as chiro- Whats more, the beneficial effects
controlled trials, acupuncture was practic and massage therapy. These lasted for at least a year beyond the
superior to sham acupuncture for methods focus on physiological end of the treatment (Cochrane Database
relieving chronic lower-back pain. structures and systems, including the Syst Rev, 2008; 4: CD001929).
However, one drawback is that the
study was only looking at short-term
results (Ann Intern Med, 2005; 142: 65163). Herbal painkillers
More recent studies suggest that
acupuncture might also help those u Capsaicin, an extract of cayenne pepper, can ease many types of
who have shoulder pain, headaches, chronic pain when regularly applied to the skin. In one study, a capsaicin
TMJ dysfunction, fibromyalgia, osteo- plaster was significantly better than a placebo in patients with chronic
arthritis of the knee, tennis/golfers back pain (Arzneimittelforschung, 2001; 51: 896903).
elbow and other painful conditions (J u Ginger appears to have both analgesic and anti-inflammatory effects
Altern Complement Med, 2009; 15: 6138; (J Ethnopharmacol, 2005; 96: 20710). In a trial of women with menstrual pain,
MMW Fortschr Med, 2007; 149: 379). ginger supplements were just as effective as the NSAIDs mefenamic acid
Nevertheless, more studies are needed and ibuprofen in providing relief (J Altern Complement Med, 2009; Feb 13: Epub
to determine whether the pain relief ahead of print).
with acupuncture is long-lasting u Devils claw (Harpagophytum procumbens) may be useful against
(Anesth Analg, 2008; 106: 61121). arthritic and lower-back pain. According to one study, for the herb to be
Other biofield therapies, including effective, the daily dose needs to provide at least 50 mg of the active
Qigong, Reiki and Therapeutic Touch, ingredient harpagoside (Orthopade, 2004; 33: 8048).
have been used to treat pain. The u Willow bark (Salix alba), which is chemically related to aspirin, appears
evidence for Qigong is the most to provide acute, short-term relief for patients with lower-back pain
encouraging, with one study rating (Cochrane Database Syst Rev, 2006; 2: CD004504).
its level of efficacy, on the basis of the

WDDTY Chronic pain 5


New discoveries
In another study of patients with serotonin, which is thought to currently available for chronic pain,
mixed chronic pain, massage therapy modulate the bodys pain-control and the search for alternative options
was at least as effective as the system. Another possibility is that continues to flourish. A major step
standard medical care. However, after massage promotes deep, restorative forward is the realization that pain is
three months, only those in the sleep, which reduces levels of sub- not always the result of a mechanical
massage group still showed significant stance P, a brain chemical associated breakdown or traumatic physical
improvement (J Altern Complement Med, with pain (J Rehabil Res Dev, 2007; 44: injury, but may be the result of a bio-
2003; 9: 83746). 195222). chemical or energetic imbalanceor
Interestingly, massage appears to even an emotional one. If so, then the
have an impact on the brain that may Pain: a new paradigm cure for chronic pain is unlikely to be
explain its painkilling effects. It may These therapies are merely a selection found by popping the usual pills.
be that massage raises levels of of the vast array of non-drug options Joanna Evans

6 WDDTY Chronic pain


Common conditions

Chronic back pain


There is now a multitude body mass index (BMI) was
of effective drug-free significantly associated with an
increased preva-lence of LBP,
alternative treatments for
particularly in women (Spine [Phila Pa
this common, often 1976], 2010; 35: 7648).
disabling, condition u Stop smoking. Cigarette-smoking
appears to be linked to LBP,
ore than 80 per cent of us according to several studies. In a

M will suffer from disabling


low back pain (LBP) at
some point in our lives.
Although most of us will recover
within a few months, some will go on
recent meta-analysis that pooled
the results of 40 separate studies,
current smokers were 80-per-cent
more likely to suffer from chronic
LBP and also had more than twice
to develop chronic LBPpain that the risk of disabling LBP (Am J Med,
persists for three months or longer. In 2010; 123: 87.e735).
most cases, its not possible to identify More worrying, exposure to
a specific cause of the pain, and the secondhand smoke during
treatment usually involves course after childhood can increase the risk of
course of dangerous drugs (BMC developing back problems later in
Musculoskelet Disord, 2010; 11: 163). life. Researchers have postulated
Happily, theres a vast array of that this might be because tobacco
complementary and alternative smoke has detrimental effects on
therapies now available for chronic the developing spine (Eur J Public spongy bone matrix to form. This
LBP, many of which are supported by Health, 2004; 14: 296300). leads to fluid absorption, resulting
good evidence of success (see box, u Get enough sunshine. Mounting in an expansive pressure that trig-
page 8). But perhaps the best way to research suggests that a lack of gers the abundant pain fibres in the
tackle LBP is to prevent it from vitamin D, produced naturally by tissues overlying the bones.
becoming a problem in the first place. the body in response to sunlight, This suggests that anyone who
could be contributing to chronic has non-specific LBP should be
Preventing back pain musculoskeletal pain, including tested for vitamin D deficiency.
According to the latest evidence, there LBP (BMJ, 2005; 331: 109). u Manage stress. Psychological fac-
are a number of ways you can reduce In one study of patients with tors such as stress and depression
your risk of LBP. chronic, non-specific (no obvious are also thought to play a role in
u Stay active. Lower levels of physical cause) LBP attending spinal and LBP. In one UK study that followed
activity are linked to LBP (Aust J internal medicine clinics in Saudi 4500 adults (aged 18 to 75 years)
Physiother, 2009; 55: 538), while regular Arabia for six years, 83 per cent for 12 months, the likelihood of
exercise appears to prevent the were found to have abnormally low having a new episode of LBP was
condition (Joint Bone Spine, 2008; 75: levels of vitamin D. After supple- greater among those who scored in
5339). This makes sense as having menting with the vitamin, however, the upper-third of a questionnaire
strong, flexible muscles are symptomatic clinical improvement for psychological distress (Spine
essential for a healthy back. was seen in all those who had low [Phila Pa 1976], 1995; 20: 27317). In
However, overly strenuous or initial concentrations of the vitamin another study, psychological dis-
excessive exercise can be bad for (Spine [Phila Pa 1976], 2003; 28: 1779). tress was a better predictor of back
the back (Pain, 2009; 143: 215), so be According to Dr Stewart Leavitt, pain than the standard diagnostic
sure to choose the right form of a member of the American techniques (Spine [Phila Pa 1976], 2004;
activity for you. Academy of Pain Management and 29: 11127). Psychological factors are
According to Wisconsin-based editor-in-chief of the online journal also implicated in the transition
spine expert Dr Peter Ullrich, an Pain Treatment Topics, vitamin D from acute to chronic LBP (Spine
ideal back workout includes a deficiency can cause musculoskele- [Phila Pa 1976], 2002; 27: E10920).
combination of stretching, streng- tal pain by causing hypocalcae- u Avoid poor posture. In particular,
thening and low-impact aerobic miaabnormally low levels of sitting in a chair for long periods
conditioning. circulating calciumwhich sets in of time creates imbalances in the
u Watch your weight. Being over- motion a cascade of biochemical musculoskeletal system that can
weight places an additional burden reactions negatively affecting bone increase the risk of pain and injury.
on the spine and strain on the back metabolism and health. One of According to one study, workers
muscles. In one study of more than these reactions is increased para- who sit for more than half a day in
60,000 men and women, a high thyroid hormone (PTH), causing a awkward postures are significantly

WDDTY Chronic pain 7


Common conditions

Drug-free treatment for back pain


u Exercise. Not just good for preventing back pain, either back school or individual physiotherapy (Clin
exercise can treat it, too. One review concluded that Rehabil, 2010; 24: 2636).
exercise can reduce pain and improve physical u Biofeedback. This mindbody technique was found to
function in chronic or recurrent LBP (Joint Bone Spine, be more effective than behavioural therapy or
2008; 75: 5339). The most effective strategy appears to conservative medical treatment for sufferers of chronic
be an individually designed exercise programme that back pain. The researchers also reported that
includes stretching and strengthening, and is carried biofeedback was the only method to significantly
out under limited supervisionfor example, home- reduce pain over the two-year follow-up (J Consult Clin
based exercises with regular follow-ups by a therapist Psychol, 1993; 61: 6538).
( Ann Intern Med, 2005; 142: 77685 ). However, group u Hypnotherapy. Numerous studies show that hypnosis
exercise can also help, especially if you join a class is an effective treatment for a range of chronic pain
that focuses on the mind as well as the body. conditions. In a small preliminary study to assess its
v Yoga. A two-year study showed that an Iyengar yoga success in chronic LBP, a brief, four-session
class twice a week can improve functional disability, standardized self-hypnosis protocol, combined with
pain intensity and depression in adults with chronic psychoeducation, dramatically reduced pain intensity
LBP, and also allowed the use of less pain medication and pain interference (Int J Clin Exp Hypn, 2010; 58: 5368).
(Spine [Phila Pa 1976], 2009; 34: 206676). u Supplements. In addition to a balanced diet, a number
v Pilates Method. Increasingly used to treat chronic of supplements may be useful for beating back pain.
LBP, this form of exercise can be effective for reducing v Vitamin D could be the key to curing LBP if you are
pain and improving general physical function (J Bodyw deficient in this nutrient (see main story). In a study
Mov Ther, 2008; 12: 36470). of 360 patients with chronic LBP, vitamin D eased
v Qigong. The main posture used in this form of symptoms in virtually all those with the most severe D
exercise is similar to the posture recommended by deficiency (Spine [Phila Pa 1976], 2003; 28: 1779). Although
healthcare professionals dealing with back pain (Wien sunshine is our best source of this vitamin, most of us
Med Wochenschr, 2004; 154: 5647). Also, when used as an don't get enough of it that way. Pain expert Stewart
adjunct to drug treatment, this meditative form of Leavitt recommends (with the supervision of a qualified
movement and breathing techniques can successfully practitioner) a daily supplement of 2000 IU of vitamin
relieve chronic pain (Am J Chin Med, 2010; 38: 695703). D3 (cholecalciferol), along with a daily multivitamin
u Acupuncture. In one major review, acupuncture was that includes calcium and 400800 IU of vitamin D. Be
found to be superior to the usual care for treating patient, as it may take up to nine months to experience
chronic LBP, thereby justifying the recent recognition the maximum effects of this regimen.
of this traditional Chinese medicine technique as a v B-complex vitamins may also help. A combination
therapeutic option for LBP by the UKs National of vitamins B1, B6 and B12, taken twice a day at
Institute for Health and Clinical Excellence (NICE) (Ann 50 mg, 50 mg and 1 mg, respectively, together with the
R Coll Surg Engl, 2010 Jun 7; Epub ahead of print). popular non-steroidal anti-inflammatory drug (NSAID)
u Massage. Several studies suggest that therapeutic diclofenac (50 mg twice daily), was better at relieving
massage is useful against chronic LBP, especially when back pain than the NSAID alone (Curr Med Res Opin, 2009;
combined with exercise and patients self-care 25: 258999).
education (Spine [Phila Pa 1976], 2009; 34: 166984). In one v Proteolytic enzymes, such as trypsin and serra-
trial, the benefits of massage were still evident 910 peptase, may be useful as they are known to have anti-
months after the therapy had ended (Trials, 2009; 10: 96). inflammatory properties (Indian J Pharm Sci, 2008; 70:
u Alexander Technique. This discipline, which 1147).
emphasizes the self-perception of body movement, u Herbs. The following may help to relieve back pain.
was found to be more effective than conventional care v Capsaicin, found in all hot peppers, can ease many
or massage as a treatment for chronic or recurrent types of chronic pain when applied regularly to the
back pain. Whats more, just six lessons followed by skin. In one study, a capsaicin plaster was significantly
prescribed exercises were nearly as successful as 24 better than a placebo in patients with chronic back pain
lessons of Alexander Technique on its own (Br J Sports (Arzneimittelforschung, 2001; 51: 896903).
Med, 2008; 42: 9658). v Devil's claw (Harpagophytum procumbens) is
u Spinal manipulation. Performed by chiropractors as effective for LBP when the daily dose provides at least
well as some osteopaths and physical therapists, 50 mg of the active ingredient harpagoside. One trial
spinal manipulation was recently pitted against back found it to be just as effective as the NSAID rofecoxib
school (consisting of group exercise and education) (Spine [Phila Pa 1976], 2007; 32: 8292).
and individual physiotherapy (exercise, passive v White willow bark (Salix alba) is chemically related to
mobilization and soft-tissue therapy) for the treatment aspirin and appears to provide short-term relief of LBP.
of chronic LBP. The results showed that spinal Studies used daily doses standardized to 120 mg or
manipulation provided better short- and long-term 240 mg of salicin, which has anti-inflammatory actions
functional improvements, and more pain relief, than (Spine [Phila Pa 1976], 2007; 32: 8292).

8 WDDTY Chronic pain


more likely to suffer from LBP (Eur twisting simultaneously. an adult (Arch Pediatr Adolesc Med, 2009;
Spine J, 2007; 16: 28398). (See WDDTY u Treat childhood back pain. 163: 6571). It is vital, therefore, that
vol 20 no 3 for tips on keeping a Contrary to popular belief, non- the condition, when it arises, be
healthy back while sitting.) specific LBP is a serious problem dealt with promptly.
Poor lifting technique can also among children and teenagers. The possible causes of childhood
be the cause of back pain. You Indeed, a review of the relevant LBP include intensive sports
should always push, rather than studies suggests that rates are activities and carrying a too-heavy
pull, when you need to move heavy almost as high as in adults (Ugeskr backpack, as well as the factors
objects and, if you have to lift, let Laeger, 2002; 164: 7558). mentioned above (Rev Chir Orthop
your legs do the work by holding the There are also clear correlations Reparatrice Appar Mot, 2004; 90: 20714).
load close to your body, keeping between experiencing LBP as a For backpack safety tips, see
your back straight and bending only child/adolescent and suffering from http://orthoinfo.aaos.org/topic.cf
at the knees. Avoid lifting and LBPespecially chronic LBPas m?topic= A00043.
Joanna Evans

WDDTY Chronic pain 9


Common conditions

Migraine misery:
triggers and treatments
If you suffer from these When four patients with migraine and
severe chronic headaches, CD were put on a gluten-free diet for
its useful to know that six months, one patient subsequently
theres a wide range of safe had no migraine attacks, while the
alternative treatments you other three experienced improvements
in the frequency, duration and intensity
can take
of their migraines (Am J Gastroenterol,
ore than just a headache, 2003; 98: 6259).

