Loolwa Khazzoom: What are your thoughts about the effectiveness of pharmaceutical versus complementary and alternative medicine for natural pain relief?
Mark Young: Pharmaceuticals continue to be a mainstay of treatment of many common painful conditions, but there are alternatives. Many complementary and natural strategies can help just as well. I think there is growing recognition of the importance of some of these natural treatments for beating pain.
LK: If you’re looking at the big picture, where do you see the role of pharmaceuticals and where do you see the role of these natural remedies? Do you see them as being in opposition? Do you see them as working together?
MY: I see them as synergistic. I think natural remedies for pain are intended to be a complement. They go together with conventional treatments kind of like bagels and cream cheese. They really work together.
I think it’s important that before any treatment be applied, the actual cause of the pain be identified. I like to tell my patients that pain management is like building a house: When you build a house, you first need a foundation — the structure upon which the house is built.
Similarly, proper management of pain requires a diagnosis; that’s the foundation. Until you have the diagnosis, you can’t really treat the pain appropriately or effectively. So we try to identify the root cause of the pain.
Once we’ve done that, we can apply different treatment modalities — the traditional methods like pharmaceuticals, injections, or physical therapy. We usually try to balance these with natural forms of treatment, complementary strategies, simple methods that are likely to serve an important role.
LK: Like what? What are some of the drug-free remedies that you find to be the most effective, or does that really depend on what the cause of the pain is?
MY: Really it’s paired according to the pain. But in general, helpful treatments include botanical creams and salves. Arnica is well-known for it’s effectiveness in treating bruises and muscle strain. Comfrey cream is also helpful for treating various types of sprains and strains of the knee, ankle, and shoulder.
There are also modalities like acupuncture and acupressure, which help decrease pain. There’s exercise, yoga, and tai chi. There are nutritional remedies like a diet high in Omega 3 fatty acids. All of these methods go a long way.
LK: How many of these modalities have been given the time and attention of scientific studies? How much has been proven to date? Where do we still have to go, in terms of formally establishing the effectiveness of these treatments?
MY: There’s still a lot more research to be done. Unfortunately, research efforts have been dampened because of the power of the pharmaceutical industry. Big pharma is not motivated to explore some of the natural remedies that clearly have no profit motives.
We’re blessed, on the other hand, that’s there are organizations like the National Institute for Complementary and Alternative Medicine — a division of the National Institute of Health that researches the effectiveness of complementary treatments. Slowly but surely, we’re seeing a revolution that’s emphasizing good, solid research in establishing the effectiveness of alternative and complementary treatments.
I believe that we’ve got lots to learn from our European neighbors, who have done research in this area for a long time. Just like there’s an FDA here, regulating the drug market, so is there a European Commission that regulates the use of herbal remedies. And they’ve lent a lot of credibility to the use of alternative methods for decreasing people’s pain and suffering. They have established the effectiveness of these remedies.
LK: Why do you think that they’re more inclined to research herbal remedies? Is it because many of them have social systems of health care?
MY: I think a lot of it does have to do with the basic social infrastructure. In addition, their practitioners are probably a bit more judicious about prescribing medications, without knowing the full spectrum of effects. Lastly, in any sort of managed care or socialistic system, one needs to search for less expensive, cheaper alternatives for health care.
Just because the alternative is not as expensive doesn’t mean that it’s not as effective. Things like Arnica cream and Comfrey and Saw Palmetto (for treating prostate) are things that really got their momentum in Europe.
LK: Can you talk a little about limitations and drawbacks of pharmaceuticals?
MY: Every medication has a side effect, no matter how good it is. Pharmaceuticals, particularly for pain, have been found to cause dangerous side effects – as in the case of Cox-2 inhibitors. Several of them were taken off the market. Prescription drugs for pain include narcotic analgesics, which obviously do a lot of damage: They can affect kidney function, people’s levels of alertness, performance in the work environment. Many pharmaceutical agents have negative side effects that undo the positive effects.
LK: Is there anything else you’d like to add about complementary and alternative methods for natural pain relief?
MY: Complementary and alternative methods should be as important to clinicians as pharmaceutical intervention. We constantly have to search for new and safe ways of treating our patients, while avoiding the toxic effects of drugs.
Mark Young, MD, MBA, FACP, is a board-certified specialist in Physical Medicine and Rehabilitation (Physiatry) and is a licensed acupuncturist. He currently serves as chair of the Department of Physical Medicine and Rehabilitation at the Maryland Rehabilitation Center, and he is editor-in-cheif of the Journal of Practical Pain Management. He is the author of over 70 publications relating to rehabilitation medicine and has co-authored three rehabilitation textbooks. His articles have appeared in periodicals including Journal of the American Medical Association (JAMA), New England Journal of Medicine, and The New York Times.