Are Popular Alternative Pain Therapies Effective?

Posted October 23rd, 2008 by Matt

Pain Management

Many chronic pain patients have been not been helped by traditional medical care. As a result, they have turned to alternative ways to deal with their pain. There isn't much evidence yet to support complementary and alternative medicine (CAM) approaches. What do we know so far?

In this report, researchers review all systematic reviews published about a wide range of CAM treatments. They searched seven different databases to find articles on any treatment-related topics on CAM.

There were five systematic reviews that met the standard set of requirements for quality and design. Fifteen other trials also met the requirements to be included. Studies in all languages were accepted.

All patients included had chronic neuropathic or neuralgic pain. This means the primary (main) area involved was the nervous system. For this study, nervous system referred to two parts: the central nervous system (brain and spinal cord) or the peripheral nervous system (spinal nerves leaving the spinal cord).

Patients with multiple sclerosis, limb amputations, diabetes, shingles, and stroke were part of the studies. Symptoms of nervous system lesions included sensations of burning, stabbing, tingling, and/or numbness. There is no obvious change in the affected nerve when it's examined. That's why it's been so hard to find a cure or effective treatment for this problem.

There were seven types of CAM treatments studied. These included acupuncture, electrostimulation, herbal medicine, magnets, dietary supplements, guided imagery, and spiritual healing. Here's what they found:

Acupuncture with deep needling helped patients with trigeminal neuralgia. Trigeminal neuralgia (also known as Tic Doloureux) is a neuropathic disorder of the trigeminal nerve in the face. It causes intense pain in the eyes, lips, nose, scalp, forehead, and jaw.

Mock electrostimulation was just as effective as acupuncture for pain relief.

Electrical nerve stimulation (also known as electrostimulation) was effective in reducing nerve pain in patients with diabetic neuropathy.

The use of herbal medicine such as marijuana (cannabis) for chronic nerve pain must be studied further. Some studies showed it works for reducing pain. Others reported no effect on nerve pain when compared with a placebo. Placebo means a substance is used that has no real effect. Any improvement is thought to be based on the power of suggestion.

Shoe magnets used for patients with diabetic neuropathies helped reduce foot pain, numbness, tingling, and burning. Testing on postpolio patients also showed a benefit in reducing pain.

Positive results were reported for guided imagery. But spiritual healing was not beneficial. In fact, negative effects were reported for spiritual healing. The authors did not specify what those findings were.

Evidence was strongest to support the use of capsaicin topical cream. Capsaicin is a counterirritant that seems to work best to reduce pain of a neuropathic (nerve) source.

As CAM becomes more and more popular, more studies to assess their effectiveness will be done. For now, there are only a few limited systematic reviews to help us understand the benefit of these alternative treatment methods.

The authors point out the difficulty of conducting quality studies in this area. Finding a way to include a control group can be difficult. These are patients who don't receive CAM for their pain. And the funding of CAM studies is very limited at this time.

With the positive early findings, there is hope that more good quality trials will be conducted. There is some concern about overrepresenting positive results and underreporting negative results by researchers who are enthusiastic about this new treatment approach.

In summarizing the studies reviewed, the authors say there is some evidence to support CAM in the treatment of neuropathic pain. Capsaicin topical cream had the best results. Further study is needed for all other modalities before recommendations can be made and treatment guidelines are published.

Max H. Pittler, MD, PhD, and Edzard Ernst, MD, PhD, FRCP, FRCP (Edin). Complementary Therapies for Neuropathic and Neuralgic Pain. Systematic Review. In The Clinical Journal of Pain. October 2008. Vol. 24. No. 8. Pp. 731-733.

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