M migraine is a chronic
condition that can have a
huge impact on peoples
lives. In fact, the World Health
Organization has rated migraine
Other types of anti-allergy diets have
also proved effective. In a double-blind
controlled trial of 88 children with
severe, frequent migraines, an elim-
ination diet led to full recovery in 93
amongst the top-20 most-disabling per cent of them. Their symptoms
chronic lifetime conditions. recurred when the suspected foods
Besides a severe headache, sufferers were reintroduced into their diets
may experience a range of other (Lancet, 1983; 2: 8659).
symptoms that include nausea, u Sleep problems. Several studies have
vomiting, abdominal pain, and an found an association between sleep
increased sensitivity to light and noise. headaches. These can vary from person patterns and migraine. In a recent
Whats more, recent evidence suggests to person and, in most cases, the Norwegian study, severe sleep
that people with migraine have a sufferer is responding to multiple disturbances were five times more
higher risk of stroke, particularly those triggers (Aust Fam Physician, 2005; 34: common among migraine sufferers
who suffer from migraine with aura 64751). than headache-free individuals (J
sensory, motor or visual disturbances Headache Pain, 2010; 11: 197206). Another
that can precede or accompany the Migraine triggers study found that overnight headaches,
headache. Smoking, oral contraceptive u Food allergies/sensitivities. One or headaches first thing in the
use and being a woman can increase factor known to bring on migraines morning, reflected a sleep disturbance
the risk even further (Neurol Sci, 2010; 31 particularly in children and in 55 per cent of patients. Treatment
Suppl 1: S1278). teenagersis food. Usually, its the of the sleep disorder varied, but the
Migraine is thought to occur when chemicals within foods that are results showed an improvement in
the blood vessels in the brain constrict thought to be the culprit. Chemicals headache symptoms in 100 per cent of
and then suddenly widen. But precisely such as tyramine (found in cheese), the participants, and complete resolu-
what brings about this pattern of phenylethylamine (found in tion in 65 per cent of cases (Aust Fam
vascular constriction and relaxation chocolate), tyrosine, monosodium Physician, 2005; 34: 64751).
remains a mystery. glutamate (MSG), aspartame, caffeine, u Infection. Helicobacter pylori (the
Doctors usually blame it on heredity, sulphites, nitrates (found in processed microorganism that causes peptic
and treat the condition with prescrip- meats) and histamine (found in wine ulcers) infection can predispose some
tion drugs such as prochlorperazine, and beer) appear to trigger the people to migraine. In one trial, 40 per
sumatriptan and ergotamine. But condition by altering the physiological cent of migraine sufferers had H. pylori
these agents do nothing to cure the processes associated with migraine infection, and the intensity, duration
condition and, worse, come with a attacks (Pediatr Neurol, 2003; 28: 915). and frequency of attacks of migraine
myriad of side-effects. Some can even A study of 577 migraine sufferers were significantly reduced in all
cause rebound headachesthat is, found that sensitivity to cheese, participants in whom the bacteria were
headaches brought on by the chocolate, red wine and beer had the eradicated (Hepatogastroenterology, 1998;
medication itself. most clear-cut associations with 45: 76570). More recently, researchers
Sufferers stand a much better attacks (Headache, 1995; 35: 3557). discovered that H. pylori infection is
chance of long-term relief if they try Theres also some evidence that most common in people whose
to work out whats causing their gluten sensitivity may play a role in migraines are not triggered by hor-
migraines in the first place. migraines. Indeed, it appears that monal fluctuations (such as during
Although its not clear why some migraine is a common feature in menstruation) and in those without a
people have migraines and others patients with coeliac disease (CD) (Mov family history of migraine (J Headache
dont, studies have identified a number Disord, 2009; 24: 235862), and one study Pain, 2007; 8: 32933).
of factors that can precipitate such found that a gluten-free diet can help. u Magnesium deficiency. Compared

10 WDDTY Chronic pain


with non-sufferers, people with
migraines have lower blood and brain Herbal helpers
levels of magnesium. However, taking
around 600 mg/day was found to u Feverfew (Tanacetum parthenium) is a popular herbal remedy for
significantly reduce the frequency of preventing migraine. Trials show that remedies standardized to around
migraine attacks (Altern Med Rev, 1999; 4: 250 mcg of parthenolide can reduce the severity, duration and frequency
8695). But lower doses of magnesium of migraines (Phytother Res, 1997; 11: 50811). When using feverfew, be
can also be effective. Another study patient, as it can take four to six weeks to see results.
found that just 200 mg/day could u Butterbur (Petasites hybridus) is another effective migraine
reduce the frequency of migraines in preventative. In one study, just 50 mg/day (standardized extract) for 12
80 per cent of those treated (Headache, weeks significantly reduced the frequency of migraines compared with
1990; 30: 168). Its thought that magnes- placebowith no adverse effects (Altern Med Rev, 2001; 6: 30310). However,
ium plays a role by counteracting the butterbur contains alkaloids that are toxic to the liver, so be sure to
sudden contraction of blood vessels, choose alkaloid-free formulations.
inhibiting platelet aggregation and u Ginger (Zingiber officinale) may help against migraineat least
stabilizing cell membranesall of according to anecdotal evidence (J Ethnopharmacol, 1990; 29: 26773).
which are involved in migraine. Clinical trials are lacking, but an observational study suggests that
u Stress. This is the factor listed most 500600 mg/day of dried ginger can relieve migraine attacks as well as
often by migraine sufferers as a trigger reduce their frequency and severity (Altern Med Rev, 1999; 4: 8695).
for their attacks. Theres also evidence u Ginkgo biloba inhibits the action of what is known as platelet-activating
that stress may even help to initiate factor, an agent that is believed to contribute to migraine headaches.
migraine in those predisposed to the Indeed, two small trials suggest that Ginkgo extract may have benefits
disorder and that migraine attacks for migraine patients. The recommended dosage, standardized to 24-per-
themselves may be a stressor, thus cent Ginkgo heterosides (its active ingredient), is 40 mg three times a day
leading to a vicious cycle of chronic (Altern Med Rev, 1999; 4: 8695).
migraines. This suggests that stress-
reduction techniquessuch as medita-
tion, yoga or regular massageor even natural ways to treat migraine. cent had reduced nausea and vomiting
a relaxing hobby may help to prevent u Supplements. The following nutri- (Cephalalgia, 1997; 17: 12730). In contrast,
and manage migraines (Headache, 2009; tional supplements may be beneficial a randomized double-blind placebo-
49:137886). for migraine. controlled trialconsidered the gold
u Environment. Bright sunlight, flick- v Riboflavin (vitamin B2). A German standard for scientific evaluation
ering lights, air quality and odours are study found that supplementing with found no significant differences
known to trigger migraines (Headache, 400 mg of riboflavin reduced the between treatment with omega-3
2009; 49: 94152). Moreover, headache is number of migraine attacks by half, supplements and placebo. However, the
a common symptom of sick building although once an attack had occurred, placebo was olive oil, which is itself a
syndrome (SBS), a condition thought the vitamin had no effect on either its source of beneficial PUFAs (J Adolesc
to result from factors such as volatile severity or duration (Eur J Neurol, 2004; Health, 2002; 31: 15461).
organic compounds (found in paint, 11: 4757). Similar results have been v 5-Hydroxytryptophan (5-HTP) can
lacquer, plastic and glue), moulds, reported in earlier studies (Neurology, be just as effective as two commonly
electromagnetic radiation, lighting, 1998; 50: 46670). Riboflavin is generally used migraine drugspropranolol and
noise, air conditioning, excessive safe, although some people taking high methysergide (Schweiz Med Wochenschr,
heating and poor ventilation. doses may develop diarrhoea. 1991; 121: 158590; Eur Neurol, 1986; 25:
According to one review, SBS may v Coenzyme Q10. A significant propor- 3279). In general, dosages of 400600
indeed be a plausible explanation for tion of migraine sufferers may be mg/day are taken.
chronic headache in some patients deficient in this vitamin-like antioxi- u Manual therapies. According to a
(Aust Fam Physician, 2005; 34: 64751). dant (Headache, 2007; 47: 7380). Placebo- review of the scientific literature,
controlled trials are lacking, but 150 spinal manipulation/mobilization is
Alternative treatments mg/day of CoQ10 may cut migraine effective for migraine (Chiropr Osteopat,
A variety of other factorsranging frequency by more than 50 per cent 2010; 18: 3). One study found that spinal
from drugs to hormones to without any side-effects (Cephalalgia, manipulation was on par with drugs
dehydrationcan bring on migraines, 2002; 22: 13741). for reducing migraine sufferingand
so the best course of action is to keep v Polyunsaturated fatty acids (PUFAs) had fewer side-effects (J Manipulative
a headache diary to help to determine may also be useful. When 129 migraine Physiol Ther, 1998; 21: 5119).
your potential triggers. Addressing sufferers were given gamma-linolenic u Transcranial magnetic stimulation
these triggerswith the help of an acid (an omega-6 PUFA) and alpha- (TMS). This non-invasive technique,
experienced practitionermay reduce linolenic acid (an omega-3 PUFA), 86 which uses a fluctuating magnetic field
the frequency of attacks or even per cent saw reductions in the severity, to stimulate neurons in the brain,
eradicate the problem entirely. How- frequency and duration of their shows promise as a migraine treatment
ever, if this approach doesnt work, migraine attacks, 22 per cent became and preventative. Indeed, a portable
there are a number of tried-and-tested migraine-free, and more than 90 per device called Neuralieve was found to

WDDTY Chronic pain 11


Common conditions
be significantly better than placebo at and better quality of life (Headache, 2009; internal physiological states. In fact,
alleviating migraine attacks (Lancet 49: 56370). numerous studies have shown that
Neurol, 2010; 9: 37380). u Acupuncture. This traditional biofeedback is effective for reducing
u Exercise. Physical activity has been Chinese technique can treat a range of the frequency and severity of head-
reported to trigger headaches in some different sorts of headaches, including aches. However, such treatment can
people, yet recent evidence also migraine. According to a review by the be expensive and time-consuming (Pain
suggests that exercise may be bene- Cochrane Collaboration, acupuncture Physician, 2009; 12: 100511).
ficial for migraines. When Swedish is at least as effective as, or possibly u Homeopathy. A two-year study
researchers studied 26 patients at a more effective than, prophylactic drug carried out in Germany suggests that
local headache clinic for 12 weeks, they treatment, and has fewer adverse homeopathy may be useful against
found that regular exercise (indoor effects (Cochrane Database Syst Rev, 2009; migraine (J Altern Complement Med, 2010;
cycling three times a week) led to 1: CD001218). 16: 34755). A qualified practitioner will
significant improvements, including u Biofeedback. This technique uses be able to prescribe personalized
fewer migraine attacks, less intense special machines to feed back treatment.
symptoms and less use of medicines, information related to your specific Joanna Evans

12 WDDTY Chronic pain


Fibromyalgia:
mind and body techniques
that help and support), the LPA group
reported improved physical function
and reduced painand these results
Eight times more women were statistically significant (Arthritis
than men develop Res Ther, 2010; 12: R55).
As Kevin Fontaine, lead author of
fibromyalgia. Although
the study, stated, The nature of
painkillers are the usual fibromyalgia's symptoms, the body
treatment, exercise may be pain and fatigue, make it hard for
a safe and effective people with this malady to
alternative. participate in traditional exercise.
Weve shown that LPA can help them
to get at least a little more physically
robably the last thing you active, and that this seems to help

P feel like doing. But the


evidence is stacking up to
show that keeping active
might be the best way to combat this
painful chronic condition.
improve their symptoms.
However, a follow-up study that
tracked the participants for 12
months suggests that the effects of
LPA are rather short-lived. Although
Several studies published over the the LPA group reported greater
last few years have found that regular perceived improvement at six and at
physical activityeven just 12 months, they no longer differed
walkingmay help alleviate the from the controls in terms of pain,
devastating symptoms of high-intensity exercise. physical activity, body point
fibromyalgia, which include wide- Nordic walking . . . offers patients tenderness, fatigue and depression (J
spread pain, fatigue, disturbed sleep, a safe and effective means of Clin Rheumatol, 2011; 17: 648).
stiffness, reduced physical regaining functionality and physical The researchers noted that
functionality and depression. fitness, the study authors concluded activity levels declined over the
In one of the latest studies, (Arthritis Res Ther, 2011; 13: 103). course of the study, suggesting
published in February 2011 in an Another studypublished in the that the participants had
international peer-reviewed journal, same international journal, but in difficulty adhering to the LPA
Nordic walkinga fitness technique 2010demonstrated that even short recommendations.
that involves walking with specially bursts of physical activity, such as
designed poleswas revealed to gardening or housework, can be Mindbody techniques
improve the physical capacity of beneficial for fibromyalgia sufferers. Another type of activity that may
women with fibromyalgia. In this report, researchers at John help fibromyalgia sufferers is exercise
A total of 58 women completed Hopkins University and the that involves the mind as well as the
the study, which compared moderate- University of Michigan in the US body.
to-high-intensity Nordic walking investigated the effects of 30 Yoga, for example, relieved a
(twice a week for 15 weeks) with minutes of lifestyle physical activity variety of fibromyalgia symptoms,
supervised, low-intensity walking (as (LPA), five to seven days a week, on including pain, fatigue and
the control condition). The results physical functionality, pain and other depression. In this study, 53 women
showed that both groups enjoyed measures of disability in 84 relatively were randomized to receive either an
clinically meaningful reductions in inactive fibromyalgia patients. eight-week yoga programme
pain and fatigue. However, LPA involves doing moderate- (involving gentle poses, meditation,
compared with the control group, intensity physical activities (intense breathing exercises and group
the Nordic walkers experienced enough to cause heavy breathing, but discussions) or standard care. The
significant fitness gains and had not to the extent that you cant hold results with yoga were clinically
significantly improved scores on a a conversation) based around significant: pain was reduced by an
fibromyalgia-specific questionnaire everyday life, such as taking the average of 24 per cent, fatigue by 30
assessing physical function. stairs instead of the lift or vacuuming per cent and depression by 42 per
Whats more, Nordic walking did the house. cent (Pain, 2010; 151: 5309).
not trigger any flareups of After 12 weeks, the findings Crucially, participants showed a
fibromyalgia symptoms, which can showed that, compared with controls strong commitment to the yoga.
happen with some other forms of (who were only given information Attendance at the classes was good

