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Alternative and Complimentary Therapies for Pain.

CONTENTS:

* The Attraction of Magnet therapy.
* Magnetic field therapy
* Healing touch
* What is chiropractic?
* Pain Management: Alternative Therapy
* Acupuncture


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The Attraction of Magnet Therapy.

Magnets as Medicine By Bob Calandra

The pull of magnets as a pain relief therapy continues to grow despite most scientific studies showing they have little if any real value.

Nevertheless, people are spending millions on all things magnetic. Shoppers can buy magnetic jewelry, shoe inserts, mattress pads, and even magnet-conditioned water. There are magnet wraps for thumbs, wrists, knees, thighs, ankles, elbows, shoulders, shins, back, and head, some complete with endorsements from professional golfers. There are even magnet products for dogs and horses.

"If you can afford to spend the money and think magnets make you feel better, that's fine," says James Livingstone, a physicist at Boston's Massachusetts Institute of Technology and author of The Natural Magic of Magnets. "I'm very skeptical. I can't convince myself to say it is totally impossible, but my own feeling is that 90-99% of it is nonsense."

Nonsense or not, the results of a magnet therapy study aren't likely to dampen the attraction. Conducted by the physical medicine and rehabilitation department at the University of Virginia Health System, the six-month study was designed to look at how static magnetic fields worked in treating fibromyalgia, a chronic pain condition of unclear origin.

While overall the results were inconclusive, the study did find that participants using one brand of magnetic sleeping pad had a statistically significant lower pain rating than those using a second brand of pad or those using a demagnetized sham pad.

"We did find some interesting differences in the active pad group that tended to score better than the sham group," says Alan Alfano, MD, a UV medicine and rehabilitation physician and a member of the study team. "That was kind of interesting and, to be honest, a surprise to me because I didn't think we would see anything like that. We think that warrants more study."

The study used two popular commercial magnetic sleeping pads, as well as a sham pad manufactured to look like the other two. Researchers installed the pads and instructed participants not to test the pad to see if it was magnetized.

Alfano says the team was aware that a participant could easily figure out which pads were really magnetized -- by holding a paper clip near the pad, for instance -- something that could compromise the scientific validity of the study.

"I thought people might check to see if their magnet was active, but I don't think they did," he says. "It seems to me that they were very honest."

Prior to beginning the study, participants were interviewed, had their medical history taken, and underwent an examination for tender points on their bodies. Examinations were repeated three months and six months later. There was no statistical difference in most of the measures.

Most -- but not all.

"We did find that on the numeric pain scale there was a statistically significant difference with one of the active pads compared to the other groups," says Alfano. "To find anything under those circumstances I think is extraordinary."

Extraordinary as it may be, Alfano says he believes the study raised more questions than it answered.

"We did find something and we found enough to want to go and do more research," he says. "We do think there is something to it. We just don't know what conditions to study and under what parameters."

Nevertheless, Alfano says, the results are way too tenuous to draw any positive conclusions about the power of magnets to relieve pain.

"Our study was inconclusive," he says. "We feel that we can't endorse magnets based on our study. In my practice I don't endorse magnet therapy. I don't think, at this point, we have a research base to do that."

The lore of the medicinal benefits of magnets dates back to the ancient Greeks. But it wasn't until the Middle Ages that magnets as medicine hit it big. According to Livingstone, Paracelsus, a 15th-century physician and alchemist, believed that since magnets could attract iron they might also be able to round up diseases.

Today, magnets play an important role in mainstream medicine. They are used in instruments such as the magnetic resonance imaging (MRI) machine and in the developing area of magnetic pulse fields, used to treat Parkinson's disease.

"Those things are real," Livingstone says. "The magnetic pulse field is being looked at for treating depression. There is pretty good evidence that this is easy electric shock therapy."

The thinking behind magnet therapy is that it increases circulation and blood flow to the area wrapped or covered by magnets by attracting iron in the blood.

