Oh, my aching... back, neck, leg, knees, elbows

By Ann Tatko-Peterson, STAFF WRITER
Inside Bay Area
Article Last Updated:09/10/2007 04:06:16 AM PDT

THE FLASHES of pain sound strikingly similar.
Allie Steele's knees hurt when she gets out of bed. Steven Nicks' throb when he stocks shelves at a grocery store and rides his bike competitively. Peter Michaelis' act up when the weather is cold.

The pain may be the same, but the reasons for it and the treatments differ.

Steele has osteoarthritis and recently began receiving medication by injection.

Nicks is healing from an overuse sports injury and finds acupuncture helps most. Michaelis blames age (he's 72), and usually a dose of ibuprofen and a topical cream do the trick.

An estimated 85million Americans report having some form of arthritis (joint disease), osteoporosis (bone disease) or serious muscle pain. And it's those people who fuel a billion-dollar pharmaceutical industry and have helped alternative treatments become more mainstream.

The real dilemma is deciding what works for the everyday aches and pains and knowing when to ask for help.

Just look at what's available over the counter for pain relief: 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, a rheumatologist at Sutter East Bay Medical Foundation in Orinda. "What may work for one person won't necessarily work as effectively for someone else."

Scientific guidance

Science can help a little with the decision-making process:

Capsaicin: Derived from ground chile pepper, this ingredient in some topical treatments delivers more than just a burning sensation. It decreases substance P, a neurochemical that transmits pain messages, to help desensitize a person to pain.

The downside? "It burns," says Dr. Melissa McNamara, a rheumatologist at the Arthritis and Rheumatology Center in San Ramon. "You should wear latex gloves when applying it because if you rub it on other places, it can cause great discomfort."

Menthol and methyl salicylate: Found in topical treatments such as BenGay and Icy Hot, these are counter-irritants. "They work to distract you," Kaye says. "For example, if you have a headache 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-counter brands have proven track records. McNamara suggests patients with liver problems should avoid acetaminophen (Tylenol), and those with kidney problems should not take the nonsteroidal anti-inflammatories naproxen (Aleve) or ibuprofen (Advil or Motrin).

Supplements: The jury is still out. In her own clinical studies, McNamara found benefits in glucosamine for osteoarthritis patients.

Studies indicate that fish oil and Omega-3 fatty acids may have anti-inflammatory gains as well. Dr. Christy Sandborg, head of Pediatric Rheumatology at Lucile Packard Children's Hospital at Stanford Medical Center, recommends her juvenile arthritis patients eat salmon.

"The reality is that those may work somewhat for patients with mild cases of arthritis," Sandborg says, "but for the more aggressive joint pain, they won't be adequate."

Doctor's call

When joints are swollen, red or warm, and stiffness lasts an hour or more, Kaye says, it's time to call a doctor.

In children, Sandborg says, it's time to call the pediatrician when pain appears during the day and is accompanied by swelling or limping. Muscle imbalance, once known as growing pains, usually occurs at night and responds to pain relievers or massage.

And all three rheumatologists agree, leaving arthritis untreated can cause serious and irreparable damage to the joints.

"Take rheumatoid arthritis," McNamara says. "Even if you bear through the pain, ultimately you might be hurting yourself by not treating the underlying inflammation."

Doctors have access to numerous treatment options, ranging from high doses of anti-inflammatory and opioid pain medications (such as Tylenol with codeine) to injectables and infusions.

Cortisone shots remain effective in decreasing inflammation confined to a specific joint, McNamara says: "It cools things off."

For more widespread joint pain, infusions such as Remicade may help.

Few treatments worked on Steele's osteoarthritis until her doctor tried OrthoVisc, an injectable hyaluronic acid that lubricates the knee and cushions the joint.

"I can bend my knee again without feeling like it's going to snap in half," Steele says.

Finding what works

Not everyone wants to try traditional medication.

In recent years, some prescription medicines (Vioxx, Celebrex and Bextra) raised concerns ranging from cardiac problems to life-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 being covered up. The inflammation is just being suppressed," Puertas says. "Natural forms of medicine are different. These put you on the road to healing."

Scientific studies have shown acupuncture can work for arthritis patients. The traditional Chinese technique involves unblocking chi (natural energy) by inserting thin needles in specific points of the body.

But, as Puertas explains, the treatment goes further, with a practitioner analyzing a patient's health history and habits, such as sleep and diet. For patients who suspect they have arthritis, chiropractors take X-rays and MRIs to reach a diagnosis.

Massage therapy also may help relieve pain, although it won't treat arthritis. But Jordan Rothstein, a certified massage therapist in Berkeley, cautions against self-diagnosing.

"A lot of people think they have arthritis and it turns out they don't," Rothstein says. "I always ask, 'Who told you that? A friend? Did you read it in a magazine?'"

Rothstein deals with a lot of false assumptions, which is why he conducts individualized assessments.

"I try to understand why a person is hurting," he says. "It's not simply a matter of hurts here, rub there. A lot of pain originates in the muscles. Someone can't necessarily tell from the feel of the pain what's causing it."

Other alternative treatments include chiropractic, which involves adjusting segments of the spinal column; hypnosis; herbal remedies; meditation; and hydrotherapy, which involves water exercises.

As with traditional medicine, finding what works means experimenting.

"When you're hurting, you'll try just about anything," says Nicks, an Oakland resident who uses acupuncture to treat his overuse injury. "Sometimes what you least expect works."