Alternative Therapies For Chronic Pain
Many of my colleagues have voiced concerns regarding the use of nutriceuticals in their practices. The expressed concerns range from “These things are unproven” and “There is no FDA scrutiny over these products” to “They don’t work all the time” and “There are no scientific, double-blind, placebo-controlled studies on their safety or effectiveness.”
I had many of the same doubts before I incorporated nutriceuticals into my practice over 12 years ago. Since my training in podiatry school was allopathic in nature, it was difficult for me to assimilate a new medical model and an integrative approach to the treatment of disease.
However, during my training at the National College of Naturopathic Medicine, I discovered the scientific basis for the use of many nutriceuticals. Indeed, there were numerous double-blind, placebo-controlled studies involving many nutriceuticals.
I also learned that all nutriceutical manufacturers are not alike. There are now several nutriceutical companies in the United States that have voluntarily submitted to credentialing as a Good Manufacturing Practice (GMP) facility with rigorous standard operating procedures. Many of those ethical companies import nutriceuticals from counties like Germany, Japan, Sweden and Italy, where nutriceuticals are made in licensed pharmaceutical manufacturing plants. Some of these nutriceutical products are prescriptions in those countries.
When it comes to treating chronic joint and neuromuscular pain, there are nutriceutical treatment options. Some of these options are offered in combination products and are available from GMP-certified manufacturers. In regard to high-quality nutriceuticals that have evidence-based studies to back them up, I rely on companies like Integrative Therapeutics, Inc. and Mediplex, a California-based company that sells to healthcare practitioners only. These products are conveniently available by phone order and one may dispense them directly from the office.
In light of the emerging research about the adverse reaction profiles of NSAIDs (see “A Closer Look At The Risks Of NSAIDs And Other Therapies” below), clinicians who have diagnosed an arthritic condition should consider the use of nutriceuticals to help restore joint health and function, and relieve pain. In light of the adverse reaction profiles of NSAIDs, the podiatrist needs to explore the use of integrated therapies that have proven clinical results with minimal to no adverse reactions.
Accordingly, let us take a closer look at the following nutriceutical therapies.
Assessing The Merits Of Botanical-Based Extracts For Joint Pain
I have used botanical-based extracts in combination to help treat joint pain. These extracts include Turmeric, Boswellia serrata, ginger extract and white willow bark extract.
Researchers have shown that Turmeric (curcumin) has potent antiinflammatory activities with specific lipoxygenase and COX-2-inhibiting properties including cytokines (TNF alpha and IL-1 beta).3 Curcuminoids also suppress super oxide anions and inhibit lipid peroxidation.3,4 The appropriate dosage for curcuminoids ranges from 200 to 500 mg qid.
An in vitro study of Boswellia (also known as frankincense) demonstrated a marked inhibitory effect on both the classical and alternate complement systems.5 These researchers also found that Boswellia, in a dose-dependent manner, blocks the synthesis of pro-inflammatory, 5-lipoxygenase including leukotriene B4 LTB4. A randomized double blind study found Boswellia to be effective in treating osteoarthritis of the knee.6 The appropriate dosage for Boswellia is 300 mg tid.