"I haven't seen good evidence of that," Livingstone says. In fact, he says, the magnets sold commercially are simply too small and weak to penetrate much beyond the surface of the skin.

"The kind of forces of the magnetic field on the blood and nerve cells is really very small," he says.

Yet there are plenty of people, including doctors, who believe magnets work. And while most studies are negative, research conducted in 1997 at Baylor University College of Medicine in Houston concluded that permanent magnets reduced pain in post-polio patients.

The study was small -- only 50 patients -- but 19% of the patients reported feeling better after using fake magnets. So combine those results with anecdotal evidence and the sheer complexity of the human body and you can understand why Livingstone is hesitant to declare magnet therapy an out-and-out hoax.

The findings from the University of Virginia study will most likely fire up the controversy. While it doesn't say magnet therapy works, the study does leave the door slightly ajar.

"We knew fibromyalgia was difficult to study, but we wanted to do a realistic study with some benefit," Alfano says. "We knew these are the people who are out there buying magnets."

Still, Alfano recommends that people suffering with pain first try mainstream medicine.

"You really need to go and have a complete and comprehensive examination by a physician to make sure that you don't have a condition that is treatable or potentially dangerous," he says.

If a patient insists on using magnets, however, Alfano says it should be under the supervision of a physician.

"I would say that in general we haven't seen any harmful side effects from magnets," he says. "But we just don't know about the long-term health effects."

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Magnetic field therapy

What is magnetic field therapy?
Magnetic field therapy uses magnets to maintain health and treat illness.

The human body and the earth naturally produce electric and magnetic fields. Electromagnetic fields also can be technologically produced, such as radio and television currents. Practitioners of magnetic field therapy believe that interactions between the body, the earth, and other electromagnetic fields cause physical and emotional changes in humans. They also believe that the body's electromagnetic field must be in balance to maintain good health.

Practitioners apply magnetic field therapy to the outside of the body. The magnets may be:

Electrically charged to deliver an electrical pulse to the treated area.
Used with acupuncture needles to treat energy pathways in the body.
Static (not electrically charged) and stationary on the treated area for periods of time to deliver continuous treatment.
What is magnetic field therapy used for?
People use magnet therapy for a wide range of health problems, including:

Joint problems, such as arthritis.
Migraine headaches.
Pain, including mild to moderate pain after surgery and long-term (chronic) pain.
Depression.
Cancer.
Overstretched muscles or injuries to muscles, ligaments, and tendons (strains and sprains).
Research has not proved magnetic field therapy to be an effective treatment for any illness.

Is magnetic field therapy safe?
Young children and pregnant women should not use magnetic field therapy, because the safety of this therapy is not proven. People who have medical devices or implants with a magnetic field, such as pacemakers, should not use magnet therapy, because it could interfere with the function of the implant.

Magnet therapy is not thought to have negative side effects or complications when it is combined with conventional medical treatment, but its effects remain unproven.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.


Author Christopher Hess
Editor Nancy Reid
Associate Editor Michele Cronen
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Marc S. Micozzi, MD, PhD - Policy Institute for Integrative Medicine

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Healing touch

What is healing touch?
Healing touch influences a person's physical or emotional health without anyone physically touching the person. It is widespread. Healing touch is also called spiritual or energy healing, therapeutic touch, or distant healing.

In the 1970s, nurses developed a specific form of healing touch called therapeutic touch to provide a more holistic (viewing the body and mind as a whole, not as individual components), compassionate approach to healing. Many nursing schools in the United States teach therapeutic touch, and it is often used in conventional medical settings (for example, before and after surgery) to help comfort patients.

Central to healing touch is the belief that a vital energy or life force flows freely through space and sustains all living organisms. In a healthy person, this energy is thought to flow in and out of the body in a balanced way. It is believed that illness results when the energy flow is out of balance.

Practitioners of healing touch use their hands in an attempt to change a person's energy flow and restore health. Healing touch does not require contact between the practitioner and the person during treatment. The practitioner moves his or her hands several inches above the person's body.