WDDTY Chronic pain 13


Common conditions
as was most participants willingness
to practice yoga while at home, said Other approaches
study author James Carson. However,
further research is needed to see if u Try TCM.According to a recent review,Traditional Chinese Medicine (TCM) appears
yoga is an effective therapy in the to be effective against fibromyalgia. Studies show that acupuncture, Chinese herbs, and
long term. a combination of acupuncture and cupping are more successful at reducing pain than
Another promising mindbody are conventional drug treatments (J Altern Complement Med, 2010; 16: 397409).
technique is tai chi, which combines u Give homeopathy a go. In a double-blind, randomized controlled trial (RCT,
meditation with slow, gentle, considered the gold standard for scientific evaluation), individualized homeopathy
graceful movements, as well as deep proved to be significantly better than placebo in lessening tender point pain and
breathing and relaxation. improving the quality of life and global health of persons with fibromyalgia (Rheumatology
In this trial, 66 fibromyalgia [Oxford], 2004; 43: 57782).
patients were assigned to either tai More recently, a review of the findings of RCTs so far revealed that homeopathy is
chi classes (one-hour sessions twice a consistently better than a placebo at alleviating the symptoms of fibromyalgia. However,
week for 12 weeks) or a control the researchers noted that more rigorous trials are needed (Clin Rheumatol, 2010; 29:
intervention of wellness education 45764).
and stretching. At the end of the u Consider massage. A particular technique called myofascial release therapy was
study, the tai chi group showed found to improve pain, quality of sleep, anxiety levels and quality of life in a 20-week RCT
clinically significant improvements study of 74 fibromyalgia patients (Evid Based Complement Alternat Med, 2011; 2011: 561753).
in symptoms, as measured by the u Go vegan. A vegan dietwhich includes no animal productsmight be helpful for
Fibromyalgia Impact Questionnaire. fibromyalgia, according to a study of 33 fibromyalgia patients who were split into two
In particular, tai chi was associated groupsone following a strict, low-salt vegan diet consisting of only raw foods, and one
with reduced pain and depression, that continued with an omnivorous diet. After three months, the vegan dieters saw
and better sleep and quality of life. significant improvements in their overall health, with less pain and stiffness, too (Scand J
No adverse effects were reported and Rheumatol, 2000; 29: 30813).
the benefits were sustained for 24 However, these beneficial effects could simply be down to the fact that the
weeks (N Engl J Med, 2010; 363: 74354). participants lost weightmost were overweight at the beginning of the study, and
But if faster-paced exercise is shifting to a vegan diet caused significant reductions in their body mass index (BMI).As
preferred, it may be worthwhile several studies have found a link between obesity and fibromyalgia (J Pain, 2010; 11:
combining your favourite aerobic 132937), it may perhaps be that the weight loss rather than the vegan diet per se was
exercise with simple relaxation responsible for the improvements.
techniques such as deep breathing u Eliminate harmful food additives. There is evidence to suggest that the artificial
and visualization (adding these to sweetener aspartame and the flavour enhancer monosodium glutamate (MSG)both
the end of your workout). In a study known to be excitotoxinsmay be involved in fibromyalgia. One study describes
from Spain, fibromyalgia patients four women with fibromyalgia who saw complete or nearly complete resolution of
who participated in an aerobic their symptoms within months of eliminating MSG or MSG plus aspartame from
exercise programme combined with their diet. More important, symptoms recurred whenever they ingested the
progressive relaxation techniques chemicals again.
experienced significant improve- We propose that these four patients may represent a subset of fibromyalgia
ment compared with the control syndrome that is induced or exacerbated by excitotoxins or, alternatively, may
group, which received sham comprise an excitotoxin syndrome that is similar to fibromyalgia, the researchers
magnetic therapy. After 10 weeks, said (Ann Pharmacother, 2001; 35: 7026).
the exercise + relaxation group In a case report including a woman with fibromyalgia, her symptoms completely
reported better sleep, reduced disappeared after she stopped consuming aspartame (Clin Exp Rheumatol, 2010; 28 [6
anxiety and improved quality of life Suppl 63]: S1313).
(Med Clin [Barc], 2011 Feb 21; Epub ahead of u Try supplements. 5-Hydroxytryptophan (5-HTP; 100 mg three times a day) and
print). S-adenosylmethionine (SAMe; 800 mg per day) may be effective for fibromyalgia,
Clearly, drugs are not the only according to double-blind trials (J Int Med Res, 1990; 18: 2019; Scand J Rheumatol, 1991; 20:
answer to fibromyalgia, as studies are 294302). Other potentially useful supplements include vitamin D (Clin Rheumatol, 2007;
now suggesting that aerobic exercise 26: 5514), magnesium with malic acid (J Rheumatol, 1995; 22: 9538), and antioxidants such
and mindbody techniques are as vitamins C and E (Redox Rep, 2006; 11: 1315). Many fibromyalgia sufferers are deficient
effective. Nevertheless, more in these and other nutrients, so it may be worth getting tested to see what youre low
research is needed to see how these in.
interventions fare in the long-term, u Check your thyroid. According to Dr John Lowe of the Fibromyalgia Research
although it appears that if you can Foundation in Boulder, CO, many of the features of fibromyalgia and hypothyroidism
stick with it, you will continue to (an underactive thyroid) are virtually identical, and thyroid hormone treatment trials
reap the benefits. For best results, have reduced or eliminated fibromyalgia symptoms as well (Med Sci Monit, 2006; 12:
work with a physical therapist who CR2829). For this reason, it may prove useful to investigate the possibility of having
can devise an exercise programme hypothyroidism, and to seek out natural treatments if you do (see WDDTY vol 20 no10,
thats right for you. pages 189).
Joanna Evans

14 WDDTY Chronic pain


Chronic fatigue syndrome
CFSalso known as longer to find out whether XMRV plays
a role in CFS or not.
myalgic encephalomyelitis
(ME) or post-viral fatigue Multiple causes
syndromeis a Although theres been a preoccu-
debilitating condition that pation with finding a single cause of
affects an estimated 17 CFS in conventional circles, holistic
million people worldwide. practitioners have long believed that
the condition has many potential
Luckily, theres now a wide
causes, each of which shares a
variety of promising common endpointsevere immune
natural treatments, suppression.
ranging from acupuncture Within such a construct, every one
to saunas and of the proposed causes of CFS
supplements. including viruses, stress, depression,
impaired liver function, environmental
illness, medicine use, adrenal insuf-
hronic fatigue syndrome ficiency, Candida albicans infection,

C (CFS) is a mysterious
illness with a long history of
controversy. Early on,
medical authorities were sceptical as
to whether or not it even existed.
leaky gut, hypothyroid, hypoglycaem-
ia, anaemia, nutritional deficiencies,
food allergies, sleep disturbances,
emotional problems, poor posture and
lack of exerciseis credible.
Today, there are still disagreements two additional laboratories, reported Successful treatment requires
as to its diagnosis, cause(s), contradictory findings. working with an experienced practi-
treatment and prevalencenot to In that study, blood samples from tioner who knows the importance of a
mention what to call it. around 100 people with and without comprehensive diagnosis that takes
Sadly, two new studies have come CFS were tested, with the result that into consideration the patients
up with nothing to help clear up the the CDC researchers could find no medical history as well as their
confusion. The first, an investigation evidence of a link between CFS and physical and emotional lives. The most
by the US Food and Drug Adminis- XMRV. This was in direct contrast to effective regime is likely to be the one
tration (FDA), reportedly confirmed the Science study, which reported the that assesses all these factors to arrive
previous research that found a link presence of XMRV in 67 per cent of at an individual plan tailored to the
between CFS and the so-called xeno- the CFS patients compared with 3.7 given patients needs.
tropic murine leukaemia virus- per cent of the healthy controls (Retro
related virus (XMRV). virology 2010, 7: 57; doi: 10.1186/1742-4690-7- Proven natural treatments
The study has yet to be published 57). Conventional medicine has little to
but, in a presentation at a blood In response, Judy Mikovits, director offer the CFS sufferer besides anti-
safety meeting in the Croatian of research at the Whittemore depressants or pain relievers that only
capital of Zagreb, virologist Harvey Peterson Institute in Reno, NV, and manage symptoms. Fortunately,
Alter, one of the study researchers, lead author of the Science study, stated although the scientific evidence is
reported a very strong CFSXMRV that the CDC report was flawed relatively weak, there are a number of
connection, independently conf- because it failed to use patients that promising natural treatments for CFS.
irming data that had been published had been officially diagnosed with u Supplements. Research suggests
in the journal Science in 2009 CFS, and it also lacked positive that the following nutritional
(www.independent.co.uk/ news/science- controls in the form of blood from supplements may be beneficial.
/study-that-solves-chronic-fatigue-syndrome- people known to be diagnosed with However, be sure to first consult a
blocked-2022195.html). Until now, other XMRV infection. qualified practitioner who can
teams have failed to replicate the Weve now got more than 1000 check for any deficiencies and
results (Science, 2009; 326: 5859). individual patients from around the advise you on dosages.
However, any hopes that such an world in whom weve detected and v Magnesium. Some CFS sufferers
association would offer a solid isolated the virus . . . I havent changed have been found to have low levels
explanationor lead to a potential my mind on this, Dr Mikovits said. of magnesium in their blood.
treatmentfor the puzzling But the FDA study that supposedly Indeed, many of the symptoms of
condition were soon dashed when supports Mikovits findings has also CFS resemble those of magnesium
another US government study, this come under criticism, and is currently deficiency (Altern Med Rev, 2000; 5:
time by the Centers for Disease undergoing a rigorous scientific review 93108). Also, in one small ran-
Control and Prevention (CDC), and process. Clearly, well have to wait a bit domized controlled trial, patients

WDDTY Chronic pain 15


Common conditions
who had weekly injections of
magnesium sulphate were more CFS symptoms
likely to feel better after six weeks
than those who had received Sufferers with chronic fatigue syndrome (CFS) can experience a wide range
injections of a dummy treatment of signs and symptoms, but the main ones include:
(Lancet, 1991; 337: 75760). Oral mag- u fatigue
nesium has also proved useful in u impaired memory or concentration
magnesium-deficient CFS sufferers, u sore throat
according to a preliminary report u painful and mildly enlarged lymph nodes in the neck or armpits
(Lancet, 1992; 340: 426). u unexplained muscle pain
v Carnitine is essential for the u pain that moves from one joint to another with no swelling or redness
production of energy in the power- u headache of a new type, pattern or severity
houses of cells (mitochondria). Not u unrefreshing sleep
enough of this nutrient can impair u extreme exhaustion that lasts for more than 24 hours after physical or
mitochondrial function, leading to mental exercise.
symptoms of generalized fatigue, Source: mayoclinic.com
along with musle pain (myalgia),
muscle weakness and malaise for three months, those taking the drome (IBS)-like symptoms seen
following physical exertion (Altern EFAs saw significant improvement in all patients, a significant finding,
Med Rev, 2000; 5: 93108). in their symptoms compared with as CFS patients have a high rate of
In addition, low carnitine levels the placebo. Moreover, the EFA IBS (Altern Med Rev, 2001; 6: 4509).
have been found in CFS patients, supplementation corrected the Another study concluded that
and one study saw a statistically abnormal fatty-acid levels noted at choosing organically grown fruit
significant clinical improvement the start of the study (Acta Neurol and vegetables is important for CFS
in those taking L-carnitine supple- Scand, 1990; 82: 20916). In contrast, patients, as they are found to have
ments for two months (Neuro- another trial using the same EFA elevated levels of pesticides in their
psychobiology, 1997; 35: 1623). supplement found no significant blood (Med J Aust, 1995; 163: 2947).
v Vitamin B12. Evidence suggests differences between the active- Pesticide exposure may be a direct
that high-dose injections of this treatment and placebo groups (Acta cause of CFS symptoms by affecting
vitamin may benefit people with Neurol Scand, 1999; 99: 1126). cell membranes or, indirectly, by
CFS. Injections of 25005000 mcg v Antioxidants may be beneficial, playing a role in the loss of natural
of B12 given every two to three as oxidative stress is thought to play tolerance for chemicals, including
days led to improvement in 50 to a role in CFS. Selenium, glutathi- those present in foods (Toxicol Ind
80 per cent of patients (Altern Med one, N-acetylcysteine, alpha-lipoic Health, 1999; 15: 38697).
Rev, 2000; 5: 93108). acid, coenzyme Q10 and oligomeric u Exercise. Traditionally, there is
v NADH (nicotinamide adenine proanthocyanidins (OPCs), as well some concern that exercise may
dinucleotide) helps make adenosine as vitamins C and E, may prove to make symptoms of fatigue worse,
triphosphate (ATP), the source of be invaluable in a CFS treatment but studies show that graded
the energy that the body runs on. In protocol. Ginkgo biloba and bilberry exercisewhich builds up gradually
a small double-blind crossover (Vaccinium myrtillus) are also from a gentle beginningcan
study, 26 CFS sufferers took either recommended (Altern Med Rev, 2001; 6: improve CFS symptoms.
10 mg of oral NADH or a placebo 4509). In a recent study of adolescent
every day for four weeks, then u Diet. As there may be a connection CFS sufferers, both graded aerobic
switched to the other treatment between food intolerance and CFS, exercise and progressive resistance
after a four-week interval. In the identifying and addressing these training were able to significantly
NADH group, 31 per cent saw their intolerances should prove helpful. improve physical capacity and
symptoms improve compared with When Australian CFS patients quality of life. However, only aerobic
just 8 per cent in the placebo group eliminated wheat, milk, benzoates, exercise improved fatigue severity
(Ann Allergy Asthma Immunol, 1999; 82: nitrites, nitrates, and food and symptoms of depression (Clin
18591). colourings and other additives from Rehabil, 2010 July 6; Epub ahead of print).
v Essential fatty acids (EFAs). Low their diet, 90 per cent of those Nevertheless, its generally advis-
levels of various EFAs could be who were able to stick with the able that CFS sufferers only do the
contributory to CFS (J Clin Pathol, diet reported improvement in the graded exercise that is prescribed
2007; 60: 1224; Neuro Endocrinol Lett, severity of a wide range of symp- and supervised by a trained thera-
2005; 26: 74551). However, whether toms, with significant reductions in pist, such as a physiotherapist.
supplements help is unclear. fatigue, recurrent fever, sore throat, u Cognitive behavioural therapy
When 63 CFS sufferers took muscle pain, headache, joint pain (CBT). This form of talking
either an EFA supplement (contain- and cognitive dysfunction. treatment is often used to treat
ing linoleic, gamma-linolenic, Whats more, the elimination chronically ill patients, and its
eicosapentaenoic and docosahexa- diet resulted in a marked improve- effectiveness in CFS was recently
enoic acids) or a placebo every day ment in the irritable bowel syn- the subject of a major review of the

16 WDDTY Chronic pain


literature. It found that those who from Japan have found that suggests that stress-reduction
received CBT were more likely to repeated far-infrared (FIR) saunas, activities such as meditation, tai
feel less tired at the end of a form of thermal therapy, may be chi or yoga may be beneficial.
treatment than patients who an invaluable treatment for CFS. Indeed, yoga appeared to help with
received the usual care from their Symptoms such as fatigue, pain, the characteristic symptoms of
doctor. Moreover, the review sleep disturbances and low-grade fatigue in an observational study
concluded that it may be more fever were all dramatically improved (J Clin Psychiatry, 2005; 66: 62532).
effective in reducing fatigue after 15 to 25 sessions (J Psychosom u Pacing is a form of treatment that
symptoms compared with other Res, 2005; 58: 3837). In fact, saunas is based on finding the optimal
psychological therapies (Cochrane may help by also encouraging the balance between rest and activity
Database Syst Rev, 2008; 3: CD001027). elimination of pesticides and other for the individual patient. Its
u Massage has many proven benefits toxins from the body (which may thought that, if those with CFS use
relevant to CFS sufferers, including be involved in CFS). See WDDTY what limited energy they have
better relief from pain, depression vol 20 no 10 for other effective ways wisely, their energy levels will even-
and anxiety, and improved sleep to detox. tually and gradually increase.
patterns. u Breathing retraining. A prelim- Randomized controlled trials are
A recent study from China found inary study carried out in Belgium lacking, but an observational study
that a technique called intelligent- identified specific breathing prob- found that three weeks of self-
turtle massage not only alleviated lems in patients with CFS. One managed pacing led to a modest
the physical symptoms of CFS, but session of breathing retraining was improvement in symptom severity
also boosted immune function (J able to improve lung function in and everyday functioning (J Rehabil
Tradit Chin Med, 2009; 29: 248). these patients, suggesting that this Res Dev, 2009; 46: 98596).
u Acupuncture. A meta-analysis of form of treatment may be useful in For this reason, a randomized
the pooled results of several studies some cases (Physiother Theory Pract, controlled comparative trial is
concluded that acupuncture is an 2008; 24: 8394). currently under-way to confirm the
effective therapy for CFS. However, u Relaxation techniques. According effectiveness of pacing, as well as
it was also noted that more high- to one study from the Netherlands, CBT and graded exercise, in
quality studies are needed to stress may well play an important addition to the usual specialist
confirm this finding (Zhen Ci Yan Jiu, predisposing, precipitating and medical care of CFS (BMC Neurol,
2009; 34: 4218). perpetuating role in CFS (Tijdschr 2007; 7: 6).
u Sauna therapy. Two case reports Psychiatr, 2009; 51: 60310). This Joanna Evans

