Hundreds of thousands of veterans of the Persian Gulf War returned home with puzzling health issues that doctors couldn’t explain. Now, 25 years later, Gulf War Illness (GWI) continues to affect 25-32 percent of the 700,000 U.S. veterans who served in the 1990-1991 war.
The condition is characterized by symptoms such as chronic headache, cognitive difficulties, debilitating fatigue, widespread pain, respiratory problems, sleep problems, gastrointestinal problems, and other unexplained medical abnormalities.
Twenty years of scientific research has traced these symptoms to Gulf War chemical exposures and the drugs taken during deployment that were meant to prevent or counteract these exposures. However, the vast majority of these studies have focused on neurological effects, but none have fully explained the body’s pathways GWI uses to affect the brain.
Now, a study from the University of South Carolina has found a gastrointestinal link that could not only help explain the health issues facing veterans, but may also point to new treatment options.
Researchers found that the chemicals, etc. that veterans were exposed to altered the microbiome � the bacteria that inhabit the gut. The affected microbiota then produce endotoxins, which pass through a thinned lining of the gut (called a leaky gut) and into the blood where they circulate throughout the body.
These compounds trigger an inflammatory response that, in turn, initiates several neurological abnormalities commonly observed in GWI.
“Humans and animals have specific types of bacteria that help aid various physiological processes, including digestion, absorption, immunity and gut integrity, and when external factors change the bacterial composition in our digestive systems, we have problems,” says researcher Saurabh Chatterjee. “Obesity, metabolic syndrome, inflammatory bowel syndrome, and liver disease have already been linked with changes in bacterial composition of the gut.”
The study showed that not only did exposures to the suspected causes of� GWI lead to inflammation in the intestines, they also lead to inflammation in the brain.
“Usually, the gut is very selective about letting only certain elements from what we eat and drink into our blood � thanks to good bacteria,” Chatterjee explained. “But when the composition changes due to an increase in certain bad bacteria, this causes disruption to the mucosal lining of the intestinal walls � leading more intestinal contents to leak into the blood.”
Once in the blood, the toxins travel throughout the body and affect different organs, including the brain. Once in the brain, the toxins cause the inflammation and neurological symptoms that previous studies have extensively linked to GWI.
“We know that many diseases like obesity, liver disease, and inflammatory bowel syndrome can be cured or at least decreased by consuming good bacteria, like probiotics,” Chatterjee said. “Now that this connection has been established, it opens the door to new studies where GWI patients take probiotics for a longer period of time and, hopefully, see improvement in symptoms connected with metabolic syndrome, gastrointestinal disturbances, and maybe even neuroinflammation.”
Recent studies have indicated that gut bacteria have an impact on a wide range of health issues. UCLA researchers found that mice fed beneficial bacteria produced microbes known to prevent cancer. Researchers suggested ingesting probiotics like yogurt or probiotic supplements could help prevent cancer from developing.
Surgery is a common approach to treat carpal tunnel syndrome. But, physical therapy may work just as well, a new study indicates.
Researchers found that physical therapy — particularly so-called manual therapy — improved hand and wrist function and reduced pain as effectively as a standard operation for the condition.
Moreover, after one month, physical therapy patients reported better results than those who underwent surgery.
“We believe that physical therapy should be the first therapeutic option for almost all patients with this condition,” said lead study author Cesar Fernandez de las Penas.
“If conservative treatment fails, then surgery would be the next option,” said de las Penas, a professor of physical therapy at King Juan Carlos University in Alcorcon, Spain.
Also, one extra benefit of therapy over surgery may be cost savings, he noted.
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes squeezed at the wrist. It often arises from repetitive motions required for work, such as computer use or assembly line work.
Symptoms usually start gradually, with patients noticing numbness and weakness in the hand and wrist.
Surgery for the condition generally involves cutting a ligament around the wrist to reduce pressure on the median nerve, according to the U.S. National Institutes of Health.
