By Catherine Guthrie
Open the newspaper or flip on the TV and you’ll see accolades for doctors’ many miraculous abilities. They can separate conjoined twins, reattach severed limbs, and shuffle organs between patients like peas in a shell game. But sit down with someone whose body is racked with the pain of osteoarthritis, migraines, or fibromyalgia, and the shortcomings of traditional medicine become blindingly clear. The humbling fact is that at least 50 million Americans live in chronic pain, and the vast majority are pretty much at its mercy. The hallmarks of daily life—work, sleep, raising families—become enormous challenges, and as if that’s not enough, most pain patients also grapple with depression. “Chronic pain can swallow you up and steal your identity,” says Penny Cowan, founder and executive director of the American Chronic Pain Association in Rocklin, California. “So many of us base who we are on what we do, on our abilities. When that is taken away, you become an un-person.” Unfortunately, chronic pain patients have traditionally been the Achilles’ heels of Western medicine. They’re hard to diagnose—pain is by its nature subjective, and can’t be located on an X-ray or under a microscope—and conventional treatments are fraught with risk. And painkillers like nonsteroidal anti-inflammatories, opioids, and morphine come packaged with a slew of side effects as well as some addictive properties, which can be more disruptive than the pain itself. No wonder pain sufferers are often perceived as “difficult”: Who wouldn’t get cranky under such frustrating circumstances?
The uneasy relationship many chronic pain patients have with doctors is driving them into the arms of alternative healers. In fact, pain is the number one reason people use alternative medicine, according to the Journal of the American Medical Association. Some therapies, such as acupuncture, biofeedback, and massage, are scientifically proven to reduce certain types of pain, while others, like reiki and meditation, can help a person get a handle on the emotional demons that chronic pain unleashes.
But while it’s tempting to paint a two-dimensional picture—conventional medicine bad, alternative medicine good—it’s also dangerously simplistic. A naturopath who tells a patient her pain will vanish with the right combination of supplements is just as irresponsible as a doctor who dashes off a prescription for opiates before running out the door. If ever there was a condition that calls for a truce between the two schools of thought, it’s chronic pain.
Enter James Dillard, a specialist in integrative pain management and the author of The Chronic Pain Solution. Trained first as an acupuncturist and chiropractor and only later as a physician, Dillard believes an integrative approach is especially important for people who struggle with chronic pain. “Because they suffer on so many levels—physically, emotionally, and psychosocially—you can’t treat chronic pain with a single therapy,” he says. “You have to have a compassionate, healing relationship with the whole person.”
That’s precisely what patients can expect at the Center for Health and Healing at Beth Israel Medical Center in Manhattan, one of several integrative pain clinics across the country, where Dillard practiced until recently. (He has since taken a position at Columbia University School of Medicine.) There, in serene feng-shuied offices high above the Midtown bustle, general practitioners, internists, and psychotherapists share space and information with acupuncturists, aromatherapists, and reflexologists. And the payoff is more than just feel-good reassurance. “By using conventional pain tools judiciously and adding complementary therapies,” Dillard says, “you can lower drug dosages, reduce side effects, and often bring down medical costs.”
Dillard’s patients run the gamut from Upper East Side matrons to Lower East Side artists, and at the core of his approach is an open mind. “You don’t have to wear robes, chant, or drink wheatgrass juice,” he says. “Just take conventional medicine and shove it a little to the left.”
Or shove alternative medicine to the right. In fact, Dillard often leans heavily on prescription drugs in the early stages of treatment. “Sometimes they’re absolutely necessary just to get people going again and give them hope that they can feel better,” he says. Once the pain has receded from center stage, Dillards brings up complementary pain management tools, such as acupuncture, chiropractic, meditation, and biofeedback. By covering all the bases—calming the mind, stretching the muscles, soothing inflammation, and manipulating the skeleton—Dillard hopes to begin addressing pain at its roots instead of just muffling its voice with painkillers.
Below are stories of three of Dillard’s patients, all of whom suffered years of torment before finally getting a grip on their pain. By the time they got to the Center for Health and Healing, some had already begun to experience relief by way of alternative therapies they’d found on their own. In all cases, Dillard added some essential ingredients to the mix, and sent his patients on their way with tools for weathering the inevitable storms that chronic pain can stir up. Even the integrative approach is no easy fix—but for some it’s clearly the best chance medicine has to offer.