WDDTY Chronic pain 17


Common conditions

Irritable bowel syndrome


There are a number of
effective alternative
ways to manage IBS
rritable bowel syndrome (IBS)

I is among the most common


problems of the digestive
system, affecting up to 15 per
cent of people in the developed
countries. Although its not life-
threatening, the symptomswhich
include abdominal pain, bloating,
wind, constipation and diarrhoea
can severely affect the IBS are typically seen in IBS (J Am Diet behind fructose malabsorption in
sufferers quality of life. Those with Assoc, 2006; 106: 16319). IBS are still in their early stages, in
IBS frequently report experiencing In one American study, cases where symptoms of gas,
loss of freedom, spontaneity and researchers at the Immanuel St bloating and diarrhoea appear to be
social contacts, as well as feelings Josephs Hospital, part of the Mayo related to eating fruit, a fructose
of fearfulness, shame and Health System in Minnesota, elimination diet might be
embarrassment (Dig Dis Sci, 2009; 54: looked at 80 patients with IBS and something worth considering.
153241). found that 31 (38 per cent) also
Adding to the problem, had fructose malabsorption. Of Other problem foods
conventional therapy is highly these patients, 26 were then put on Besides fruit sugars, other ferment-
inadequate. Many treatments (such a fructose-restricted diet, and able, poorly absorbed carb-
as antispasmodics, antidiarrhoeals, those who managed to stick with ohydratessuch as lactose (found
bulking agents, tranquillizers and the diet (only around half of them) in milk), fructans (found in wheat
sedatives) can harm more than enjoyed significant improvements and onions) and sorbitol (a
help, and none of them has proved in their symptoms, including common sweetener)are also able
to be globally effective at treating abdominal pain, belching, bloating, to cause or exacerbate the usual
IBS symptoms (J Chin Med Assoc, 2009; feelings of fullness, indigestion and symptoms of IBS (J Am Diet Assoc,
72: 294300). diarrhoea. The patients who didnt 2009; 109: 120414; Curr Gastroenterol Rep,
Its no surprise, therefore, that a stick with the dietary restrictions, 2009; 11: 36874).
growing number of IBS patients are on the other hand, generally saw no Whats more, some of the foods
turning to complementar y and change in their symptoms (J Clin that are commonly recommended
alternative medicine ( Gastroenterol Gastroenterol, 2008; 42: 2338). to ease IBS may actually be making
Clin Biol, 2009; 33 Suppl 1: S7983). Similarly, in a study of 32 the condition worse. Wheat bran,
children with persistent un- for instance, often prescribed for
The role of sugar explained abdominal pain, 11 of constipation due to its high fibre
Part of the problem of treating IBS them were found to have fructose content, only helped 10 per cent of
is that no one knows what causes it. malabsorption and, so, were sufferers in one study. On the other
The latest research, however, subsequently put on a low-fructose hand, more than half of the IBS
suggests that certain foods might diet. After two months, all but two sufferers followed-up by researchers
play a role, an idea that alternative of these children showed rapid at the University Hospital of South
practitioners have been expounding improvement of their symptoms, Manchester, in the UK, reported
upon for years. In particular, the and all continued to report positive that bran made their symptoms
more recent studies have revealed changes thereafter. The res- including bowel disturbances, and
that around a third of IBS patients earchers, from the New York abdominal distention and pain
may have problems with processing Medical College in the US, worse, leading the researchers to
fructose, the type of sugar that is concluded that fructose conclude that excessive con-
found in fruits, some vegetables, malabsorption may be a significant sumption of bran in the community
honey and high-fructose corn problem in children and that may actually be creating patients
syrup. Fructose malabsorption, as management of dietary intake can with irritable bowel syndrome
its officially knownwhich refers be effective in reducing gastro- (Lancet, 1994; 344: 3940).
to the bodys failure to completely intestinal symptoms ( J Pediatr Considering that wheat (along
absorb fructose as it passes Gastroenterol Nutr, 2008; 47: 3038). with milk and eggs) is one of the
through the small intestinecan Although the researches into the most common triggers of
lead to many of the symptoms that precise role and mechanism(s) symptoms in those with IBS, such

18 WDDTY Chronic pain


results are hardly surprising ( Am J Dangerous IBS drugs
Gastroenterol, 1998; 93: 218490).
If any fibre is to be Most of the drugs prescribed for irritable bowel syndrome come with a
recommended, then Plantago host of unwanted side-effects.
seedsa source of soluble fibre Anticholinergicsdrugs that block the effects of the neurotransmitter
that is sold commercially as acetylcholinesuch as Buscopan, for example, can cause dry mouth and
psyllium or ispaghula fibre blurred vision (Phytomedicine, 2005; 12: 6016), whereas bulking agents and
appears to be a better option, but it antispasmodic drugs such as Spasmonal (alverine citrate) can trigger
can still aggravate symptoms in nausea, dizziness, itching, rash and headache, according to the Electronic
some IBS sufferers (Townsend Letter Medicines Compendium (see http://emc.medicines.org.uk/medicine/
Docs, 2004; 252: 159). 15704/XPIL/Spasmonal+60mg/).
Probiotic yoghurt is another Whats more, one drug has even been linked to life-threatening adverse
popular recommendation for effects. Alosetron (Lotronex), currently used in the US only for the
people with IBS, but this, too, can management of severe diarrhoea-predominant IBS in women, was
make symptoms worse. While withdrawn from the market in 2000 following reports of five deaths and 70
probiotics may be beneficial for the cases of serious adverse reactions. These reactions included ischaemic
condition in some, dairy products colitis (fever and gut pain caused by insufficient blood supply) and
have also been found to trigger obstructed or ruptured bowels as a complication of severe constipation.
symptoms in a significant Yet, the US Food and Drug Administration (FDA) advisory panels
proportion of IBS sufferers. recommended that the drug be reintroduced in 2002 (albeit with restricted
According to Dr Stephen O. use and availability)the first case ever of a drug being brought back onto
Wangen, Chief Medical Officer of the US market after being withdrawn for reasons of safety.
the IBS Treatment Center in Dr Sidney Wolfe, director of the Public Citizens Health Research Group,
Seattle, WA, A large number of our commented, With the exception of some drugs used to treat cancer, the
patients who experience IBS are frequency and severity of a life-threatening adverse reactionin this case,
actually suffering from a dair y ischaemic colitis in patients using alosetronis among the highest I have
allergy but dont realize it. Yogurt, seen for any other drug (BMJ, 2002; 324: 1053).
although it is fermented, is still a
dairy product and can be a potent
trigger of their digestive problems. Cochrane Collaboration, which functional relaxation or
For these people, the consumption resulted in a pooled meta- enhanced medical care
of yogurt, even brands with high analysis of four studies involving (standard treatment plus two
probiotic bacteria content, is 147 patients altogether, counselling sessions) for five
inadvisable ( Townsend Letter, 2008; hypnotherapy was superior to weeks, the results showed that
June: 35). both the standard medical care functional relaxation was
Clearly, diet is a crucial factor in and no treatment in relieving significantly more effective than
IBS, but there is no one-size-fits-all abdominal pain and other IBS the control treatment. Indeed,
approach when it comes to symptomsat least for the short the positive effectsboth
successful treatment. Experi- term (Cochrane Database Syst Rev, physical and mentalwere still
menting with limiting or 2007; 4: CD005110 ). Clearly, present three months later (J
completely eliminating certain however, more high-quality Altern Complement Med, 2010; 16:
foods from your usual diet and/or studies are needed before any 4752).
working with an experienced definitive conclusions can be A small-scale (21 IBS
nutritional practitioner may be the drawn. patients), randomized controlled
best way to get the condition under u Relaxation. As numerous trials trial, carried out at Tohoku
control. have already identified the role University Graduate School of
of psychological and emotional Medicine in Japan, involved the
Other treatment approaches factors as triggers in patients use of autogenic training (AT),
Along with a change of diet, there with IBS, relaxation techniques a relaxation technique that
are a number of other natural ways are often recommended. In teaches your body how
to tackle IBS. Germany, the technique called to respond to your verbal com-
u Hypnotherapy. Emotional and functional relaxationa term mands through six standard
psychological factors appear to coined decades ago to describe a exercises. The technique appears
be involved in IBS, which may form of relaxation that is also to combine elements of both
explain why hypnosis has proved known as self-hypnosisaims self-hypnosis and biofeedback.
helpful for patients with the to maintain equilibrium within The results of this study suggest
condition. According to an the nervous system and appears that AT can benefit IBS by
extensive review of the to be beneficial for IBS. In a enhancing self-control, as
medical/scientific literature randomized controlled trial of reflected by the patients
carried out by the prestigious 80 patients, who received either responses to a number of IBS-

WDDTY Chronic pain 19


Common conditions

related questionnaires ( Appl peppermint oil and 29 per cent complained of gastrointestinal
Psychophysiol Biofeedback, Dec 8 2009; for placebo. However, even discomfort while the other
Epub ahead of print). though peppermint oil usually experienced headaches ( JAMA,
u Exercise. There is also evidence comes in specially coated 1998; 280: 15859).
to suggest that exercise may be capsules designed to protect the u Acupuncture. The results of one
an effective intervention for IBS. stomach, these capsules may trial in the US found that
When pitted against con- still lead to side-effects such as acupuncture combined with
ventional care in a 12-week trial, heartburn or rectal irritation moxibustion may be promising
the patients in the exercise (Phytomedicine, 2005; 12: 6016). for IBS management (Gastroenterol
group reported significant u Chinese herbal medicine Nurs, 2009; 32: 24355).
improvement in symptoms of (CHM). In a trial involving more However, a major review of the
constipation (Int J Sports Med, 2008; than 100 IBS patients, those studies up to 2006 found only six
29: 77882 ). Another trial treated with CHM, using randomized controlled trials,
concluded that even mild formulas that were either which were, in fact, inconclusive
physical activity can reduce gas individualized or standardized, due to poor quality or not
and abdominal bloating (Am J saw significant improvements in comparable because of too many
Gastroenterol, 2006; 101: 25527). terms of bowel symptoms as well differences in the variables
u Peppermint oil. According to a as overall quality of life. studied.
review of the literature, eight However, only the CHM group Also, orthodox researchers
out of 12 placebo-controlled taking herbals tailored to the have concluded that it is still not
studies showed statistically patient were able to maintain clear whether traditional
significant positive effects with the improvements 14 weeks acupuncture is any better than
peppermint oil for the treatment later. sham acupuncture at reducing
of IBS. The average response Furthermore, only two IBS symptoms (Cochrane Database
rates, as a reflection of overall patients taking CHM reported Syst Rev, 2006; 4: CD005111).
success, were 58 per cent for any adverse effects: one Joanna Evans

20 WDDTY Chronic pain


Tested treatments

Healing magnets
Do magnetic devices truly
was seen in patients receiving fake
heal, or are they just
magnet therapy. In fact, the active- above, the patients knew they had
hokum? magnet group used 1.5 mg more real magnets as they often were
agnetic devicesfrom morphine than the fake-magnet stuck to their keys in their pockets

M bands and bracelets to


leg wraps and shoe
insertsare used by
thousands of people worldwide,
thanks to a multimillion-pound
group (Anesth Analg, 2007; 104: 2904).
Similarly, magnets were no more
effective than a placebo for carpal-
tunnel syndrome and chronic lower-
back pain (J Fam Pract, 2002; 51: 3840;
(BMJ, 2006; 332: 4).
In fact, the authors of that study
were themselves aware of the
problem ( BMJ, 2004; 329: 14504).
Similarly, the authors of the study
industry that claims they can cure a JAMA, 2000; 283: 13225), and a meta- on magnet therapy for chronic
laundry list of ailments, especially analysis of nine randomized, pelvic pain admitted that blinding
pain. But do these products work? placebo-controlled trials of various efficacy was compromised (Am J
pain-related conditions reported Obstet Gynecol, 2002; 187: 15817).
What the science says that the evidence does not support However, its possible that the
Despite their popularity, theres the use of static magnets for pain conflicting results were due to the
little scientific evidence that relief (CMAJ, 2007; 177: 73642). strength of the magnets used, as
magnets are beneficial to health. However, the pain of OA of the studies that failed to show any effect
Although theyre often used to hip and knee was decreased by on pain generally used weaker
manage pain in chronic wearing magnetic bracelets magnets (1950 mTesla), while
musculoskeletal disorders, one compared with a dummy bracelet in those that found an effect used
study found that magnetic wrist a study of 194 men and women (BMJ, stronger ones (47180 mTesla)
straps were no better than a 2004; 329: 14504). Also, in a (BMJ, 2004; 329: 14504). Nevertheless,
placebo. preliminary study of 29 patients its clear that more research is
A total of 45 osteoarthritis (OA) with OA of the knee, magnets needed to determine whether this is
sufferers were randomly allocated to showed statistically significant indeed the answer.
one of four treatments, all using the efficacy compared with a placebo
same devicesa standard magnetic (Altern Ther Health Med, 2004; 10: 3643). The bottom line
wrist strap; a weakened magnetic Others found magnets to be better Although many people swear by
wrist strap; a demagnetized than a placebo for chronic pelvic magnets, the bulk of the research so
(dummy) wrist strap; and a copper pain and diabetic neuropathy (Am J far suggests that theyre no better
(non-magnetic) braceletbut in Obstet Gynecol, 2002; 187: 15817; Arch than a placebo for relieving pain.
different sequences. Each device was Phys Med Rehabil, 2003; 84: 73646). Yet, looked at another way, magnets
worn for at least eight hours a day Nevertheless, some scientists then do have an effect, albeit all in
for four weeks, after which the question these findings, pointing the head.
patients filled in questionnaires to out that many so-called controlled Ultimately, the studies show that
assess symptoms. tests are unreliable, as participants the mind is a powerful healer, and if
The results showed no significant can usually work out whether magnets can help it to perform that
differences among the devices for theyre in the real or fake magnet function, then perhaps theyre
pain relief, with similar findings for group, which can affect the results. useful after all.
stiffness, physical function and Indeed, in the BMJ study mentioned Joanna Evans
medication use. The overall
conclusion was that magnetic and
copper bracelets are generally Static vs pulsed magnetic fields
ineffective for managing pain,
stiffness and physical function in
Magnets are claimed to cure a variety of ills besides pain, although scientific
osteoarthritis, and that any
proof is lacking; for example, although magnets supposedly increase
reported therapeutic benefits were
circulation, a well-designed study found this wasnt so (Sci Rev Alt Med, 2002;
most likely due to non-specific
6: 912). Other research shows that magnets are ineffective for snoring, sleep
placebo effects (Complement Ther Med,
apnoea, tinnitus, and reducing heart rate and blood pressure (Wis Med J,
2009; doi: 10.1016/j.ctim.2009. 07.002).
1997; 96: 357; Clin Otolaryngol Allied Sci, 1991; 16: 3712; Clin Rehabil, 2002; 16:
Other studies have arrived at
66974).
much the same conclusions. In a
However, static magnets (those marketed to consumers) shouldnt be
placebo-controlled trial of 165
confused with pulsed electromagnetic-field therapy (PEMF), which involves
patients with postoperative pain,
brief exposures to much stronger electromagnetic fields. PEMF is effective
the effects of magnet therapy on
for treating slow-healing fractures and shows promise for other conditions,
pain intensity and opioid
including arthritis (Wien Klin Wochenschr, 2002; 114: 67884; Injury, 2008; 39: 41929).
requirements were similar to what