For this study, de las Penas and his colleagues followed 100 women from Madrid who had carpal tunnel syndrome. Half were treated with physical therapy and half underwent surgery.
For three weeks, the therapy patients received weekly half-hour manual therapy sessions — meaning therapists only used their hands. The therapists focused on the neck and the median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. On their own, patients performed neck-stretching exercises at home.
After one month, the therapy group reported greater daily function and greater “pinch strength” between the thumb and forefinger compared to the surgery patients. After three, six and 12 months, however, improvements were similar in both groups. All participants experienced similar reductions in pain.
Study co-author Joshua Cleland is a professor with the physical therapy program at Franklin Pierce University in Rindge, N.H. “Manual physical therapy may be just as beneficial in improving function and symptom severity as surgery despite the severity of their condition,” he said, noting that 38 percent of those in the therapy group had “severe” carpal tunnel syndrome.
“These manual physical therapy techniques are commonly used here in the United States as well and should become a standard of practice for physical therapists working with patients who have carpal tunnel syndrome,” Cleland said.
Dr. Daniel Polatsch is co-director of the New York Hand and Wrist Center at Lenox Hill Hospital in New York City. He treats several hundred cases of carpal tunnel syndrome each year, of which 15 to 20 percent require surgery.
Treatment should be decided on a case-by-case basis, Polatsch said. Mild cases may be treated with conservative approaches that can include splinting, injections, therapy and activity modification, he added.
“Surgery is necessary when there is muscle weakness or atrophy from the nerve being compressed at the wrist,” he said.
Polatsch added that this type of surgery is generally safe and effective.
Still, operations can have complications, said Cleland. He cited a previous research finding that “approximately 25 percent of individuals undergoing surgery for carpal tunnel syndrome experience treatment failure with half of those requiring an additional surgical procedure.”
According to the researchers, almost half of all work-related injuries are linked to carpal tunnel syndrome. And, more than one-third who undergo surgery for the condition are not back at work eight weeks later.
Because this was a small study focusing only on women, the study authors said that future studies need to examine men.
The study results were published in the March issue of the Journal of Orthopedic & Sports Physical Therapy.
Massage is a popular therapy used to relieve fluid retention, spasms, inflammation, muscle tension, pains and stiffness. Other benefits include improved circulation (blood and lymph), general flexibility, range of movement, and increased tissue elasticity (eg, scar tissue).
Another kind of massage contains full-body massage, which often leaves the patient feeling relaxed and free of anxiety.
How Can Massage Function to Relax Muscles?
As the therapist uses their hands or specialized tools to rhythmically knead, wipe, and stroke (effluerage) muscles, circulation is stimulated. Blood flow is essential to helping muscles eliminate waste products, such as lactic acid, that may accumulate in muscles from spasms and delivers oxygen and nutrients.
Following trauma, muscles may act as mini-splints like a cast on a broken arm to safeguard and limit motion. An average example is somebody who uses a computer for a prolonged time period without taking a break to stretch the neck. The result: a stiff, aching neck and occasionally pain. Taking regular breaks to rub (mini-massage) and stretch the neck will boost circulation to the muscles.
What’s Swedish Massage?
This really is one of the most famous types of massage in America. Often, a lotion or oil is used to lessen skin friction. The therapist combines light stroking in one way with deep pressure in another to loosen muscles. The treatment expedites blood flow to flush uric acid, lactic acid, and other waste products from the muscles. Ligaments and tendons are stretched, increasing their suppleness. Nerves are excited and relaxed, and anxiety is relieved. The general goal is to loosen muscles.
What Is Deep Tissue Massage?
Long-term muscle tension is targeted by this technique. The therapist’s strokes are slower, using more direct pressure and friction. Determined by the texture of the deeper layers of tissue and muscle felt, the therapist occasionally adjusts intensity, strokes, and their hand positions to work the tissues to release tension.
What Is Myofascial Release?