Like other complementary medicines, healing touch starts with the idea that people are naturally healthy. The way people live and think may disturb their natural energy, and they may become ill. The aim of healing touch is to focus (or channel) healing energy to restore natural health.

What is healing touch used for?
People use healing touch to help treat many diseases. Supporters of healing touch believe it is especially helpful for healing wounds, curing infections, and relieving pain and anxiety. Some research studies have shown that, like yoga and meditation, healing touch reduces anxiety and stress.

Little research has been done on the effects of healing touch, and it is a difficult form of therapy to study using traditional scientific techniques. However, some studies on distant healing show benefits.

Is healing touch safe?
You can safely use healing touch along with conventional medical treatments, but it is not considered appropriate or safe for serious, life-threatening situations or to replace other proven treatments that are known to improve a disease. There is no known risk in adding healing touch or distant healing to your medical treatment.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.


Author Katy E. Magee, MA
Author Sydney Youngerman-Cole, RN, BSN, RNC
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer Patrice Burgess, MD - Family Medicine
Primary Medical Reviewer Martin Gabica, MD - Family Medicine

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What is chiropractic?

Chiropractic is a hands-on therapy based on the theory that dislocations in the spine may cause many medical disorders (especially disorders of the nervous system). Chiropractic medicine originated in the late 1800s in the United States.

Chiropractic treatments usually involve adjusting the joints and bones in a person's spine using twisting, pulling, or pushing movements. Some chiropractors use heat, electrical stimulation, or ultrasound to help relax the person's muscles before doing a spinal adjustment.

The primary theory behind chiropractic therapy is to help the body heal itself by correcting dislocation of the joints, particularly the bones of the spine (vertebrae).

What is chiropractic used for?
Research has shown chiropractic therapy to be effective in treating low back pain and to be helpful in treating neck pain and headaches.1 The effects of chiropractic treatment on nonspinal conditions, such as high blood pressure or ear infections, have not been scientifically proven.

Is chiropractic safe?
Chiropractic treatment is a safe treatment for certain conditions when done by a licensed and experienced chiropractor who correctly diagnoses the problem. However, if the diagnosis is incorrect, it may delay appropriate medical treatment. Although very rare, stroke and spinal cord injury have occurred after cervical (neck) manipulation.

Other side effects may include minor pain or discomfort at the point of manipulation, headaches, and fatigue. Most of these effects go away within a day.

If the chiropractor makes an incorrect diagnosis, chiropractic treatment can be harmful. In rare cases, chiropractic treatment can worsen a herniated or slipped disc.

Chiropractic students must have a minimum of 3 years (90 credits) of undergraduate study before applying to a chiropractic college. Upon completion of a 4-year program, the chiropractic student receives a Doctor of Chiropractic (DC) degree. Chiropractors are licensed in every state and must pass a four-part examination with the National Board of Chiropractic Examiners.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Citations
Vickers A, Zollman C (1999). ABC of complementary medicine. The manipulative therapies: Osteopathy and chiropractic. BMJ, 319(7218): 1176–1179.


Author Shannon Erstad, MBA/MPH
Author Lila Havens
Editor Kathleen M. Ariss, MS
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kathie Hummel-Berry, PT, PhD - Physical Therapy
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics

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Pain Management: Alternative Therapy

Chronic pain can occur anywhere in the body. Treating chronic pain can be challenging. Alternative therapy has become an option for pain management.
The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been sufficiently scientifically documented or identified as safe and effective for a specific condition. Alternative therapy encompasses a variety of disciplines including acupuncture, guided imagery, chiropractic treatment, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others.

In the past decade, strong evidence has been accumulated regarding the benefits of mind-body therapies, acupuncture, and some nutritional supplements for treating pain. Other alternative therapies such as massage, chiropractic therapies, therapeutic touch, certain herbal therapies, and dietary approaches have the potential to alleviate pain in some cases. However, the evidence supporting these therapies is less concrete.