WDDTY Chronic pain 21


Tested treatments

Serrapeptase: a natural
anti-inflammatory
An enzyme found in with the placebo ( Pharmathera-
silkworms is touted as a peutica, 1984; 3: 52630).
natural alternative to non- Yet another study showed that
serrapeptase is better than the
steroidal anti-inflammatory
traditional post-surgery advice:
drugs (NSAIDs). But what bed rest, elevation and the
does the science say? application of ice. In patients
undergoing surgery of the ankle,
errapeptase, or serra- those treated with serrapeptase

S tiopeptidase, is a proteolytic
(protein-digesting) enzyme
with a long history of use in
Germany and Japan. Now known
worldwide for its anti-inflammatory
had 50-per-cent less postopera-
tive swelling compared with those
who followed the traditional
advice. The serrapeptase group
also became pain-free sooner
effects, its purported to treat than the control group did
everything from arthritis to heart (Fortschr Med, 1989; 107: 678, 712).
disease and infections. But what u ENT disorders. An Italian study
does the science say about of 193 patients suffering from
serrapeptase? ear, nose and throat disorders
(acute or chronic) found that
What the studies say serrapeptase treatment led to a
Serrapeptase has been the subject of significant reduction in symp-
intense study in recent decades and, toms compared with a placebo. In
although much of the research has addition, not only did the enzyme Compared with no treatment,
been in humans, larger-scale higher- act rapidly on localized inflamma- 30 mg/day of the enzyme for four
quality trials are needed. tion, but it also led to less water weeks reduced both the amount
Nevertheless, so far, the evidence retention, while boosting clot- of phlegm (sputum) produced
suggests that the enzyme may be busting effects (fibrinolysis), thus and the frequency of coughing
useful for a range of conditions. speeding up healing (J Int Med Res, (Respirology, 2003; 8: 31620).
u Postoperative pain and swelling. 1990; 18: 37988). u Carpal tunnel syndrome (CTS).
In a study of 24 healthy subjects u Chronic obstructive pulmonary Twenty CTS patients were
undergoing tooth extraction, all disease (COPD). A small study enrolled in a clinical study to
were given a treatment combina- carried out in Japan investigated investigate whether serrapeptase
tion of either serrapeptase (5 mg) the effects of serrapeptase in could help in the treatment of
or placebo tablets and parace- patients with COPD, such as their symptoms. Following a short
tamol (acetaminophen) tablets emphysema and bronchitis. course of the non-steroidal anti-
(1000 mg) at the time of the
operation. Those taking serrapep-
tase reported significantly less
pain and swelling after surgery
What is serrapeptase?
compared with the placebo- Serrapeptase is an enzyme produced by the Serratia bacteria that live in
control group (Int J Oral Maxillofac the intestines of silkworms. Once the silkworm has completed its
Surg, 2008; 37: 2648). transformation into a moth, it uses this substance to melt a hole in its
In a much larger study, this confining cocoon, allowing it to escape. Unlike other biological enzymes,
time in patients with chronic serrapeptase affects only non-living tissue, such as the silk cocoon. In
empyema (where pus collects humans, it breaks down the protein debris resulting from toxins and
around the lungs and in the chest inflammation while sparing healthy tissues and cells.
wall) undergoing surgery, the Serrapeptase is taken orally typically at a dosage of 1030 mg/day. To
patients were given either ensure maximum absorption in the small intestine and to stop stomach acid
serrapeptase or a placebo both from destroying the enzyme, it usually comes in enteric-coated tablets.
before and after their operation. Currently, research is underway to develop topical preparations of
Here again, the degree of post- serrapeptase in the form of ointments and gels (Indian J Pharm Sci, 2010; 72:
operative swelling was signifi- 6571).
cantly less with serrapeptase than

22 WDDTY Chronic pain


inflammatory drug (NSAID) group vs just 3 per cent with the the brain (www.serrapeptase.info/content.
nimesulide, the patients were placebo (Singapore Med J, 1989; 30: asp?page=Dr-H-A-Nieper).
given 10 mg of serrapeptase twice 4854). However, more clinical studies
a day for six weeks. At the end of u Infections. Serrapeptase was are needed to ascertain whether or
the study, 65 per cent reported effective for eradicating infection not serrapeptase is, in fact, effective
significant improvements in their caused by Staphylococcus epider- for any of these conditions.
symptoms, with no serious side- midis bacteriaat least in rats,
effects (J Assoc Physicians India, 1999; so this may not apply to humans. Serrapeptase safety
47: 11702). Larger, higher-quality Nevertheless, these findings led In general, no significant side-
trials are now needed to confirm the researchers to conclude that effects have been reported with the
these findings. the enzyme might be able to use of this enzyme, although there
u Breast disease. Serrapeptase may enhance antibiotic efficacy in have been a few case reports of
be beneficial for breast engorge- the treatment of staphylococcal eosinophilic pneumonia (usually
ment, the painful overfilling of infections (J Bone Joint Surg Am, triggered by an allergic reaction,
the breasts with milk. When 70 2006; 88: 120814). often to a medication) in response
women with the condition were to serrapeptase (Nihon Kokyuki Gakkai
given either Danzen, a Japanese Heart disease and beyond Zasshi, 2009; 47: 2548; 2000; 38: 5404).
serrapeptase preparation, or a The potent anti-inflammatory Although the reaction is unusual,
placebo for three days, Danzen effects of the enzyme make it a good it nevertheless highlights the fact
proved to be superior to placebo candidate for treating a variety of that natural is not always harmless.
for improving breast pain, breast other disorders, including arthritis, Other potential adverse effects
swelling and induration (harden- fibromyalgia, migraine, irritable include diarrhoea and gastro-
ing). Indeed, while 86 per cent of bowel syndrome and even heart intestinal problems. However, these
the Danzen patients achieved disease. Indeed, the late German effects are usually mild, especially in
moderate to marked improve- physician Dr Hans Nieper reported comparison to the often severe side-
ments, only 60 per cent of the that serrapeptase is an invaluable effects of NSAIDs. Yet, until we know
patients taking the placebo saw agent for the safe removal of fibrous more, its up to users to monitor
similar improvements. Also, a clots from coronary arteries and, in their own health when using this
marked improvement was seen particular, from the carotid arteries product.
in 23 per cent of the treatment in the neck, which supply blood to Joanna Evans

WDDTY Chronic pain 23


Tested treatments

Cetylated fatty acids


Cetylated fatty acids are
among the latest natural
remedies for joint health,
and are said to be even
better than glucosamine.
But what does the science
say about these fats?

etylated fatty acids (CFAs)

C are a group of naturally


occurring fats that are
widely marketed as a treat-
ment for osteoarthritis. These fats
are thought to help lubricate joints
patients to get up and go from a
chair, go up and down stairs, balance
and weight distribution across the
soles of the feet during quiet
and muscles, soften tissues, reduce and move their knees. standing (J Strength Cond Res, 2005; 19:
inflammation and increase flexibility. Celadrin was superior to placebo 11521), while the other reported that
The question is, do they really work? and had fast-acting effects. Climbing it significantly reduced pain and
ability, for example, improved just improved functional performance in
CFA studies so far 30 minutes after initial treatment individuals with OA of the knee,
Several studies used a proprietary (J Rheumatol, 2004; 31: 76774). elbow and wrist (J Strength Cond Res,
blend of CFAs called Celadrin (70- The other two studies of this series 2005; 19: 47580).
per-cent CFAs and 30-per-cent olive also found Celadrin to be effective for
oil) which comes as an oral supple- relieving the pain of OA. One found Beyond arthritis
ment or topical cream. In one study that it improved postural stability Some websites claim that CFAs can
using the capsules, 64 patients with
chronic knee osteoarthritis (OA)
were given either Celadrin (350 mg,
plus 50 mg of soy lecithin and 75 mg
Other supplements for osteoarthritis
u
of fish oil, taken six times daily) or a Glucosamine. Numerous studies have shown that this is a safe and
placebo (vegetable oil) for 68 days. effective way to reduce symptoms of OA (Arthroscopy, 2009; 25: 8694). The
At the end of the study, those in results of a three-year, double-blind trial suggest that the nutrient (1500
the Celadrin group saw a significant mg/day in one dose) may even slow the progression of the disease
improvement in their knee range of (Lancet, 2001; 357: 2516).
u
motion (flexibility) and overall joint Chondroitin. A recent review concluded that oral chondroitin sulphate is
functioning compared with those in a valuable and safe symptomatic treatment for OA disease. Interestingly,
the placebo group. 800 mg/day had nearly the same effects as 1200 mg/day in one study
CFA may be an alternative to the (Osteoarthritis Cartilage, 2008; 16 Suppl 3: S1921). Its often recommended that
use of non-steroidal anti-inflam- chondroitin be taken in combination with glucosamine.
u
matory drugs for the treatment of S-adenosylmethionine (SAMe). Double-blind trials show that SAMe
OA, the researchers concluded (J (1200 mg/day) reduces pain, stiffness and swelling better than a placebo,
Rheumatol, 2002; 29: 170812).
and as well as painkilling drugs such as ibuprofen and naproxen in OA
The topical version of Celadrin has sufferers (Am J Med, 1987; 83: 813; Am J Med, 1987; 83: 6671).
u
also been tested in three separate Pycnogenol (pine bark extract). This supplement (150 mg/day) was
studies by a team of researchers at tested against a placebo on 100 patients with mild-to-moderate OA of the
the University of Connecticut. knee. After eight weeks, the Pycnogenol group reported a significant
Again, the product was trialled in reduction in pain, and the benefits were still evident three months later.
patients with OA of the knee. They also had less stiffness in the joints, and were able to carry out more
In the first of this series of studies, day-to-day activities and reduce their use of painkillers; in contrast, 10
40 older patients (mean age: 65 per cent in the placebo group had to increase their dose of analgesics
years) were randomly assigned to one (Phytother Res, 2008; 22: 108792).
u
of two treatment groupsCeladrin Bromelain. Mounting evidence suggests that this extract, derived from
cream or a placeboand were pineapple, may be a useful treatment for OA. The research so far shows
evaluated before application, 30 that it has powerful anti-inflammatory and painkilling properties, although
minutes after application and 30 more studies are needed to determine the optimal dosage (Evid Based
days after treatment. Assessments Complement Alternat Med, 2004; 1: 2517).
included how long it took the

24 WDDTY Chronic pain


be used to treat a range of condi- might benefit the heart and blood- chondroitintwo popular natural
tions other than OA, such as skin circulation status by reducing treatments for arthritisno
problems, gum disease, gout and platelet aggregation (blood-clot comparative studies have been
lupus. However, theres little formation). The researchers, who conducted.
research to support these claims. tested the combination on 24 Another point to bear in mind is
One small-scale, preliminary study healthy people, reported that it had that the studies have been carried
suggested that Celadrin cream might aspirin-like effects (Clin Lab Sci, 2010; out with a specific brand of CFAs
be helpful for people with psoriasis, a 23: 326). Nevertheless, more research (Celadrin), so we dont know if
chronic autoimmune skin disorder. is needed to confirm these results. other preparations will have the
However, although it was a double- same results.
blind, placebo-controlled study, the Consider this As for safety, no adverse effects
results have yet to be published in a CFAs appear to be a promising have been reported with the use of
peer-reviewed journal, but are treatment for OA, but the research CFAsbut then, no one appears to
available at the following website: is far from conclusive, and some be looking. This suggests that, in
http://celadrininfo.com/studies/ claims go far beyond the current particular, there need to be studies
SafetyHumans.pdf. evidence. Indeed, while some claim to determine the effects of their
Another small study found that that these fatty acids are more long-term use.
Celadrin together with glucosamine effective than glucosamine and Joanna Evans

WDDTY Chronic pain 25


Tested treatments

The next Russian revolution


SCENAR is a new way of their condition (Kossovski I. An Overview of
healing that challenges the the Basic Results of a SI Medicine Treatment
worlds cash-strapped Complex. MediSCEN Inc., 2001).
healthcare systems The sole study published in a West-
he Russian problem ern medical journal pitted SCENAR

T used to mean the spread


of Communism to the
West. Today, the term
could just as easily be applied to
a new healing modality,
against TENS (transcutaneous electric-
al nerve stimulation). In this trial, 24
chronic neck-pain sufferers received
six months of treatment with either
SCENAR or TENS, or no treatment
SCENAR frequency modulation and,
using biofeedback, begins a dialogue
developed behind the Iron (controls). The researchers reported with the patients central nervous
Curtain during the Cold War and that the SCENAR group showed system. Eventually, SCENAR is said to
which, its advocates claim, will significant reduction of neck pain stimulate neuropeptides in damaged
revolutionize Western medicine. and disability compared with either the cells to speed recovery by helping cells
TENS or control group. They also to remember their healthy signature
The SCENAR (Self-Controlled pointed out that none of those in the state. The healing process continues
Energo-Neuro-Adaptive Regulation) SCENAR group reported any adverse long after the session ends, although it
device is the size of a TV remote, and reactions (Chiropractic & Osteopathy, 2007; may take many sessions to achieve full
runs on a single 9-V battery. 15: 9; doi: 10.1186/1746-1340-15-9). health, depending on how chronic the
Researchers and doctors in Russia The device has also been used by condition is.
claim that it can reverse most diseases athletes to speed recovery time after However, if the problem is acute,
without drugs or surgery. In the UK, its injury. French football star Djibril Cisse such as a sports injury, SCENAR practi-
licensed as a pain-relief device. has prepared a YouTube testimonial, tioners say the device can heal the
The problemlike so much of alter- claiming the SCENAR helped him to problem even before bruising appears.
native medicine that doesnt enjoy the recover more quickly from an ankle
sizeable profits of the drugs industry injury. Also, SCENAR is currently being SCENAR in the West
is the lack of good scientific evidence used by the Greek professional football SCENAR is becoming part of the
from a double-blind placebo-controlled team Panathinaikos, based in Athens. accepted medical therapy in Russia,
trial to support such ambitious claims. and is now being used in clinics and
There are, however, thousands of How does it work? hospitals. It is also gaining a foothold in
case studies gathered from the 10,000 SCENAR has been described as elec- Germany, where there are around 3000
thera-pists and doctors in Russia who tronic acupuncture and space-age practitioners.
routinely use SCENAR in their medicine, the latter in reference to its However, inroads into the UK market
practices. Dr Yuri Gorfinkel, who use in the late 1970s as a healing aid have been more torturous. There have
became a SCENAR therapist after for cosmonauts training in zero gravity. been several attempts to introduce it
working in the Chernobyl clean-up Although Dr Alexander Karasev into Great Britain, but infighting and
operations, has collated 18,255 case invented the device in 1976, it was dev- squabbles between various competing
studies of SCENAR treatments for eloped by two electronics engineers, groups have impeded its progress.
almost every conceivable diseasefrom who were awarded the Order of Lenin Today, the SCENAR licence for the UK
gastritis, haemorrhoids and impotence for their work. The technology was and Ireland is held by 21st Century
to bronchitis, hypertension and acute secret and classified until Perestroika Energy Medicine, and its CEO is former
heart failure. Of these patients, there in the mid-1980s opened up the Soviet IT consultant Richard Cumbers.
was no recurrence in 88.5 per cent of Union. It was then that SCENAR was SCENAR is officially distributed in the
cases, while 6 per cent reported signif- made available to Russian doctors. UK by its sister company Pain Genie.
icant improvement in symptoms, with SCENAR is a simple hand-held Nevertheless, Cumbers has been
only 3 per cent reporting little or no device controlled by four buttons. The forced to fight a constant battle against
change for the better (SCENAR Therapy, practitioner brushes the device along black-market versions of the device,
SCENARMedical Assessment and Expertise, the patients skin, looking for any which are often sold on the Internet by
1998; 4). resistance or stickiness, as SCENAR workers at the Russian factoryand at
In a later report compiled by Dr Irina therapists call it. Such stickiness a far lower price. However, the black-
Kossovski, who tracked hundreds more indicates disease, inflammation or market versions dont come with any
case reports involving a similarly wide injury, while different areas of the skin training or support.
range of diseases, Russian SCENAR correlate with different internal organs Cumbers sells the Pain Genie Home
practitioners were said to have achieved and muscle groups, similar to the SCENAR for 469, which includes a
a complete recovery rate of around 66 acupuncture model. training manual and DVD. Although
per cent, while the remaining third of Once a problem area has been some retailers believe that only properly
patients reported some improvement in detected, the practitioner changes the trained practitioners should use it,