Myofascial release, or soft tissue mobilization, is a therapy used to release tension in the fascia. Fascia are sheets of fibrous tissue that encase and support muscles. Following injury, the fascia and muscles may shorten limiting the flow of blood. The techniques used in myofascial release loosen muscle tension and break up fascial adhesions.
What’s Trigger Point and Myotherapy?
The treatment goals include alleviating muscle spasms, enhancing circulation, and releasing trigger points.
The therapist extends the muscle using a technique called Stretch and Spray as trigger points are released. This technique incorporates a superficial cooling agent such as Fluori-Methane, a local anesthetic that depresses nerve reaction. The anesthetic is sprayed over muscles as they may be softly stretched, soothing tight muscles.
Are There Other Kinds of Massage?
There are many kinds of massage; only a few are mentioned here. Shiatsu is an old oriental treatment predicated on acupressure, as is Jin Shin Jyutsu. Reiki is a Japanese type of massage that attempts to correct the entire body’s energy.�Rolfing can be uncomfortable; the goal is to adjust the muscle fascia to its fullest extension.
A Word of Caution
Speak to your doctor, before getting a massage for back pain or neck pain. She or he may have the ability to refer you to a licensed or certified massage therapist.
Ergonomics is a scientific discipline that’s been in existence for many years. Keeping their work environments safe and efficient and traditionally concerned with factory workers, ergonomic professionals have expanded their work to include all types of workers from laborers to seniors to office workers & students.
In addition, it looks for means to adjust our environment to lower the risks of illness and harm, enhance productivity, and improve the caliber of our work life.
The Goals of Ergonomics
The profession of ergonomics has two main concentrations (which frequently overlap):
1. Industrial ergonomics – occasionally called work-related biomechanics – is concerned with the physical aspects of work including force, position, and repetitive movements.
2. Human factors ergonomics looks as the psychological features of work like mental anxiety and decision-making.
The aims of ergonomics contain the following:
Reduce work-related injury and illness
Help include workers’ compensation costs for companies
Enhance the standard of work
Reduce absenteeism
Help companies comply with government regulations regarding work surroundings
Ergonomics professionals include:
Engineers
Security professionals
Industrial hygienists
Physical therapists
Occupational therapists
Nurse practitioners
Chiropractors
Occupational doctors
How Ergonomics Enhances Work & Safety
The association between work injury and illness is old. It is even believed that Ancient Man concerned himself with developing the right tools that allowed for the efficiency and least amount�of distress.
Now, we continue to look for ways to boost the relationship between our “tools” and�our jobs. One means to do that is to look at the risk factors in the workplace. These are able to be divided into 3 areas: physical characteristics, environmental features, and workplace hazards.
1. Physical Characteristics Of Work:
Bearing
Drive
Repetition
Duration
Recovery time
Velocity/acceleration
Heavy exertion that is dynamic
2. Segmental Vibration Environmental Characteristics Of Work:
Sciatica is medically defined as a series of symptoms, particularly pain, which often extend along the sciatic nerve. The symptoms generally begin in the lower back, radiating down the buttocks and legs, through the back of the thighs and into the calf and foot.
The characteristic symptom of pain associated with sciatica can manifest abruptly or may develop gradually over time. Individuals diagnosed with sciatica describe the pain as a sharp, shooting or electric shock-like in nature. Movement of the lower extremities can aggravate the pain and it may be evenly distributed along the leg, although there can be specific spots where the pain may be more intense. Other symptoms reported by sciatica sufferers include tingling sensations and numbness in the distribution of the sciatic nerve.
Sciatica is commonly caused after an injury or condition results in the irritation and inflammation of the structures surrounding the lumbar region of the spine, which may in turn lead to the compression or impingement of the sciatic nerve and/or the surrounding nerve roots. The added pressure can be due to a variety of common injuries and conditions, including: ruptured intervertebral discs, spinal stenosis or the narrowing of the spinal canal.
