Theflashes of pain sound strikingly similar.
Allie Steele's knees hurt when she gets out of bed. StevenNicks' throb when he stocks shelves at a grocery store and rides hisbike competitively. Peter Michaelis' act up when the weather is cold.
The pain may be the same, but the reasons for it and thetreatments differ.
Steele, of Walnut Creek, Calif., has osteoarthritis andrecently began receiving an injectable. Nicks, of Oakland, is healingfrom an overuse sports injury and finds acupuncture helps most.Michaelis, of Antioch, blames age (he's 72), and usually a dose ofibuprofen and a topical cream do the trick.
An estimated 85 million Americans report having some form ofarthritis (joint disease), osteoporosis (bone disease) or seriousmuscle pain. And it's those people who fuel a billion-dollarpharmaceutical industry and have helped alternative treatments becomemore mainstream.
The real dilemma is deciding what works for the everyday achesand pains and knowing when to ask for help.
Just look at what's available over the counter for painrelief: more than a hundred brands of pills, capsules, creams, sprays,patches and supplements.
How do you decide what's best?
"Mainly, trial and error," says Dr. Brian Kaye, arheumatologist at Sutter East Bay Medical Foundation in Orinda, Calif."What may work for one person won't necessarily work as effectively forsomeone else."
Scientific guidanceScience can help a little with the decision-making process: Capsaicin: Derived from ground chilepepper, this ingredient in some topical treatments delivers more thanjust a burning sensation. It decreases substance P, a neurochemicalthat transmits pain messages, to help desensitize a person to pain. The downside? "It burns," says Dr. Melissa McNamara, a rheumatologistat the Arthritis and Rheumatology Center in San Ramon, Calif. "Youshould wear latex gloves when applying it because if you rub it onother places, it can cause great discomfort." Menthol and methyl salicylate: Found intopical treatments such as BenGay and Icy Hot, these arecounter-irritants. "They work to distract you," Kaye says. "For example, if you have aheadache and you smash your toe, you forget about the headache.Basically, the burning sensation makes you forget about the pain."Pain relievers: Several over-the-counterbrands have proven track records. McNamara suggests patients with liverproblems should avoid acetaminophen (Tylenol), and those with kidneyproblems should not take the nonsteroidal anti-inflammatories naproxen(Aleve) or ibuprofen (Advil or Motrin). Supplements: The jury is still out. Inher own clinical studies, McNamara found benefits in glucosamine forosteoarthritis patients.
Studies indicate that fish oil and Omega-3 fatty acids may haveanti-inflammatory gains as well. Dr. Christy Sandborg, head ofPediatric Rheumatology at Lucile Packard Children's Hospital atStanford Medical Center, recommends her juvenile arthritis patients eatsalmon. "The reality is that those may work somewhat for patients with mildcases of arthritis," Sandborg says, "but for the more aggressive jointpain, they won't be adequate." Doctor's callWhen joints are swollen, red or warm, and stiffness lastsan hour or more, Kaye says, it's time to call a doctor.In children, Sandborg says, it's time to call the pediatricianwhen pain appears during the day and is accompanied by swelling orlimping. Muscle imbalance, once known as growing pains, usually occursat night and responds to pain relievers or massage. And all three rheumatologists agree, leaving arthritisuntreated can cause serious and irreparable damage to the joints. "Take rheumatoid arthritis," McNamara says. "Even if you bearthrough the pain, ultimately you might be hurting yourself by nottreating the underlying inflammation." Doctors have access to numerous treatment options, rangingfrom high doses of anti-inflammatory and opioid pain medications (suchas Tylenol with codeine) to injectables and infusions.
Cortisone shots remain effective in decreasing inflammationconfined to a specific joint, McNamara says: "It cools things off." For more widespread joint pain, infusions such as Remicade mayhelp. Few treatments worked on Steele's osteoarthritis until herdoctor tried OrthoVisc, an injectable hyaluronic acid that lubricatesthe knee and cushions the joint. "I can bend my knee again without feeling like it's going tosnap in half," Steele says. Finding what worksNot everyone wants to try traditional medication. In recent years, some prescription medicines (Vioxx, Celebrexand Bextra) raised concerns ranging from cardiac problems tolife-threatening reactions. Some patients also may not respond to drug therapy or surgery.That's when rheumatologists may refer them to a licensed acupuncturist,such as Lorenzo Puertas of East Bay Pain Care in Oakland. "With modern drugs, you can feel the effects of pain beingcovered up. The inflammation is just being suppressed," Puertas says."Natural forms of medicine are different. These put you on the road tohealing." Scientific studies have shown acupuncture can work forarthritis patients. The traditional Chinese technique involvesunblocking chi (natural energy) by inserting thin needles in specificpoints of the body.
But, as Puertas explains, the treatment goes further, with apractitioner analyzing a patient's health history and habits, such assleep and diet. For patients who suspect they have arthritis,chiropractors take X-rays and MRIs to reach an accurate diagnosis. Massage therapy also may help relieve pain, although it won'ttreat arthritis. But Jordan Rothstein, a certified massage therapist inBerkeley, cautions against self-diagnosing. "A lot of people think they have arthritis and it turns outthey don't," Rothstein says. "I always ask, 'Who told you that? Afriend? Did you read it in a magazine?'" Rothstein deals with a lot of false assumptions, which is whyhe conducts individualized assessments. "I try to understand why a person is hurting," he says. "It'snot simply a matter of 'hurts here, rub there.' A lot of painoriginates in the muscles. Someone can't necessarily tell from the feelof the pain what's causing it." Other alternative treatments include chiropractic, whichinvolves adjusting segments of the spinal column; hypnosis; herbalremedies; meditation; and hydrotherapy, which involves water exercises.As with traditional medicine, finding what works meansexperimenting. "When you're hurting, you'll try just about anything," saysNicks, the Oakland resident who uses acupuncture to treat his overuseinjury. "Sometimes what you least expect works." Reach Ann Tatko-Peterson at 925-952-2614 or atatko@bayareanewsgroup.com.Source: Contra CostaTimes, Walnut Creek, Calif. Distributed by McClatchy-TribuneInformation Services. Powered by Yellowbrix.
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