Mind-Body Therapies
Mind-body therapies (MBT) are treatments that are meant to help the minds ability to affect the functions and symptoms of the body. MBT use various approaches including relaxation techniques, meditation, guided imagery, biofeedback and hypnosis. Relaxation techniques can help alleviate discomfort related to chronic pain.

Acupuncture
Although the World Health Organization currently recognizes more than 30 diseases or conditions that can be helped by acupuncture treatment, one of the main uses of acupuncture is for pain relief.

Sixteenth century Chinese doctors believed that illness was due to an imbalance of energy in the body. In acupuncture, disposable, stainless steel needles are used to stimulate the body's 14 major meridians, or energy-carrying channels, to resist or overcome illnesses and conditions by correcting these imbalances.

Acupuncture is also thought to decrease pain by increasing the release of chemicals that block pain, called endorphins. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like chemicals produced in our own bodies during times of pain or stress). Endorphins, along with other neurotransmitters (body chemicals that modify nerve impulses), block the message of pain from being delivered up to the brain

Acupuncture may be useful as an accompanying treatment for many pain-related conditions, including: headache, low back pain, menstrual cramps, carpal tunnel syndrome, tennis elbow, fibromyalgia, osteoarthritis and myofascial pain. Acupuncture also may be an acceptable alternative to or may be included as part of a comprehensive pain management program.

Chiropractic Treatment and Massage
Chiropractic treatment is the most common non-surgical treatment for back pain. Improvements of people undergoing chiropractic manipulations were noted in some trials. However, the treatments effectiveness in treating back and neck pain has not been supported by compelling evidence from the majority of clinical trials. Further studies are currently assessing the effectiveness of chiropractic care for pain management.

Massage is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage can reduce stress and relieve tension by enhancing blood flow. This treatment also can reduce the presence of substances that may generate and sustain pain. Available data suggest that massage therapy, like chiropractic manipulations, holds considerable promise for managing back pain.

Therapeutic Touch and Reiki Healing
Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so called "energy-based" techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient.

In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health. Although beneficial effects with no significant adverse side effects were reported in several studies, the limitations of some of these studies make it difficult to draw definitive conclusions. Further studies are needed before the evidence-based recommendation for using these approaches for pain treatment can be made.

Dietary Approaches to Treating Pain
Some people believe that changing dietary fat intake and/or consuming plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation.

A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not randomized and was without a control group. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis.

Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.

Nutritional Supplements
There is solid evidence indicating that glucosamine sulfate and chondroitin sulfate are effective for knee osteoarthritis. These natural compounds were found to decrease pain and increase mobility of the knee and were well tolerated and safe.

Other dietary supplements, such as fish oils, also show some evidence of benefit, although more research is needed.

Herbal Remedies
It has been difficult to draw conclusions about the effectiveness of herbs. If you decide to use herbal preparations to better manage your pain, it is of critical importance to share this information with your doctor. Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health.

Things to Consider
Alternative therapies are not always benign. As mentioned, some herbal therapies can interact with other medications you may be taking. Always talk to your doctor before trying an alternative approach and be sure to tell all your doctors what alternative treatments you are using.

Reviewed by the doctors at The Cleveland Clinic Center for Integrative Medicine.

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Acupuncture

For arthritis pain relief, you do not necessarily have to rely solely on pain pills and steroids. Acupuncture is an alternative therapy for chronic pain treatment.To ease arthritis pain, you do not necessarily have to rely solely on pain pills and steroids; there are a few alternative treatments that may help you find relief, including acupuncture.

What Is Acupuncture and How Does It Work?
Sixteenth century Chinese doctors believed that illness was due to an imbalance of energy in the body. In acupuncture, disposable, stainless steel needles are used to stimulate the body's 14 major meridians, or energy-carrying channels, to resist or overcome illnesses and conditions by correcting these imbalances.