Anatomy of the Sciatic Nerve
The sciatic nerve is the longest and widest nerve in the body, measuring approximately three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves found in the lower back, along the lumbosacral region of the spine. The lumbosacral spine refers to the area where the lumbar spine and the sacrum come together. The sciatic nerve and it’s nerve root branches’ primary function is to allow movement and provide feeling in the thigh, knee, calf, ankle, foot and toes.
The sciatic nerve itself can be found running through the low back or the lumbar region of the spine. The nerve roots in this area are found along the L4 and L5 vertebrae. The sciatic nerve also travels through the pelvic region or sacrum.
In most individuals, the sciatic nerve runs under the piriformis muscle, the important muscle which is in charge of moving the thighs from side to side. The sciatic nerve then descends from the piriformis muscle, through the buttocks and the back of the thighs. By the area behind the knee, the sciatic nerve branches out into smaller nerve roots which continue traveling down and into the feet.
The sciatic nerve is part of the body’s nervous system, a complex network of nerves responsible for transmitting signals of sensation along with sensations of pain to other areas of the body. With sciatica, an injury or condition, such as a herniated disc, which causes irritation and inflammation along the tissues and other structures surrounding the sciatic nerve, can compress and apply unnecessary pressure to the nerve roots, radiating pain down the legs.
The sciatic nerve exits the sacrum in the pelvic area through a nerve passageway known as the sciatic foramen. At the upper part of the sciatic nerve, two branches form: the articular branches; and the muscular branches. The articular branch goes to the hip joint while the muscular branch serves the leg flexor muscles to enable movement. Other complex nerve structures are also involved: the peroneal nerves; and the tibial nerves. The peroneal nerves originate from the nerve roots along the L4 and L5 vertebrae of the spine and in the S1 and S2 vertebrae of the sacrum. After the peroneal nerves exit the pelvis, they travel down the front and side of the leg into the outer side of the knee and foot. The tibial nerves originate from the nerve roots at the L4 and L5 as well as the S1 through S3 vertebrae of the spine. The tibial nerves travel in front of the knee and down into the foot. When the sciatic nerve becomes compressed or impinged, it can cause painful symptoms along these pathways, characteristic of sciatica.
Should Sciatica be Treated with Surgery?
Most patients diagnosed with symptoms of sciatica can experience relief from non-surgical treatments, such as chiropractic care, and surgical interventions are generally not required to treat it. However, when the compression or impingement of the sciatic nerve manifests more serious symptoms, it may be necessary to receive further advice from a healthcare professional on the best form of treatment you should follow.
Severe symptoms such as: bowel or bladder dysfunction; advanced stages of spinal stenosis; neurological dysfunction including severe leg weakness; and intense symptoms where non-surgical treatments are no long effective; could indicate the need for surgery to treat sciatica.
The two common spinal surgeries for sciatica are:
Discectomy and microdiscectomy. With both of these procedures, the surgeon removes all or part of a herniated disc which may have been applying pressure against the sciatic nerve, causing your symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, many patients recover quicker from this type of surgical procedure.
Laminectomy or laminotomy: These procedures both involve a part of the spine called the lamina, or the bony plate which functions to protect the spinal canal and spinal cord. A laminectomy involves the removal of the entire lamina; a laminotomy involves the removal of only a part of the lamina. These procedures can create more space for the nerves, reducing the risk of the nerves being compressed or impinged.
Over-the-counter medication, such as non-steroidal anti-inflammatory drugs or NSAIDs, can help reduce the irritation and inflammation of the body which may relieve the symptoms of pain. These however are only considered temporary treatments and the source of the individual’s sciatica should be addressed to promote overall health and wellness. Be sure to consult your healthcare provider on the best treatment option for your sciatica.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
A good attitude about weight loss will go a long way in helping you to achieve success. Whether your weight problem has resulted from eating the wrong foods, lack of routine physical exercise, using food to resist anxiety, age, or genetics �you can help defeat that by setting reasonable goals and expectations that are realistic.