26 WDDTY Chronic pain


Cumbers promotes its use among the other alternative device or technology. works through the gold-standard
public, although he emphasizes the As the technology is now more than clinical trials. SCENAR attacks the very
importance of after-sales support. 30 years old, this is perhaps not so heart of medicineits protocols and
In the three years that he has held surprising. Nevertheless, its success theorieswhich is avidly guarded
the SCENAR licence, Cumbers has rate is impressiveand far higher than directly by the pharmaceutical industry,
trained around 1200 practitioners in that of any single drug or conventional and indirectly by medical schools and
the UK. His efforts have interested a therapy. government-approved bodies, and even
few doctors in the UK, including Dr But such success arouses suspicion the mainstream media.
Jan Beute, from the Doncaster Royal among doctorsit all seems too good Undaunted, Cumbers and others
Infirmary Accident & Emergency to be trueespecially as there have nevertheless believe that the time is
department. Beute, who uses his own been little independent research and now right for making a serious pitch to
SCENAR on patients, has said: The few clinical trials published in Western governments, which are looking to cut
Pain Genie will save the NHS a medical journals. costs wherever they can, and whose
tremendous amount of money because For SCENAR practitioners and allegiances may lean more towards the
its so easy, cheap and effective to use. advocates like Cumbers, this is public purse and less towards protect-
There are only a handful of frustrating, as they see the technology ing the conventional medical paradigm.
practitioners in the US, where it has as an inexpensive and effective They also point to the Russian health
light touch Food and Drug Adminis- alternative within the mainstream of system, where there is already wide
tration (FDA) approval as a relaxant and Western medicine, especially at a time acceptance of SCENAR.
muscle re-educator. when the National Health System and For Prime Minister Cameron,
its counterparts around the world are President Obama and other world
SCENAR and the future virtually bankrupt. leaders, it could be the start of the
In fact, there are more case studies However, the issue runs far deeper Russian problem all over again.
of SCENAR effectiveness than for any than just proving that the modality Bryan Hubbard

WDDTY Chronic pain 27


Tested treatments

Exercise for a better back


Many people who suffer Intern Med, 2005; 142: 77685).
from back pain fear that For those who dont have the time
physical activity will do or money for personal training,
however, joining a yoga class may be
more damage. But now, another useful option. In one study,
research shows that patients participating in a 12-week
staying active may yoga programme enjoyed significant
be the key to beating back improvement in back pain and
pain for good. function compared with those given
a self-care exercise book. Whats (AT) is beneficial for back pain. This
ost people know that more, the benefits persisted for discipline emphasizes the self-

M regular exercise will


improve their physique
and fitness levels, but few
realize that keeping active may also
be beneficial for low back pain, one
several months (Ann Intern Med, 2005; 143:
84956).
In yet another study, just one week
of intensive yoga practiceincluding
postures, breathing practices, medi-
perception of movement, and was
recently found to be more effective
than the usual care or massage as a
treatment for chronic back pain. Also,
just six lessons followed by prescribed
of the most common causes of tation and philosophical concepts exercises was nearly as successful as
disability in the West. reduced pain-related disability and 24 lessons of AT on its own (BMJ, 2008;
According to Wisconsin-based improved spinal flexibility signifi- 337: a884; doi: 10.1136/ bmj.a884).
spine expert Dr Peter Ullrich, When cantly better than a conventional Pilates, another discipline with a
done in a controlled, gradual, and exercise regime (J Altern Complement focus on posture, has also produced
progressive manner, active exercise Med, 2008; 14: 63744). impressive results (J Orthop Sports Phys
distributes nutrients into the disc Precisely why yoga is so effective for Ther, 2006; 36: 47284).
space and soft tissues in the back to back pain is not clear, but it appears But what about aerobic activity? Do
keep the discs, muscles, ligaments to be a combination of mindbody the more vigorous forms of exercise
and joints healthy. Consequently, a factors. As one report noted: Yoga cause more harm than good? It
regular exercise routine helps to may be beneficial for back pain appears not. A study of patients aged
avoid stiffness and weakness, mini- because it involves physical from 30 to 60 with low back pain
mize recurrences of low back pain, movement, but it may also exert found that those who indulged in
and reduce the severity and duration benefits through its effects on mental aerobic exercisewalking or cycling
of possible future episodes of low focus. Mental focus may help people for 45 minutes four times a week
back pain (www.spine-health.com). to relax tense muscles, relieve mental required significantly fewer pain-
But you dont have to take his stress, and increase their awareness of medication prescriptions and were
word for it. There are numerous how they are moving and positioning given fewer physical-therapy referrals
studies supporting the benefits of their body (Ann Intern Med, 2005; 143: than those who did not exercise. The
exercise for low back pain. 84956). researchers also noted that exercise
Indeed, just a few weeks ago, a This synthesis between physical improved the patients moodyet
review by the Lausanne Institute of movement and mental focus might another excellent reason to stay active
Sports Science and Physical Educa- also explain the results of a study (Spine J, 2001; 1: 95101).
tion concluded that exercise is showing that the Alexander Technique Joanna Evans
effective for both the prevention and
treatment of low back pain. As a
treatment, exercise reduced pain and Stretch the pain away
improved physical function in
patients whose condition was chronic According to Dr Peter Ullrich, daily stretching is an important part of any
or recurrent (Joint Bone Spine, 2008 Sep back pain exercise routine. The most important muscles to target in any
16; Epub ahead of print). back pain regimen are:
Other studies have looked at u hamstrings, which run along the back of the leg, help to correct posture

specific types of exercise to find out while sitting and standing; they also support the gluteus muscles in the
what works best. According to one, buttocks and the hip flexors, and minimize stress on the low back
the most effective exercise strategy u piriformis, which runs from the back of the femur (thigh bone) to the

is an individually designed exercise sacrum (the base of the spine); when tight, this muscle can cause
programme carried out under limited sciatica-like pain, and has been linked to sacroiliac joint dysfunction
supervisionfor example, home u psoas major, which is attached to the front portion of the lower spine and

exercises with regular follow-up by a can greatly limit lower back mobility if tight, making it difficult to stand for
therapist. Stretching and muscle- extended periods of time or to kneel on both knees
strengthening exercises proved best u gluteus muscles of the buttocks, which support hip flexibility as well as

for improving pain and function (Ann the pelvis.

28 WDDTY Chronic pain


Your questions answered

(NICE.
Lumbago
Interventional Procedure Overview of
Laser Lumbar Discectomy. 26 August 2003;
http://guidance.nice.org.uk/ download.aspx?
o=ip075overview).
As for other surgical options, the

Q
A friend of mine has been
told he has a deter- most common operation is to
iorating disc and needs a connect the two vertebrae sur-
laser operation. What can rounding the problem disc (spinal
be done, if anything? Are there any fusion). However, the spine inevitably
alternative treatments?C.B., via e- becomes more rigid which, in the
mail long term, puts extra strain on the
rest of the spine and may create pain

A
Your friends problem elsewhere. Other complications
sounds like a crumbling include eating disorders, wound
disc in the spine, called infection, urinary retention, pseudo-
lumbar degenerative disc arthritis, blood clots in the lung and
disease (DDD). Discs act as shock- paralysis.
absorbers between the spinal One of the latest surgical
vertebrae but, over time, they lose techniques is to replace the damaged
their resilience. This happens to disc with an artificial one. Theres a
virtually everyone over the age of 40 bionic disc that has been available for osteopathy/chiropractic and acu-
but, for most of us, it isnt a problem. about four years. Called Charit, it puncture. Unconventional man-
However, it can cause chronic pain in consists of two metal plates that are ipulative techniques have been
a sizeable minority. The most attached to adjacent vertebrae, notoriously underresearched, but
common symptoms are low back between which is inserted an there is good evidence that
pain, hip pain, or aches in the artificial disc made of polyethylene. osteopathy can help to ease lower
buttocks or thighs. There may also be Its theoretical advantage is that it back pain (J Can Chiropr Assoc, 2005; 49:
occasional tingling or weakness in mimics a natural disc, allowing 27096). However, no studies appear
the knees. normal spinal movement. However, to have been done on DDD per se.
Nowadays, surgery is generally in practice, the bionic replacements Acupuncture can also work and is
only offered as a last resort, as its turn out to be not nearly as tough as widely usedand not only in China.
usually irreversible and invasive. Natures original. Serious wear, German researchers have done
Nevertheless, theres a bewildering deformations, cracks and fractures clinical trials on herniated (slipped)
array of surgical options, of which have forced many surgeons to rip discs, and found that acupuncture is
laser treatment is just one. Laser them out and resort to simple an effective pain-reliever (Am J Chin
discectomy uses a powerful laser to fusionoften causing further spinal Med, 2000; 28: 2533).
vapourize the crumbling bits of disc damage in the process. A study from Shanghai University
soft tissue. The laser is inserted In the UK, one NHS hospital group tested two types of electroac-
through a small incision in the back. recently reported that the Charit upuncture, and demonstrated that
The operation is claimed to be device barely improved spine single-point acupuncture is
minimally invasive, cost-effective and mobility or reduced pain, leading superior to the more usual multi-
free of postoperative pain, and can be them to abandon it (J Bone Joint Surg Br, point methods for prolapsed lumbar
done in an outpatients setting. 2007; 89: 7859). Yet, a long-term survey intervertebral discs (Zhongguo Zhen Jiu,
However, the clinical evidence in a French hospital found an 82-per- 2006; 26: 31921).
isnt all that favourable, with a recent cent success rate (Spine, 2007; 32: Finally, percutaneous electrical
review concluding that theres only 6616). Success may depend on the nerve stimulation (PENS) uses fine
moderate evidence of pain relief skill of the individual surgeon as needles, inserted up to 4 cm into the
(Pain Physician, 2007; 10: 7111). In fact, much as on the quality of the skin (not at acupoints), through
the official UK health watchdog NICE implant. which a mild pulsed electrical
(National Institute for Health and A new version of Charit has just current is passed.
Clinical Excellence) is fairly been approved by the Food and Drug A placebo-controlled trial of DDD
scathing, describing the procedure Administration, the US health showed that back pain was reduced
as having uncertain risks and watchdog. This uses two pieces of by 50 per cent, with major
benefits. NICE warns that it may hinged stainless steel without the improvements in mobility, sleep
have serious complications, such as polyethylene cushion (FDA news, 19 July quality and general wellbeing.
damage to nerve roots, vertebral 2007). This may prove to be superior if Indeed, 81 per cent of the 60
endplates and neighbouring only because there are fewer parts to participating patients said they
structures, and disc space infection. fail. would fork out their own money to
Because of the high failure rate, Ideally, though, its best to avoid pay for the treatment (Anesth Analg,
many operations have had to be back surgery altogether. The classic 1999; 88: 8416). Sadly, PENS is not, as
repeated using conventional surgery treatment alternatives are yet, widely available.

WDDTY Chronic pain 29


Your questions answered
frequencies and intensities to
Help for period pain relieve pain. A number of small
studies found high-frequency TENS
to be effective for dysmenorrhoea
Taking 100 mg/ day of thiamine (Cochrane Database Syst Rev, 2002; 1:

Q
I am aged 36, and am
increasingly experiencing a (vitamin B1) may be effective: 87 CD002123).
very high level of pain and per cent of patients were cured after In one trial, 4260 per cent of
discomfort with each three months of treatment and patients achieved at least moderate
period. I have breast pain for a week remained pain-free two months later relief, and required the use of fewer
before, and then excruciating pain on (Indian J Med Res, 1996; 103: 22731). additional analgesics (BMJ, 2006; 332:
the day of my period, along with Other helpful supplements are 11348).
vomiting and diarrhoea. I have no pyridoxine (vitamin B6), magnesi- u Heat. A randomized, controlled trial
children and Im also having difficultly um, vitamin E and fish oil, found that a heat patch (at 39 C)
conceiving. I have tried quite a few particularly Neptune Krill Oil (BMJ, used for 12 hours a day was as
alternative therapies to no avail, so any 2006; 332: 11348; Altern Med Rev, 2003; 8: effective as ibuprofen (400 mg three
advice would be much appreciated. 1719). times a day) and more effective than
D.S., via e-mail Changing your diet may also placebo in reducing pain (Obstet
bring relief. Endometriosis and Gynecol, 2001; 97: 3439). Another study

A
Period painor dysme- dysmenorrhoea are known to be found that a heat wrap was better
norrhoea, in medical- related to a low intake of vegetables than paracetamol (acetaminophen)
speakaffects up to 95 per and fruit, and a high intake of for pain relief over an eight-hour
cent of menstruating vegetarian polyunsaturated fat, time period (J Reprod Med, 2004; 49:
women (Nurs Times, 2004; 100: 403). ham, beef and other red meat (Eur J 73945).
Cramping lower abdominal pain is Obstet Gynecol Reprod Biol, 2007; 132: u Magnets. A 2700-gauss static
common, but the pain can also extend 1407). Another study found a magnet attached over the pelvic area
to the lower back and thighs, and lead significant improvement in significantly reduced menstrual pain
to nausea, vomiting, diarrhoea and menstrual pain and PMS symptoms and irritability compared with a
fatigue (Aust Fam Physician, 2006; 35: 8424, with a low-fat vegetarian diet (Obstet placebo (140-gauss) magnet (J Altern
8469). Gynecol, 2000; 95: 24550). Complement Med, 2005; 11: 6817).
But period pain doesnt have to be u Herbs. A Japanese herbal u Aromatherapy and massage. In a
simply endured, particularly if its formulation known as Toki- trial of 67 college students,
impacting on your lifestyle and daily shakuyakusana blend of six herbs, aromatherapy (topically applied
activities. But before starting any including angelica and peony root lavender, clary sage and rose) eased
treatment, you need to establish reduced menstrual pain (Am J Chin the severity of menstrual cramps (J
whether you are suffering from primary Med, 1997; 25: 20512). Together with Altern Complement Med, 2006; 12: 53541).
or secondary dysmenorrhoea. Primary another remedy called Shakuyaku- Combining aromatherapy with
dysmenorrhoea is menstrual pain kanzo-to (including peony and massage is also a good idea, as a
without pelvic disease; secondary liquorice), this combination may Korean study found that women
dysmenorrhoea is pain associated with also help women with secondary receiving abdominal meridian
an identifiable condition, usually dysmenorrhoea to conceive (Clin Exp (Kyongrak) massage had
endometriosis, fibroids or pelvic Obstet Gynecol, 2003; 30: 958). significantly less menstrual pain
inflammatory disease (BMJ, 2006; 332: u Acupuncture. When 649 women than the control group (Taehan Kanho
11348). with dysmenorrhoea received Hakhoe Chi, 2005; 35: 132532).
As you are over 25 and having acupuncture (15 sessions over three u Biofeedback. A study of nine women
trouble conceiving, secondary months) in addition to their usual suggested that thermal biofeedback
dysmenorrhoea is a possibility, so you medical care, they saw significant may be effective for painful periods
may wish to see your doctor for a improvements in pain and quality of (Biofeedback Self Regul, 1982; 7: 499520).
diagnosis. life compared with those receiving Another study reported that thermal
Treating the cause of the pain is only the usual care (Am J Obstet biofeedback may be a promising
more effective than treating just the Gynecol, 2008; 198: 166). Other trials treatment for menstrual pain and
pain itself. Conventional treatments have also been positive, although other symptoms related to
usually involve non-steroidal anti- one trial found that acupuncture endometriosis (Appl Psychophysiol
inflammatory drugs (NSAIDs) or oral worked well for primary Biofeedback, 2003; 28: 27989).
contraceptives, but these have various dysmenorrhoea but was only u Relaxation techniques. High levels
adverse effects and may not work in up satisfactory for cases of secondary of stress can greatly increase
to 25 per cent of sufferers (Cochrane dysmenorrhoea (Akush Ginekol [Sofiia], dysmenorrhoea (BMJ, 2006; 332: 1134
Database Syst Rev, 2004; 3: CD002119). 1996; 35: 245). 8), but a review of the literature
Fortunately for you, there is a variety u Transcutaneous electrical nerve suggests that relaxation techniques
of alternative treatments, many with stimulation (TENS). This involves may help to relieve symptoms
good evidence of success. stimulation of the skin using (Cochrane Database Syst Rev, 2007; 3:
u Dietary changes and supplements. currents at various pulse CD002248).

