Patients who use traditional medicine are often given drugs, but no answers. It’s like the story about the old man who went to the doctor complaining of pain in his right knee. The doctor prescribed pain medication, but the old man wanted to know why his knee hurt. The doctor said, “Well Mr. Smith, you are 78 years old—you have to expect some aches and pains.” The old man replied, “But the other knee is also 78 years old, and it doesn’t hurt.” He wanted to know the cause and to have the cause treated and not merely mask his symptoms with drugs. As a chiropractor, you know there are many safe, effective and natural ways to relieve pain. When you treat pain naturally, there are no side effects and you address the problem at its source.
Patients with pain certainly are not alone, 80% of all visits to the doctor are pain related. Nearly 43 million U.S. adults have been diagnosed with arthritis and, according to the CDC, each year there are 600,000 more cases. 25 million Americans regularly have migraine headaches and many as 45 million Americans have chronic, severe headaches that can be disabling.
In 2001, over 13 million people saw a physician for the treatment of back pain. According to the NIH, 65 to 80% of all people have back pain at some time in their life. Back pain is the most frequent cause of activity limitation in people younger than 45 years old.
Chronic pain has been said to be the most costly health problem in America. Estimated annual costs, including direct medical expenses, lost income, lost productivity, compensation payments, and legal charges, are about $90 billion. There are over 800 pain clinics in the United States, treating those who have failed to get help from the traditional health care system.
There is a tendency to think of pain medicine as the only way to treat pain and inflammation. Most people automatically take medication when they have pain. Some people with chronic pain take medication regularly without giving it much thought. More than $4 billion is spent each year on over-the-counter pain medications for headaches. Americans consume 20,000 tons of aspirin each year. Our challenge as chiropractors is to teach them that medication not a cure for pain; it often makes matters worse.
According to research appearing in the July 27, 1998 issue of the American Journal of Medicine, “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nosteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under appreciated”
Other research links pain medications to high blood pressure, kidney failure, heart failure, ulceration of the GI tract, and some drugs even interfere with bone repair. In the July 23, 1996 Archives of Internal Medicine, it states that in nearly 2,000 arthritic patients studied, ulcer risk increased 10-fold. It also stated that almost 25% of NSAID users have ulcers, most of which are without symptoms.
NSAID use perpetuates the very problem that it is designed to treat. NSAIDs actually increase the body’s oxidative stress—leading to further inflammation. Research articles appearing in the journals Pharmacological Research Communications and the Lancet have demonstrated that NSAIDs interfere with the formation of cartilage. So someone with arthritis who takes these drugs is trading short-term relief for long-term degeneration.
One thing many arthritis sufferers have done is to take glucosamine sulfate or chondroitan sulfate products to help to restore cartilage. Studies have shown that these products have some promise in helping arthritis sufferers. There are several research articles supporting the use of these products. Patients suffering from arthritis in the knee experienced relief ( Drugs Aging. 2003; 20(14):1041-60 (ISSN: 1170-229X)). The researchers concluded, “In short-term clinical trials, glucosamine provided effective symptomatic relief for patients with osteoarthritis of the knee. In addition, glucosamine has shown promising results in modifying the progression of arthritis over a 3-year period. Glucosamine may therefore prove to be a useful treatment option for osteoarthritis.” The Journal of the American Medical Association (2000; 283(11):1469-75) acknowledged that these supplements may be of benefit to arthritis sufferers.
Patients hear about research like this, and their tendency is to go out and buy glucosamine supplements and to take them in place of the NSAIDs. Many scientific studies take this approach. One group will take a drug and the other group will take glucosamine or chondroitan supplements. Generally, in the beginning of the study, the people taking the drug will feel better than the group taking the supplements, but as time progresses, the group taking the supplements do better. This should be obvious, because the supplements help to repair cartilage and the drugs destroy it. The drugs also undermine the body’s general health and make it more prone to inflammation—short term relief turns into long term degeneration.
Knowing about these studies will get patients used to the idea that natural substances may be valuable in helping to get rid of pain. With a little luck and explanation they will not run out and buy supplements to use in place of medication. We want them to start thinking more holistically. In order to make natural health care really effective, patients must change how they think of pain.
Various herbs, like ginger, willow bark or curcumin are anti-inflammatory. Taking herbs can indeed help reduce pain and inflammation, the glucosamine and chondroitan supplements can help with joint repair. The problem, people want to use these things like they are drugs—addressing symptoms.
Chiropractic and nutrition improve the body’s infrastructure. When patients understand that, you can get very good results. Combine chiropractic care with nutrition to improve the general health of the patient—healthy bodies don’t hurt. Improving health in general, will mean less pain for your patient. While herbs and other supplements can help reduce pain and inflammation, they can be much more effective if you pay attention to diet and lifestyle. They are not substitutes for pain medication.
There is research to support the importance of diet and exercise. How you live and what you eat really does have an effect on how much pain you feel. Eating a diet that is high in fresh fruit and vegetables will decrease your pain and inflammation. Researchers at the University of Athens Medical School found that people who ate the highest amount of cooked vegetables had a 75% lesser risk of developing rheumatoid arthritis, in a study published in the American Journal of Clinical Nutrition. The Journal of the American Medical Association has published research that a diet high in vegetables and olive oil—the so called “Mediterranean Diet” helps to reduce pain and inflammation.
There is a lot of research showing that omega-3 fatty acids reduce inflammation. A combination of fish oil and vitamin E reduced the levels of cytokines (pro-inflammatory proteins that cause the joint swelling, pain and tenderness) in mice. Fish oil, in general is anti-inflammatory. Dr Richard Sperling, found in his research that fish oil may reduce inflammatory substances produced by white blood cells. Professor Caterson and other Scientists at Cardiff University (Wales, UK) have found that the Omega-3 fatty acids in cod liver oil work by inhibiting enzymes that break down joint cartilage. A study in Journal of Nutrition(1991;121:547-555), found that cytokine production was reduced in women taking omega-3 fatty acids. Fish oil was shown to benefit rheumatoid patients according to research published in Nutrition (2005;21:131-136).
Along with their chiropractic care, patients should be consuming a lot of fresh fruit and vegetables, and omega-3 fatty acids, like those found in fish oil. They also need to avoid foods that promote pain and inflammation. High fat and high sugar diets promote inflammation, according to research appearing in the American Journal of Clinical Nutrition. Even the Journal of the American Medical Association has published research that says a low-sugar diet reduces pain and inflammation.
We always talk about chiropractic addressing the cause of pain. We need to add nutritional strategies and exercise to make our therapy more effective.