The initial step to take would be to discuss your set for weight loss and general health by means of your physician. Your physician can assist you to make informed choices about treatments that contain weight loss plans and exercise suitable to your needs.
Therapies include dietary, behavioral, drug, and for some patients, surgical alteration of the digestive system to reduce the quantity of food consumed. A safe and realistic weight reduction plan may result in success.
Evaluating your body weight is more involved than stepping on the scale. This info is assessed to find out your risks due to extra weight (eg, high blood pressure).
Nutrition Means To Feed Your Body
In the event you haven’t detected, the ‘D’ word (Diet) hasn’t been used in this post as it relates to weight reduction. Granted, caloric reduction will be required by a weight loss program. Yet, for many overweight or obese folks, a weight loss program means exercising, handling anxiety, and making lifestyle changes, which might comprise relearning how to eat.
It’s vitally crucial that you feed your body the nutrients it needs to be healthy and live. No one food contains all the essential nutrients �it takes combining a wide variety of foods to help meet your body’s needs. If you have been heavy or obese for a long time, your body may really be starving for necessary nutrients!
Nutrients Their Food Sources & Activities In The Human Body
*Fats are essential in taking the fat-soluble vitamins A, D, E, and K. There are just three types of fats:
Saturated Fat will raise blood cholesterol levels. These fats are found mostly in meat and diary products.
Polyunsaturated Fat tends to lower blood cholesterol levels. It’s mainly found in plant sources such as safflower, sunflower, soybean, corn, and cottonseed.
Monounsaturated Fat tends to lower the bad cholesterol or LDL (low density cholesterol). Examples include canola oil, olive oil, peanut oil, and avocados.
Although this amount is exceeded by most Americans, dietary ingestion of fat shouldn’t exceed 30% per day.
Remove the skin from poultry, trim visible fat from meat, an easy method to cut back fat consumption is to choose lean cuts of meat, choose water-packed tuna, and pick dairy products made from skim or low-fat milk.
Seizing on the opioid epidemic as a chance to expand their reach, naturopaths and chiropractors�are aggressively lobbying Congress and state governments to elevate the role of�alternative therapies�in treating chronic pain. They�ve scored several victories in recent months, and hope the Trump administration will give them a further boost.
Their Most Powerful Argument: We Don�t Prescribe Addictive Pain Pills
Shunning pharmaceuticals, they treat pain with everything from acupuncture to massage to castor oil ointments. They offer herbal supplements and homeopathic pills.
There�s little rigorous scientific research to back up such treatments. Yet patients often say they feel relief. And providers say their alternative approaches are vitally needed at a time when more than 30,000 people a year die of opioid overdose in the US alone � and half of those deaths involve a prescription painkiller, according to the Centers for Disease Control and Prevention.
�I am surprised that with the crisis where it is today, more people aren�t picking up on alternative treatments,� said John Falardeau, a senior vice president with the American Chiropractic Association.
Chiropractors scored a big victory recently in Oregon, where the state Medicaid program decided to cover spinal adjustment for lower back pain starting in 2016. Vermont, Virginia, and Nevada are considering similar moves.
Another win came earlier this year, when the American College of Physicians recommended non-surgical interventions such as acupuncture, yoga, and chiropractic care as the go-to treatments for lower back pain.
�The American College of Physicians is our new best friend,� said Robert Hayden, a Georgia chiropractor and spokesperson for the�American Chiropractic Association. Hayden said the the industry considers the decision �a direct result of the fact that we are in an opioid crisis in this country.�
Hoping For Help From The Trump Administration
Hoping to make even more inroads, both naturopaths and chiropractors are lobbying Congress to push the Veterans Affairs health system to hire alternative providers. Chiropractors are also pushing for a role in the National Health Service Corps, which puts providers to work in community health centers, often in rural areas.
And this month, naturopaths will descend on Washington, D.C., for a meeting all about chronic pain. �Naturopathic doctors are poised to be the leaders in combating the opioid epidemic,� the promotional materials claim.