30 WDDTY Chronic pain


Healing Foods

inflammation (Fertil
Endometriosis
Steril, 2008; 90 [4
Suppl]: 1496502; Fertil Steril, 2001; 76:
71722), although whether supple-
ments will benefit women in real
u Avoid toxic chemicals. Certain life remains to be seen. However, a

Q
Ive just been diagnosed
with endometriosis, and environmental pollutants, such as daily dose of omega-3 (1080 mg of
I am having difficulty dioxins and polychlorinated eicosapentaenoic acid and 720 mg
finding information on biphenyls (PCBs), may play a role of docosahexaenoic acid) plus
effective alternative treatments. in endometriosis (Environ Health 1.5 mg of vitamin E improved
Can you help?C.C., via e-mail Perspect, 2009; 117: 10705). Experts symptoms of dysmenorrhoea (pain-
believe that over 90 per cent of ful menstruation), which may be

A
Endometriosis is a gynae- human exposures to these related to endometriosis (Am J
cological condition where chemicals comes from food, mainly Obstet Gynecol, 1996; 174: 13358).
cells of the mucous mem- animal fat, so eating an organic, u Take Chinese herbs. A review of all
brane lining the womb wholefood diet low in animal fats randomized controlled trials found
become deposited elsewhere in the may be beneficial. that Chinese herbals were just as
body. It affects around 10 per cent of u Limit caffeine. Caffeine intake may effective as the hormone drugs
women of reproductive age, causing be related to endometriosis and gestrinone and danazol for
symptoms such as painful, heavy or infertility. Women who consumed symptom reliefwith fewer side-
irregular periods, bowel and bladder more than 5 g/month of caffeine effects (Cochrane Database Syst Rev,
problems, tiredness, insomnia and (about 1.5 cups of coffee a day) 2009; 3: CD006568). A variety of herbs
depression. However, some cases have were nearly twice as likely to have can be used, so be sure to consult a
no symptoms at all. endometriosis and be infertile as a qualified practitioner for advice.
Endometrial deposits are most result (Am J Epidemiol, 1993; 137: u Consider curcumin. Derived from
commonly found on the ovaries, 135360). the popular Indian spice turmeric,
fallopian tubes and peritoneum. But u Eat more fruit & veg. In more than curcumin has properties that
other sites may be involvedeven, in 1000 women in northern Italy, suggest benefit for endometriosis.
rare cases, the eye. The cells then those with low intakes of fresh fruit A study in mice showed significant
behave just as they do in the womb, and green vegetables had a signifi- antiendometriosis effects, although
bleeding during menstruation, caus- cantly higher risk of endometriosis. these results may not necessarily
ing inflammation and often forming Those who ate a lot of beef and red apply to humans (Indian J Biochem
fibrous adhesions that make organs meat were also more likely to have Biophys, 2009; 46: 5965).
stick to each other. Inflammation or the disease (Hum Reprod, 2004; 19: u Try acupuncture. This well-known
scarring of the reproductive organs, 17559). pain treatment was both safe and
particularly the fallopian tubes, can u Exercise. This may influence the effective for endometriosis-related
result in infertility. risk of endometriosis. Women who pelvic pain in adolescents (J Pediatr
No one knows exactly what causes reported frequent, high-intensity, Adolesc Gynecol, 2008; 21: 24757), and
endometriosis or how to cure it, so physical activity had a 76-per-cent was just as effective, if not more so,
the goals of conventional medicine lower risk than those who did not than the drug danazol in relieving
are pain relief, slowing its progression engage in any such physical activity symptomsand again, with far
and relieving infertility, if present. (Am J Epidemiol, 2003; 158: 15664). fewer side-effects (Zhongguo Zhen Jiu,
However, the treatments prescribed u Increase antioxidants. Endometri- 2006; 26: 8635).
painkillers, hormonal drugs and osis sufferers were found to have a u Use biofeedback. A small study of
surgeryall come with high rates of lower intake of antioxidants (vita- five women reported that thermal
recurrence and significant risks (Coch- mins A, C and E, zinc and copper) biofeedback helped to improve the
rane Database Syst Rev, 2009; 3: CD006568). than women without the disease. pain and other symptoms of endo-
Gonadotropin-releasing hormone Consuming more of these nutrients metriosis (Appl Psychophysiol Biofeed-
(GnRH) agonists, for example, among through either diet or supplements back, 2003; 28: 27989). Other mind
the most popular drugs for the may help (Reprod Biol Endocrinol, 2009; body techniques, such as hypnosis
condition, can induce a pseudo- 7: 54). Indeed, in women with pelvic and meditation, may also help to
menopause, complete with hot pain possibly due to endometriosis, control endometriosis-related pain
flushes, vaginal atrophy, mood swings taking vitamins E (1200 IU/day) (see Special Report, pp 69).
and osteoporosis (Aust Fam Physician, and C (1000 mg/day) for two u Join a support group. Sharing with
2006; 35: 8647). Happily, there are safer months led to improvement in pain other sufferers may also help in
ways to manage the condition. in 43 per cent of cases. In contrast, coping with the condition. When
none of the women taking a place- women had a chance to speak with
Alternative approaches bo reported pain relief (Townsend other endometriosis patients and
Although more research is needed, Lett, 2004; 253/254: 36). to meet with a counsellor, they all
the evidence so far suggests that the u Boost omega-3 fats. Animal and reported being highly satisfied with
following may be helpful for women test-tube experiments show that their overall care (J Psychosom Obstet
with endometriosis. omega-3s can help by reducing Gynaecol, 1997; 18: 2558).

WDDTY Chronic pain 31


Your questions answered
another trial, TENS took four weeks
Phantom-limb pain to work but, after four months, the
treated patients reported signifi-
cantly less PLP than the controls
analgesics and opioids to antidep- (J Bone Joint Surg Br, 1988; 70: 10912).

Q
Since my friend had a
below-knee amputation ressants and anticonvulsants, all of Another promising treatment is
five months ago, shes which come with a truckload of side- acupuncture. Similar to TENS, elec-
been troubled by severe effectsand may be no better than trical stimulation of acupoints was
phantom-limb pain and itching where a placebo (Lancet Neurol, 2002; 1: 1829). effective at reducing PLP by an
her lower leg once was. Doctors have Surgery is another option but, average of 66 per cent in controlled
prescribed drugs, which help, but the here again, results are generally studies (Pain, 1975; 1: 35773). Tradi-
side-effects have stopped her from disappointing (Br J Anaesth, 2001; 87: tional needle acupuncture may also
using them. Are there any effective 10716). However, a recent uncontrol- be beneficial (Minerva Med, 1979; 70:
alternative treatments available? led study found that surgical treat- 384351; Arch Phys Med Rehabil, 1981;
A.C., via e-mail ment of the peripheral nerve was 62: 22931). Needling of the residual
successful in reducing PLP in 14 of limb according to Western medical

A
First described more than the 15 patients involved (Plast Reconstr acupuncture resulted in complete
500 years ago, phantom- Surg, 2006; 118: 156272). Deep brain relief of PLP and other sensations in
limb pain (PLP) is the stimulation also alleviated PLP two out of three patients (Acupunct
strange phenomenon of albeit in only three sufferers (J Clin Med, 2004; 22: 937).
feeling pain in a limb that has been Neurosci, 2005; 12: 399404). Neverthe- Another option to consider is
amputated. Although the limb is less, its clear that more research is Farabloc, a nylon and stainless-steel
gone, the nerve endings at the site needed. In the meantime, there are fabric that is meant to be worn over
of the amputation continue to send far less-invasive treatments on offer. the site of amputation. The manu-
signals to the brain that make it One of them is transcutaneous facturer claims that it filters out
think that the limb is still there. electrical nerve stimulation (TENS), harmful electromagnetic waves that
Almost all amputees feel at least a safe and painless technique that aggravate the severed nerve endings.
some sort of sensation in the missing involves sending a weak electrical A study cited on their website
limb such as tingling, itching and current to specific points on the skin (www.farabloc.com) has been pub-
heat or cold. But up to 80 per cent overlying a nerve pathway. In a lished and, according to the results,
suffer actual painfrom throbbing placebo-controlled study, TENS it may be effective in reducing PLP
and stabbing pain to cramping and applied to the outer ear reduced (Can J Rehab, 1993; 6: 15561).
burningwhich can persist for years PLP as well as non-painful phantom- Finally, theres evidence that
after the surgery (Lancet Neurol, 2002; limb sensations in amputees (J Pain rewiring the brain can help to deal
1: 1829). Symptom Manage, 1991; 6: 7383). In with the pain (see box).
Although particularly common
after amputation of an arm or leg, it
can also occur with removal of other
Brain over pain
body partsafter mastectomy or
There is evidence to support the use of biofeedback, hypnosis and relaxation
tooth extraction, for example. Rarely,
training in PLP (Appl Psychophysiol Biofeedback, 2005; 30: 8393; Clin Rehab, 2002;
PLP has been reported in people born
16: 36877). One way these techniques may work is by reducing stress, thought
without limbs.
to be a factor in PLP (J Psychosom Res, 1990; 34: 717). In one study of 16 PLP
The precise cause of PLP remains
patientstwo recent amputees and 14 with chronic painmuscle-relaxation
unclear and its notoriously difficult
exercises combined with biofeedback resulted in virtually complete pain relief in
to manage. As one study noted,
more than half the participants. Moreover, these results were sustained for up to
So far, none of the more than 40
three years (Pain, 1979; 6: 4755).
treatment methods has proven to be
A particularly novel treatment for PLP is the use of a mirror box to produce
really effective (Zentralbl Chir, 2005; 130:
the illusion of two healthy limbs. Using such visual feedback, the patient is
559). Even more shocking, a 2006
able to move the phantom limb and release it from a potentially painful
survey revealed that 53 per cent of
position. Mirror-box therapy has proved useful for upper- and lower-limb
patients with PLP38 per cent of
amputees (Disabil Rehabil, 2004; 26: 9014).
whom had severe painreceived no
Similarly, virtual reality may combat PLP. UK scientists have reported that PLP
treatment whatsoever (Arch Phys Med
may be relieved by attaching the real limb to an interface that allowed
Rehabil, 2006; 87: 2707).
the sufferer to see two limbs moving in a computer-generated simulation (Disabil
Rehabil, 2007; 29: 14659).
Treatment options These techniques may work by increasing a sense of control over the
Pharmaceuticals are usually the first
phantom limb which, in turn, rewires the brain. Indeed, amputees who used a
course of action for PLP sufferers,
fully functioning prosthesis on the affected limb showed significant reductions
although there are no specific drugs
in PLP whereas the controls, wearing a cosmetic prosthesis with little
for the condition. Your friend could
functionality, showed no changes (Neurosci Lett, 1999; 272: 1314).
have been prescribed anything from

32 WDDTY Chronic pain


Carpal tunnel syndrome
of the upper body, along with manifestation of a deficiency of this

Q
Ive recently been
diagnosed with carpal relaxation twice a week for eight vitamin, as some sufferers do
tunnel syndrome in my weeks, significantly improved their experience pain relief with its
right hand, probably grip strength and pain reduction supplementation. However, so far,
related to my job, which involves using compared with the controls (JAMA, studies have been poorly designed
a computer mouse for long hours. Can 1998; 280: 16013). and inconclusive (Nutr Rev, 2004; 62:
you recommend any effective u Massage. The results of a recent 96104). Nevertheless, given the low
treatments that dont involve drugs or preliminary study suggest that both risk of toxicity at the suggested
surgery?J.F., London targeted and general massage may doses, it may not hurt to try B6
be useful for CTS sufferers. Targeted supplements at dosages up

