Complementary therapy for pain – worth a try?

It seems to be a growing trend in the UK - seeing an osteopath or acupuncture specialist to treat chronic pain.

By recent estimates, half of Brits are affected by chronic pain, with low back pain alone costing £5 billion a year in terms of treatment and sick days taken.

So why are people turning to complementary therapy? And can it live up to the promises it makes?

Complementary therapy in the UK

In addition to the selected conventional approaches of contemporary medicine, complementary therapy includes a wide range of treatments, some of which are so well-established it's easy to mistake them as mainstream treatment. The most popular treatments are herbal medicine, acupuncture, aromatherapy, and homeopathy, as well as manual therapy such as osteopathy and chiropractic.

Although these all come under the banner of "complementary therapy" in reality there's a huge variation in the evidence base for these treatments, the risks involved, and their acceptance by health professionals.

For example, while the NHS has pulled funding for homeopathic hospitals in London, an increasing number of NHS trusts are setting up "pain clinics" which offer complementary treatments such as manual therapy and acupuncture in addition to conventional treatments such as medication and physiotherapy.

So why are some health professionals embracing complementary therapy for pain management?

"In a large number of subjects…the outcome of conventional therapy is not satisfactory since most standard therapies for pain frequently pose adverse effects, particularly in older patients" says Dr Dhiya Houssien, a rheumatologist practicing at 10 Harley Street and the London Osteoporosis Centre.

“Patients with connective tissue diseases such as rheumatoid arthritis usually have been treated by anti-inflammatory medications and painkillers such as NSAIDs. These are to offer temporary pain relief during a flare-up while waiting for DMARDs medication such as methotrexate to start or to take effect.”

“Non-steroidal anti-inflammatory drugs (NSAIDs) increase risk of gastrointestinal bleeds and affect the renal, cardiovascular and central nervous systems. Furthermore, NSAIDs and Opioid analgesics aren't used to stop the disease's progression, and even cause side effects and carry a greater risk of addiction. Therefore, a natural approach for pain relief (management) is becoming more popular to avoid the side effects of NASIDs.”

Overall, many health professional view complementary treatments as a way to enhance their care and improve their symptoms of pain.

Do complementary therapies work?

For a treatment or drug to be widely accepted by the health professional community and officially licensed for use in the NHS, it has to pass a rigorous procedure of clinical trials with a large number of participants.

Some complementary therapies don’t have this evidence base, so the evidence that they work is weaker. In some cases, the treatment in question is difficult to test systematically because it’s designed to be customised to the patient. In other cases, evidence is growing – there’s just not enough of it yet.

Still, it’s worth researching what evidence does exist. For example, it’s important to check if there’s evidence that the treatment works for your condition – it’s very unlikely a treatment can cure everything.

And there’s a big difference between a lack of evidence that a therapy does work, and an abundance of evidence that it doesn’t work or causes deterioration.

Are complementary therapies safe?

It depends on the particular treatment. Arthritis Research UK have written a useful report which rates the safety of a wide range of complementary treatments on a scale from 1 to 5.

In a lot of cases, it also depends on what condition you have. For example, if you have a lung condition, rheumatoid arthritis, or a recent fracture, manual therapy might not be safe.

Always check with your GP before trying out complementary therapy – they’ll be able to give you advice on what is and isn’t suitable for you.

How do I find the right practitioner?

Practitioners of complementary therapy are not regulated in the same way as health professionals. Only chiropractors and osteopaths are required to be part of a national council (the General Chiropractic Council and the General Osteopathic Council respectively). Other fields of complementary therapy have voluntary membership councils.

Generally speaking, it’s better if a practitioner is part of a national association – and even better if they also practice conventional medicine. That way, they can advise you on any interactions between the treatment you’re getting for your condition and the complementary therapy that you’re considering.

A good example of best practice is Dr Dhiya Houssien, who in addition to his rheumatology practice, has pioneered a complementary treatment known as low-level laser acupuncture therapy for chronic pain. This involves the stimulation of traditional acupuncture points with low-intensity, laser irradiation (LLLT).

Dr Houssien explained to us how the treatment works: “Laser acupuncture affects the function of connective-tissue cells called fibroblasts and increases the production of natural substances such as endorphin which decreases the pain and Serotonin which decreases the muscle spasm”

Dr Houssien’s treatment is based on a number of studies which report significant pain reduction following LLLT sessions in various neurological and musculoskeletal disorders. With 20 years of experience as a consultant rheumatologist, his decision to offer the treatment is based on a clear understanding of the limits of what conventional medicine can achieve, and he is in a position to provide expert advice on any risks involved in choosing complementary therapies. Dr Houssein offers the therapy in conjunction with anti-inflammatory drugs, and in this way aims to combine the best of conventional and complementary medicine.

Summary – top tips on choosing complementary therapy

• Speak to your GP or specialist if you’re considering complementary treatment and find out if there are any treatments that aren’t suitable for you
• Research your options. The Arthritis Research UK report is a good place to start, and it’s also worth checking out this guide from the National Osteoporosis society . Finally, NHS choices provides good information on the evidence base behind different for of complementary therapy.
• Research local practitioners. Check if they’re registered with a national professional membership association. Ideally, find a Top Doctor who also practises complementary treatments.