The pain workshops will be followed by a three-day conference to set a lobbying agenda and teach naturopaths organizing techniques.
The American Association of Naturopathic Physicians clearly sees an opening to make gains: The arrival of the Trump administration and a new, Republican-controlled Congress �opens up new opportunities for AANP to push for insurance non-discrimination, to have [naturopaths] included in the VA, and to emphasize that naturopathic care is a much-needed alternative to opioids for the treatment of chronic pain,� the AANP website declares.
Chiropractors, too, are hopeful. President Trump has talked about giving more Americans access to flexible spending accounts�for health care. That, they say, will make it easier for�consumers to pay for treatments that insurance doesn�t cover � like chiropractic care.
�I think they see an opening. Whether it actually works or not is secondary. It�s basically an opening for them to try to claim some legitimacy.�
Dr. David Gorksi, surgical oncologist
Some mainstream doctors � who often range from skeptical to fiercely critical of alternative medicine � are wary. They worry that naturopaths or chiropractors might persuade patients with serious diseases to shun conventional medical care. And they point out that some herbal treatments interact badly with chemotherapy or other pharmaceuticals.
Other skeptics dismiss the push to claim a role in treating pain as a public relations ploy.
�I think they see an opening,� said Dr. David Gorski, a surgical oncologist and an editor of the blog Science-Based Medicine. �Whether it actually works or not is secondary. It�s basically an opening for them to try to claim some legitimacy.�
He finds it particularly galling that alternative providers often mix sound advice on diet and exercise, drawn from mainstream medicine, with fringe therapies that have no evidence behind them, like homeopathy pills. �It becomes hard for the average person to figure out what is and it isn�t quackery,� he said.
But other doctors are cautiously embracing the idea of new ways to treat chronic pain. They say if alternative remedies help � even if only through a placebo effect � patients may be able to avoid addictive pills.
Helping Patients Gain Control Over Their Pain
Emily Telfair, a naturopath in Maryland, said she often sees chronic pain patients who feel frustrated that conventional treatments haven�t worked to treat their pain. Or those patients haven�t been able to tolerate the tough side effects of pain medication. They come to her hoping for relief.
�That�s the place where naturopathic medicine shines. It offers another option for folks who haven�t found help,� Telfair said.
Telfair uses massage therapy, including a specific type of treatment known as craniosacral massage. She also sends patients home with castor oil packs and topical creams to apply to their pain points, all of which she said are noninvasive ways �to invite the body to heal and let go of the chronic symptom.�
�It offers another option for folks who haven�t found help.�
Emily Teflair, naturopath
She said her job isn�t always to cure a patient�s pain � it�s to help patients see that their pain won�t always be unrelenting and oppressive, and to help them gain control.
�Knowing their pain can be different from one day to the next, that is a very powerful tool,� she said. �I know I can�t help everybody with chronic pain. But you [can] change the person�s relationship to their pain.�
That�s been the case for 70-year-old James Fite, who has had both hips replaced and now needs a shoulder replaced. He�s hesitant to have the surgery because of his chronic pain.
�It�s always there. Sometimes it�s just blinding, excruciating,� he said. But he�s found relief with an acupuncturist and naturopathic care from Telfair.
He uses roll-on castor oil, sticks to an anti-inflammatory diet, and also receives massage therapy. Other times, he takes opioids. Fite said he has had 15 providers trying to treat aspects of his pain. He feels his acupuncturist and Telfair are the most �tuned in� to his body�s condition.
�None of these things are cure-alls for a chronic condition like mine,� he said. �But I�ve gotten as much help from them as from anybody.�
With various combinations of treatments, Fite said he�s more able to manage his pain than he has been before. He�s found the energy to teach chess after school twice a week at a nearby library and can spend more time playing with his grandkids.
Other naturopaths said they see their goal as finding and addressing the root cause of a patient�s pain. And they argue they have more time than a medical doctor to do that.