A
Carpal tunnel syndrome massage may be especially to 200 mg/day (J Am Acad Nurse Pract,
(CTS) is caused by beneficial, as it resulted in greater 2003; 15: 1822).
compression of the median gains in grip strength than general u C-TRAC. This new hand-traction
nerve, which runs through a massage (J Altern Complement Med, 2008; device (see www. carpaldoctors.com
U-shaped space in the wrist called the 14: 25967). or www.carpaltunnelcure.co.uk) has
carpal tunnel. Symptoms include u Heat. Heat-wrap therapy can relieve proved to be both effective and well
numbness, tingling, pain and weakness various types of wrist pain, including tolerated when used for only 5
in one or both wrists and hands. In CTS, within one to three days. In minutes, three times a day, in a
severe cases, the condition can lead to addition, it improves grip strength, recent study of CTS patients, all of
a permanent loss of feeling in some joint stiffness and hand function whom had failed to respond to
fingers. (Arch Phys Med Rehabil, 2004; 85: conservative therapy. Overall, 79 per
Repetitive computer use is 140916), so try applying a warm cent of patients rated the treatment
commonly assumed to cause CTS, but compress to the wrist several times as excellent; however, the study had
the scientific evidence is unclear. In a day. no control group for comparison (J
one US study, the frequency of CTS in u Vitamin B6. CTS might be a Hand Ther, 2007; 20: 207).
computer users was similar to that of
the general population (Neurology, 2001;
56: 156870). In a Danish one, however, Less strain, less pain
people who used a mouse device for
more than 20 hours a week had a By far, the best way to treat carpal tunnel syndrome (CTS) is to deal with
higher risk of developing CTS (JAMA, whatevers causing it. Making the following changes may reduce repetitive
2003; 289: 29639). strain while you work.
Other conditions can contribute to u Improve your posture. Make sure that you are sitting properly, and that
CTS, including diabetes, inflammatory your keyboard and monitor are positioned correctly:
arthritis, untreated thyroid disease and v your back should be straight and not slouching, and you shouldnt
pregnancy (J Gen Intern Med, 1999; 14: be stretching forward
3104). In your case, assuming an v you should be looking down at your monitor, and it should be at least
underlying condition has been ruled an arms length away
out, the following may help. v your chair and keyboard should be set so that the thighs and forearms
u Osteopathy. This has proven suc- are horizontal and level
cess in treating CTS, especially v your wrists should remain straight when typing, and not be bent down
using the opponens roll man- or back, and they shouldnt be resting on anything when typing.
oeuvre. Used together with self- u Warm up. Before you begin work, warm up your muscle groups with a
stretching exercises, it resulted in few simple exercises, just as you would prepare your body before
less restricted wrist movement and beginning a workout at a gym.
improved nerve conduction in all u Take frequent breaks. Give your hands and wrists a break every 1520
treated wrists (J Am Osteopath Assoc, minutes by gently stretching and bending them. Alternate with other
1994; 94: 647). tasks whenever possible.
u Yoga. A study published in a pres- u Change your mouse. Choose a mouse design that fits your hand, but is
tigious medical journal found that a as flat as possible to reduce wrist extension. Consider a larger mouse
yoga-based regimen was more such as the Perfit or Whale mouse, or try a pen-shaped design for a more
effective than wrist splints or no comfortable grip. In one study, a mouse with a pivoting pen-shaped
treatment in relieving the handle significantly reduced muscle tension ( Int J Occup Saf
symptoms and signs of CTS. The Ergon, 2003; 9: 46377).
study participantsmedian age 52 For more tips on how to improve your computer workstation, visit the
yearswho practised 11 yoga Cornell University Ergonomics Web at www.ergo.human.cornell.edu.
postures that worked the joints

WDDTY Chronic pain 33


Your questions answered

Ulcerative colitis
Avoiding sulphur-containing amino

Q
Ive recently been
diagnosed with ulcera- acids (such as eggs, cheese, whole
tive colitis. My doctor milk, ice cream, mayonnaise, soy
wants to start me on milk, wine, mineral water, nuts and
drug therapy as soon as possible, cruciferous vegetables) can also ease
but Id rather try natural treatments symptoms and reduce relapse rates
first. What do you suggest?C.S., (Altern Med Rev, 2003; 8: 24783).
via e-mail u Increase fibre. Too little fibre
increases the risk of UC, so a high-

A
Ulcerative colitis (UC) is fibre diet might be protective in patients with UC and other
a type of inflammatory (Digestion, 1989; 44: 21721). Specifically, irritable bowel disorders (IBDs) have
bowel disease (IBD) that psyllium husks (410 g twice a day) proved promising (Wien Med Wochen-
leads to frequent bowel and germinated barley foodstuff schr, 2002; 152: 3738). In one study, 82
movements and diarrhoea accom- (GBF; 10 g twice a day) may be per cent of UC patients treated with
panied by blood or mucus; other especially beneficial (Altern Med Rev, the resin (350 mg three times a day
symptoms include weight loss, 2003; 8: 24783). During flare-ups, how- for six weeks) achieved remission vs
abdominal cramps, anaemia, fever ever, fibre may need to be reduced 75 per cent with the drug sulpha-
and fatigue. No one knows for sure until inflammation subsides. salazine (Eur J Med Res, 1997; 2: 3743).
what triggers UC, but it appears to u Limit sugar and fat. A high Another natural anti-inflamma-
be a combination of genetic and intake of sugar and animal fat is tory is aloe vera. In a double-blind
environmental factors. associated with an increased risk for trial, oral aloe gel resulted in
Conventional treatment usually UC (Gut, 1997; 40: 75460). remission or improved symptoms in
involves drug therapy or surgery. u Take probiotics. In a double- 47 per cent compared with 14 per
However, both options are risky and blind trial of 116 UC sufferers, cent with placebo (Aliment Pharmacol
not always effective. Indeed, 4060 therapy with a non-pathogenic strain Ther, 2004; 19: 73947). Other helpful
per cent of IBD patients will not of Escherichia coli was as effective herbs are Ginkgo biloba, ginger, slip-
benefit from the available treatments as low-dose mesalazine for control- pery elm, fenugreek and devils claw
(J Clin Gastroenterol, 2007; 41: 799809). ling symptoms and maintaining (Carcinogenesis, 2008 Jun 20, Epub ahead of
Its not surprising, then, that so remission. Both achieved around 70- print; J Ethnopharmacol, 2008 May 15, Epub
many sufferers turn to alternative per-cent remission, lasting for about ahead of print; Aliment Pharmacol Ther, 2002;
ways to manage UC naturally. six months on average (Lancet, 1999; 16: 197205).
354: 6359). A combination using four u Melatonin. This natural hor-
Nutritional strategies strains of Lactobacillus, three strains mone may be useful in the treatment
u Address deficiencies. Working of Bifidobacterium and one strain of of UC (Inflamm Bowel Dis, 2008 Jul 14,
with a qualified health practitioner Streptococcus has also proved to be Epub ahead of print). However, while
to identify and correct nutritional beneficial (Drugs, 2006; 66: 137187). melatonin is freely available as a
deficiencies may improve specific u Try EFAs. Fish-oil supplements, supplement in the US, its difficult
symptoms as well as overall health. rich in omega-3 fatty acids, can to find in the UK and other European
Helpful supplements are vitamins A, reduce inflammation and lower the countries. Also, further study is
C, E and K as well as beta-carotene, need for anti-inflammatory drugs. needed on its side-effects and
folic acid, calcium, magnesium, With few exceptions, studies show potential drug interactions.
selenium and zinc (Altern Med Rev, 2003; its beneficial effects in UC patients u Hypnotherapy. A recent UK
8: 24783). (Altern Med Rev, 2003; 8: 24783). The study had 17 patients with active
u Rule out allergy. Although recommended dosage is 12 g of UC undergo a 50-minute session of
doctors continue to rebut any link EPA/DHA three times a day. gut-focused hypnotherapy and com-
between food allergy and UC, this u Other nutrients. Bromelain pared them with controls who
may be one of the first things to (0.51 g twice a day), quercetin (500 listened to music. Blood levels of
check. UC sufferers put on an elim- mg two or three times a day) and interleukin-6, a marker of inflamma-
ination diet excluding commonly glutamine (1.53 g/day) may help to tion in the body, fell by 53 per cent
allergenic foods had significantly improve symptoms of UC (Altern Med in the hypnosis group, whereas the
fewer symptoms (primarily diarrhoea Rev, 2003; 8: 24783). music-listeners showed no changes
and rectal bleeding) compared with whatsoever (Am J Gastroenterol, 2008; 103:
patients on a normal diet. Foods Other natural treatments 14609).
likely to trigger symptoms include u Herbs. The gum resin of Bos- For more information on UC and
dairy, pork, tomatoes, spicy foods, wellia serrata (Indian frankincense) IBDs, see The WDDTY Guide to Good
citrus fruit, apples, grapes and is a traditional Ayurvedic remedy for Digestion, which is available from our
shellfish (S Afr Med J, 1995; 85: 11769). inflammatory diseases. Clinical trials website at www.wddty.com.

34 WDDTY Chronic pain


Osteoarthritis
disease (Lancet,

Q
Is there an alternative 1985; ii: 11-3; Am J Mrf,
way of dealing with 2987; 83: Suppl 5A: 29-34), largely
osteoarthritis, specifically because NSAIDs inhibit cartilage
spondylitis? As you are repair and speed up cartilage
no doubt aware, orthodox medicine destruction (J Rheumatol, 1982; 9: 3-5).
has no answer. In fact, following an X- Although modern medicine argues
ray, which established that three of that osteoarthritis is a natural
my vertebrae of the neck were without consequence of growing older, it is
the cushioning discs, my doctor flatly not true that cartilage loss is
stated that there is no treatment. inevitable. Poor nutritional status or
P.B, Ipswich food intolerance may create the
deficiencies that lead to collagen

A
Osteoarthritis (OA) has destruction.
always been considered an Your first port of call should be to
inevitable feature of determine whether your problem is
ageing, only because it caused by allergy or intolerance to
affects so many people as they grow certain foods. Although OA is often
older. Some surveys reckon that 80 associated with the presence of
per cent of those over 50, usually certain antigens in the body, few
women, have the disease. OA involves doctors associate OA with allergies. that vitamin E inhibits the enzymes
the degeneration or destruction of But there is a connection with the which break down collagen; in one
cartilage, after which the joint drugs usually dispensed for this clinical trial, OA patients given 600
hardens and the cartilage is replaced condition. NSAIDs make the gut IU of vitamin E significantly
by large bone spurs, called calcified more permeable, increasing a improved (J Am Geriatrics Society, 1978; 26:
osteophytes, in the spaces between persons chances of becoming food 328-30). Both vitamins have certain
the joints. However, unlike sensitive (Melvyn Werbach, Healing Through synergistic effects in slowing the
rheumatoid arthritis, there is only Nutrition, Thorsons, 1995). destruction of cartilage and so
slight inflammation, if any. There are also many anecdotal should be taken together.
Although osteoarthritis principally reports of patients whose Large doses of niacinamide, or
affects the joints of the hand, knees osteoarthritis improves once they vitamin B3 (900 mg 4 g taken in
and hips, it can also involve the remove foods usually known to spark divided doses), have been long
spine. Spondylitis is an inflammation off arthritis such as the nightshade advocated as a treatment for OA. In
of one or more vertebrae of the spine. family (potatoes, tomato, bell one study, 663 patients receiving
It is true that general wear and peppers, aubergine). The best way of niacinamide had a greater range of
tear on the joints is one cause of determining which foods may be movement , compared with controls
osteoarthritis, causing a breakdown exacerbating your problem is to (J Am Geriatric Society, 1955; 3: 927). One
in the network of the cartilage and undergo a controlled exclusion diet, patient of WDDTY panellist Melvyn
often the release of enzymes which noting when certain foods make your Werbachs was so crippled she could
further destroy collagen. The reason condition worse, or to use barely get up out of her chair; three
OA mostly affects people over 50 neutralizing/desensitizing methods months after taking 250 mg of
usually has to do with a lessening of to isolate the foods which may be niacinamide every 11/2 hours (for a
their bodys ability to synthesise causing the problem (see the WDDTY maxmum of 10 doses per day) she
collagen. Allergy Handbook). had regained her strength, could
Other causes of osteoarthritis walk on her own and get in and out of
include hormonal changes, trauma, Antioxidants chairs and bed. Setbacks only
rheumatoid arthritis or even surgery. Another possible culprit is low levels occurred if she used her hands too
The usual medical solution is to of certain antioxidants. Vitamin C, much in knitting, which would
offer pain killers (nonsteroidal anti which is necessary for collagen temporarily reduce mobility.
inflammatory drugs NSAIDs) or to synthesis, is often deficient in the One caveat: you should never
wait until the joint is completely elderly. In one study, comparing OA embark on this kind of regime
destroyed and then to offer major patients given vitamin C, beta without careful medical supervision
joint replacement surgery. carotene and vitamin E against as high levels of niacinamide can
What is little known, according to controls, those taking high doses of cause liver damage and glucose
US naturopaths Joseph Pizzorno and vitamin C reduced the rate in which intolerance, among other side
Michael Murray, is that modern cartilage was lost by 70 per cent effects.
medicines treatment of OA usually (Arthritis Rheum, 1996; 39: 648-56). Another good natural remedy is
makes the problem worse. NSAID use Vitamin E is also essential to boron. Naturopath Rex Newnham
simply speeds the progress of the collagen repair. Studies have shown reports positive results with boron

WDDTY Chronic pain 35


Your questions answered

supplementation. In one double relieves pain better than NSAIDs and, chondroitin sulphate, one of the
blind (admittedly small) trial, half unlike the drugs, apparently helps to main glycosaminoglycans found in
the boron patients improved, reverse the disease process, cartilage, and so another of its
compared to only one tenth on stimulating the synthesis of building blocks. CS is generally
placebo (J Nutri Med, 1990; 1: 127-32). Dr cartilage. made from bovine, whale and shark
Werbach suggests that since the In a large scale study of more than cartilage. Glucosamine sulphate
minimum daily allowance for boron 1000 Portuguese arthritis patients and chondroitin sulphates supp-
hasnt been established, patients given glucosamine sulphate for two osedly have synergistic effects.
increase consumption of boron rich months, pain symptoms and Patients having a proprietary
foods: vegetables, such as soy, movement improved significantly in form of chondroitin injections have
cabbage, lettuce and peas; fruits, 59 per cent and sufficiently in been shown to have joint changes
such as apples, dates, raisins and another 36 per cent (Int J Tissue Ract, visible on X-ray (Semin Arth Rheum,
prunes; and nuts, especially almonds, 1992; 14: 243-51). 1987; 17: 2: Supple 1: 35-53 ) and a
hazelnuts and peanuts. In another study, of 80 OA reduced narrowing of joint spaces
B12 and folic acid may also play a patients given either 500 mg of (Rheumatol Med Int, 1986; 20: 24-8).
role in controlling joint pain. In one glucosamine sulphate three times a Although glucosamine seems to
study of 26 OA sufferers, these two B day (a standard dose) or a placebo, have no side effects in standard
vitamins were more effective than those taking glucosamine had a doses, intramuscular doses of
drugs in controlling hand joint pain significantly larger reduction in chondroitin have been linked with
(J Am College Nutrition, 1994; 13; 351-6). overall symptoms, compared with the severe kidney liver toxicity (Lancet,
placebo group (73 per cent vs 41 per 1989; 1:1275).
Glucosamine cent), after a month on the regime. Other potentially useful
Some researchers have theorized An electron microscopy sample of alternative solutions include New
that arthritis is the result of cartilage from the treated patients Zealand green lipped mussel extract
abnormal glucosamine metabolism. showed evidence of new growth (Clin (Lancet, 1981; i: 439); the antioxidant
Glucosamine is one of the chief Ther, 1980; 3: 260-72). superoxide dismutase; omega-3
components of the proteoglycans, a In another double blind study, fatty acids, largely found in flaxseed
major building block of cartilage. It where glucosamine sulphate was and fish oils; zinc; and sulphur,
seems to work by stopping the compared with ibuprofen, a popular taken as colloidal sulphur or
proteoglycans from breaking down NSAID, the ibuprofen group sulphur baths. Capsaicin cream
and rebuilds damaged cartilage recorded a better response initially. (made from chili peppers) has been
(Orthop Praxis, 1970; 9: 225). Sulphate, However, the glucosamine group found to reduce pain and tenderness
another naturally occurring experienced a steady improvement by 40 per cent (J Rheumatology, 1992; 19:
substance, appears to strengthen with pain to the point where by the 604-7). As for herbs, extract of yucca
glucosamines effect (Pharma- second month, their improvement and devils claw (Harpagophytum
therpeutica, 1981; 2: 504-8). outstripped that of the drug takers procumbens) have both been found
The research on glucosamine (Curr Med Res Opin, 1982; 8: 145-9). to reduce pain and increase mobility
sulphate demonstrates that it Glucosamine is often sold with (J Applied Nutrition, 1987; 27: 45-50).

36 WDDTY Chronic pain