In 1995, Fred Kramer, a 44-year-old registered nurse, was in a minor auto accident from which he walked away unhurt. Or so he thought. The next morning, his left shoulder was in such pain that he could barely move his arm, so he tossed back a couple of Motrin, put on an ice pack, and called in sick. After a couple of days on the couch, however, he grew impatient and hauled himself back to work, still in pain.
Two months after the accident, the searing pain had put an end to all but the mildest activities. On a friend’s suggestion, Kramer saw an orthopedic surgeon, who sent him home with the pat advice to “give it time.” But in the end, time became Kramer’s biggest enemy.
A year after the accident, a coworker casually suggested Kramer’s injury might be myofascial pain syndrome (MPS). Often accompanying another injury, MPS results when muscles lock themselves into place to protect a part of the body from injury, forming a shield of sorts. Over time the tension slows circulation to the muscles. Without sufficient blood, the cells become starved for oxygen, and strained nerves send the brain increasingly loud pain signals. As the muscles tighten, so do the surrounding sheaths of tissue, called fasciae. Unless the muscles are coaxed back into relaxing soon after the injury, the initial problem can spiral into greater levels of pain and continuing loss of mobility.
Kramer, relieved to have an actual diagnosis, began chiropractic treatments that he hoped would unlock his tight muscles. They helped, but not enough, and by this time he had become seriously depressed. “I never felt like myself,” he says. “The pain gnawed at me every day. I was functioning, but only doing what I had to do to survive.”
Then, as he puts it, the events of September 11, 2001, knocked the self-pity right out of him. “That experience lit a fire under me,” he says. He began seeing a physical therapist, who used trigger point therapy to goad his frozen muscles into melting back into position. Trigger points are knots of muscle tissue caused by long-standing tension that can send waves of pain into neighboring muscles. A therapist will use his or her fingers to put deep, steady pressure on a point for several minutes at a time. In addition to these sessions, the therapist helped Kramer rebuild the shoulder’s strength and mobility.
Last fall, after seeing James Dillard’s PBS special on pain titled Chronic Pain Relief, Kramer made an appointment at the Center for Health and Healing. To get the chi flowing to the shoulder, Dillard suggested he add acupuncture to his regimen. He also recommended omega-3 fatty acid supplements, which are known for their anti-inflammatory properties as well as their ability to combat the blues.
Today Kramer is nearly pain-free for the first time in eight years. Instead of singling out a specific alternative treatment, he credits them all.
“So many doctors told me I could have this pain for the rest of my life,” he says. “Thank God I’m finally starting to see the light at the end of the tunnel.”
At 40, Meredith Powers blends in easily with the 20-something students at a café near a Manhattan university. Only her red-rimmed eyes, nervous energy, and habit of holding herself closely, as if cradling a delicate sculpture, reveal her history of chronic pain.
As a competitive swimmer throughout high school and into college, Powers was not one to be sidelined by pain. When the gnawing sensation in her shoulders first got her attention, she simply kept going. But eventually she had to shelve her swimsuit for good, and her pain went away. A year later it was back, though she’s hard-pressed
to say why. Maybe it was the typing, driving, or holding a book to read—all things she can no longer do comfortably. Six years later, she’s still struggling to get a handle on her suffering. “I can’t do anything with my shoulders or arms,” she says. “I’m in agony.”
Powers began her search for relief with conventional care, but results of MRIs, X-rays, and blood work all came back normal. Her case befuddled every doctor she called on. Her default diagnosis was tendonitis, but when the standard treatments for that ailment didn’t work—rest, ice, and anti-inflammatories—she became very depressed.
On a doctor’s suggestion, Powers got herself to the Center for Health and Healing, where Dillard decided to try a shotgun approach. He started with acupuncture to reduce the inflammation and later added chiropractic adjustments to open up the shoulder joint.
He also sensed that Powers would benefit from a more mind/body type of therapy and recommended hypnotherapy. A clinically proven way to reduce blood pressure, lower heart rate, and decrease stress hormones, hypnotherapy works by guiding a person into a trancelike state where he or she becomes highly receptive to the power of suggestion.
Powers responded well. More important, the hypnotherapy warmed her to the idea of using a variety of mind/body practices to fight her pain. Last year she had her first real breakthrough when treated with reiki, a form of energy healing that originated in Japan.
“Reiki reduced my anxiety, lessened my pain, and improved my mood,” she says. Powers has since added daily meditation and self-guided imagery to her routine.