�It�s not as simple as a replacement for an opioid. We treat the cause of the pain. We don�t just mask it with a painkiller,� said Michelle Brannick, a naturopathic provider in Illinois who markets her services specifically to pain patients. Brannick relies on homeopathic arnica and herbal supplements, among other treatments.
A Cautious Approach From Physicians
Taxpayers subsidize roughly $120 million a year in federal grants to research alternative medicine through the National Institutes of Health.
Even after all that research, Dr. Josephine Briggs, the director of the NIH�s National Center for Complementary and Integrative Health, said she is aware there isn�t much robust evidence to support many alternative pain therapies.
�We can�t call this a slam dunk. This is not a situation where we�ve got an easy answer for a tough clinical problem,� she said.
But she pointed out that many alternative remedies are fairly low-risk. And some physicians are opening their minds up to the idea � with caveats.
�As a physician, I would never just say, �You have pain, so we�re going to just put you on pain medicine,�� said Dr. Andrew Esch, a clinician and consultant with the Center to Advance Palliative Care in New York.
Doctors stress that pain can vary wildly from one patient to the next, and treatments won�t be the same for every patient, either. �Sometimes that�s physical therapy and Motrin, sometimes it�s acupuncture and antidepressants,� said Esch.
Dr. Charles von Gunten, a palliative care specialist at OhioHealth, agreed alternative therapies like acupuncture and massage can be part of a doctor�s toolkit.
�They�re not either-or types of approaches,� he explained.
�As a physician, I would never just say, �You have pain, so we�re going to just put you on pain medicine.��
Dr. Andrew Esch, palliative care expert
But doctors also are leery of sending cancer patients or others with serious illnesses to a naturopathic provider who might convince them to go off of chemotherapy or forgo conventional medical care.
�That�s certainly a concern,� said Briggs. There�s also concern that homeopathic remedies like St. John�s wort will interfere with a patient�s prescribed medication and make those drugs less effective. Encouraging pain patients to experiment with alternative treatments might open the door to those risks.
But Esch said he doesn�t see those concerns as a reason for doctors to dismiss naturopathic approaches that their chronic pain patients are interested in trying. Most patients he sees are using some sort of alternative treatment � and many will continue to do so whether doctors like it or not, he said.
�If someone is going to take shark cartilage because they think it will make their pain better, my approach is not to immediately say no,� he said.
Instead, he scours the evidence, the side effects, and the potential drug interactions that might put a patient at risk. If it seems safe for a patient to try, he gives them the green light and checks back regularly to see if it�s helping.
�It�s part of the responsibility of physicians to know what people are taking and not dismiss it, because it�s our job to know they�re going to do it safely,� he said.
One State Weighs The Costs Of Treating Pain
Many dietary supplements � which don�t have to go through a regulatory review for safety or efficacy before hitting the market � are relatively cheap: Shoppers can snag 60 homeopathic arnica tablets off a drugstore shelf for less than $10.
But other alternative therapies can be costly: Craniosacral massage and acupuncture, for instance, can each run over $100 for an hourlong session, and patients may need multiple visits each month.
The Oregon Health Plan, which is the state version of Medicaid, weighed those expenses when deciding whether to cover chiropractic adjustment for lower back pain.
The chiropractic care costs more than would for a short course of opioids � a single vertebrae adjustment can cost around $65. But health officials are hopeful that they�ll save money in the long run by reducing the number of people addicted to opioids.
�We�re trying to offer up some of these treatment options from the beginning, with the goal of trying to reduce the transition from acute pain to chronic pain,� said Denise Taray, who coordinates the Oregon Pain Management Commission.
That commission spearheaded the research into what treatments should be covered and ultimately recommended that state Medicaid cover chiropractic care. They�re now looking at alternative medicine treatments for other pain conditions, such as fibromyalgia.
�We�re all focused on the opioid epidemic and managing prescribing,� said Taray. �The part that still seems to be falling through the cracks is the patient perspective and the treatment and the care of pain.�
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