Acupuncture is also thought to decrease pain by increasing the release of chemicals that block pain, called endorphins. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like chemicals produced in our own bodies during times of pain or stress). Endorphins, along with other neurotransmitters (body chemicals that modify nerve impulses), block the message of pain from being delivered up to the brain.

What Conditions Are Treated With Acupuncture?
Although acupuncture is not a "cure-all" treatment, it is very effective in treating several diseases and conditions. Acupuncture is most effective at treating chronic pain, such as headaches; menstrual cramps; and low back, neck, or muscle pain. It can also be used to treat arthritis, facial pain, pain from shingles, and spastic colon and colitis conditions. Acupuncture has also been successful in treating obesity and addictions such as nicotine or drugs. Acupuncture also can improve the functioning of the immune system (the body's defense system against diseases).

Also, don't rely on acupuncture for treatment of chronic or serious illness unless you see a doctor first. Acupuncture may not be the only way to improve your condition. Your health-care provider may recommend acupuncture treatment along with other treatment methods such as physical therapy or medication. For certain conditions, such as cancer, acupuncture should only be performed in combination with other treatments.

What Happens During Acupuncture Treatment?
The acupuncturist, the person who performs acupuncture, will swab each acu-point area with alcohol before tapping a hair-thin, metal needle into the site. The number of needles used during treatment can vary and are placed at various depths. They are placed under the skin in carefully determined points on the body.

After the needles have been inserted, they stay in place for several minutes to an hour. During the treatment, acupuncture needles are twirled, energized electrically, or warmed to intensify the effect of the treatment. When electricity is applied, a tingling sensation is common. However, if the sensation becomes too strong, you can ask your acupuncturist to reduce the electricity at any time.

In a treatment series, the acupuncturist will use different combinations of points, different needling techniques, or both. These combinations help stimulate new sources of healing as the person's response to treatment is observed.

Does Acupuncture Hurt?
You may feel a slight prick when the needle is inserted, but it is much less than the prick you feel during an injection, since the needles are much thinner. You may feel a heaviness, numbness, tingling, or mild soreness after the needles have been inserted.

Is Acupuncture Safe?
Yes. When acupuncture is performed with disposable needles under clean, sterile conditions, and by a qualified practitioner it is highly unusual to have any complications.

What Are the Advantages of Acupuncture?
One benefit to acupuncture is that it is a drug-free way to minimize pain. With drugs, people often develop a tolerance, or the need for an increased dosage to achieve the same required effect. However, this does not happen with acupuncture. In addition, acupuncture allows the doctor to immediately examine a person's response to the treatment and adjust it if necessary.

Does the Medical Establishment Approve of Acupuncture?
Yes. There are approximately 6,500 licensed acupuncturists in the U.S. and 3,000 doctors who perform acupuncture as part of their medical practice. In addition, the World Health Organization currently recognizes more than 40 medical problems, ranging from allergies to AIDS, which can be helped by acupuncture treatment. Lastly, the FDA regulates acupuncture needles as medical devices.

Will My Health Insurance Policy Cover Acupuncture Treatment?
Some insurance companies will pay for acupuncture treatment. Because each insurance provider has different restrictions, it is best to consult with your provider to determine if your treatment will be covered.

How Often Should I Be Treated With Acupuncture?
The number of treatments required depends on each person's condition and response to acupuncture. One acupuncture session does not usually result in lasting pain relief. Usually at least two sessions a week for four to five weeks is a normal course of treatment. It may take several treatments before you notice any benefit, so try at least five or 10 treatments before giving up.

Can I Resume My Daily Activities Following a Treatment?
It is best to bring someone with you on your first acupuncture treatment so that you will have transportation home. This is because acupuncture has a very calming effect. You may feel overly relaxed after the treatment and shouldn't drive. No matter how good you feel after the treatment, it is important not to overextend yourself. You should take it easy for a few days after the treatment. In addition, it is important to continue taking your prescribed medications.

Reviewed by the doctors at The Cleveland Clinic Department of Rheumatic and Immunologic Diseases.
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