“I’m learning that my pain isn’t something I’m going to fix,” she says. “But reiki has given me my first real hope that I can get through it.”
4 New Ways to Relieve Pain
Low-Level Laser Therapy
If alternative medicine standbys like acupuncture, biofeedback, and massage don’t ease your pain, there are some new options that might. Some use modern technology; others require nothing more than a little sugar water and a few needles. They’re not yet backed by stacks of scientific studies, but many practitioners report using them on their patients with great success. Low-Level Laser Therapy (also known as cold laser therapy)
What it is: Low-level lasers emit a specific wavelength of light that penetrates several inches below the skin, where it decreases inflammation and muscle spasms and increases blood flow and production of ATP, the body’s all-purpose energy molecule. According to Robert Bonakdar, a physician and director of pain management at the Scripps Center for Integrative Medicine in La Jolla, California, low-level lasers provide more than just pain relief. “They actually help the tissue heal,” he says.
What it’s good for: Low-level laser therapy was recently approved by the FDA for a wide range of conditions, including arthritis, carpal tunnel syndrome, muscle and joint pain, and muscle spasms.
Where to find it: Bonakdar uses one of the most common types of low-level laser therapy, called the SportLaser. To find the nearest physician with a SportLaser, look on www.sportlaser.com. However, other types of low-level lasers exist; to learn more about the therapy, visit www.laser.nu.
Electrical Field Stimulation
What it is: The ancestor of the field is static magnet therapy, in which magnets worn on the body are said to promote healing through a variety of possible mechanisms, including increasing blood flow and balancing the body’s energy patterns. But in the latest version, a number of devices deliver actual electric current or pulses of electromagnetic energy. Transcutaneous electrical nerve stimulation, or TENS, has been in use for a while. One of the newer additions is the BioniCare Bio-1000, which sends microelectric currents into arthritic knee joints, reducing pain and possibly even spurring production of new cartilage. “I think it’s going to be pretty revolutionary for people with osteoarthritis in their knees,” Bonakdar says. He’s also excited about a machine made by Magnatherm that generates pulses of electromagnetic energy to heat the tissue.
What it’s good for: The Bio-1000 is the first noninvasive, nondrug treatment approved by the FDA to treat arthritis of the knee, and the company is currently developing machines to treat arthritis in other areas of the body, too. The Magnatherm device is good for chronic pain in hard-to-treat areas, such as the lower back and pelvis, Bonakdar says, as well as for specific types of pain such as tendonitis and bursitis.
Where to find it: To find a physician with access to BioniCare Bio-1000, you’ll have to call the company at 866.246.5633. The same is true for the Magnatherm device; the number is 800.432.8003.
What it is: This simple therapy involves the injection of a concentrated solution—usually dextrose—into an aching joint. The sugar water is thought to set off an inflammatory response, which can jump-start the body’s own healing process. Once popular among orthopedic surgeons, prolotherapy fell out of favor with the advent of surgical techniques. But according to Chris Centeno, a physician and director of the Centeno Clinic, in Westminster, Colorado, many studies have shown it to be effective.
What it’s good for: Injured or aging tendons and ligaments, particularly in small, gliding joints like the jaw, wrist, elbow, knee, and ankle.
Where to find it: Most major cities have at least a few prolotherapy practitioners. To find one, go to the website of the American Association of Orthopaedic Medicine: www.aaomed.org.
Intramuscular Stimulation (IMS)
What it is: Intramuscular stimulation is not for the faint of heart: A practitioner inserts acupuncture needles from one-half to two inches deep to reach what are known as muscle motor points, or areas where nerves are concentrated in the muscle. The needle pokes a tiny hole in the muscle membrane, triggering the muscle to contract and eventually release.
What it’s good for: IMS is used to treat chronic soft tissue pain caused by muscles that have permanently shortened after an injury or repeated stress. According to Centeno, IMS is an effective last resort for those who have exhausted other options.
“Our average IMS patient has struck out with chiropractic, physical therapy, massage, and acupuncture,” he says. “The results in this population are amazing.”
Where to find it: Although intramuscular stimulation has been around for decades and is common in Canada and Europe, just a handful of trained practitioners exist in the United States, and more than half of them work at Centeno’s clinic (www.centenoclinic.com). The others can be located on www.istop.org. It’s important to find a qualified practitioner, Centeno points out, since inserting needles that deep requires extensive