Alternative treatments to painkillers making inroads
By Michael Boylan, Cronkite News | Friday, Dec. 30, 2016
PHOENIX – Joyce Rash, who lives in Canada but spends her winters in Arizona, was using muscle relaxers and traditional physical therapy to help with her leg pain, but they weren’t working.
“The muscles in my leg were so tight I could hardly walk,” Rash said. “I was walking with a cane. I was seeing this physiotherapist and I had just tried everything.”
When traditional means of pain management didn’t work for her. Rash decided to try an alternate treatment for her pain – dry needling. She said the results were immediate.
“I got up off that bed and I walked out of there and I didn’t have to use the cane,” Rash said.
Along with dry needling, other alternative treatments like cryotherapy and cold-light laser (or low-level laser) therapy have become more widely used over the past few years.
Alternative treatments may unnerve some, but Rash said at a certain point nothing is worse than the pain she was feeling.
“I am a big chicken when it comes to needles, so I really don’t know why I wanted it so badly,” Rash said. “I was just desperate. I had tried everything and nothing was really working.”
Dry needling involves a physical therapist sticking a fine filament needle into a specific spot in a muscle that is causing pain.
“When I strike the restricted area or the trigger point, the muscle will actually twitch and it will release, and that’s where we get the immediacy of the impact of the treatment,” said Doug Howard, clinical director at the Arrowhead location of Foothills Sports Medicine Physical Therapy.
“It restores your functional activity through means of releasing myofascial restrictions, restoring joint mobility and ultimately getting back to function.”
Research is mixed about the effectiveness of these alternative treatments.
In 2013 the Arizona Physical Therapy Association recognized “that dry needling for the management of neuromusculoskeletal conditions is consistent with the scope of practice of licensed physical therapists in Arizona.”
It was the first physical therapy association based in the United States to recognize the efficacy of dry needling, and several other state associations have since joined Arizona.
A 2016 study in the Journal of Thermal Biology found that cryotherapy could have positive effects, but because of a lack of standardization in procedures and temperatures and differences in technologies, it’s difficult to get consistent results throughout.
There are similar issues when it comes to laser therapy. A 2014 review of laser therapy studies in Frontiers in Physiology showed that positive effects could be found for laser use with chronic pain, but a lack of standardization makes interpreting the benefits difficult.
Convincing patients to try something new is usually not difficult for professionals who use alternate treatments.
“It’s usually a pretty easy selling point, just the immediate impact that we see with dry needling,” said Howard. “That’s what people want these days. They don’t want to spend time and weeks and months in physical therapy. They want impact.”
After trying it, patients like Rash realize it’s not nearly as intimidating as they expected.
“In your mind, you think it’s going to really hurt, and it doesn’t,” Rash said. “Mostly you don’t really feel the needle go in at all. You just feel your muscle spasm a little and then it relaxes.”
Howard has seen acceptance of dry needling by patients improve the last six years.
“When I first started dry needling, there was a lot more encouragement or my needing to convince someone that this is going to be an effective treatment for them,” Howard said. “At this point, it’s become so popular, especially in this part of the Valley, that I have people coming here seeking the actual treatment.‘’
Cryotherapy, which treats arthritis, chronic degeneration, tendonitis and ankle sprains, among other issues, involves the patient stepping inside a chamber that is then filled with nitrogen gas, lowering the temperature to around -175 degrees Fahrenheit.
“Once they go through one or two treatments, they know what to expect and how cold it actually feels,’’ said Shane Clatterbuck, director of the Scottsdale location for Endurance Rehab. “The majority of people think it feels like it’s going to be a lot colder than what it really is.”
The goal is to decrease inflammation and swelling in the body.
Cold light laser therapy involves the use of a laser applied to the specific area of need.
“Cold light laser really is a treatment of using laser to interact with the cellular membrane,” said Dr. Chris Serafini, chiropractor at Valley Spinal Care-Kierland. “What that’s going to do is increase ATP production of the cell, which is going to rapidly increase the power of the cell.”
Added Dr. Carson Robertson, chiropractor at Alpha Chiropractic & Physical Therapy: “It’s going to trigger receptors in the body. Different receptors do different things. We can turn systems on or turn systems off. It can activate different sensors in the body to shut off those pain signals that are traveling to the brain.”
Most agreed their alternate pain management technique is a better option than taking medication.
“Certainly the first reason is you don’t have to take any pain medication,” Howard said. “I can reach the actual restriction in the fibrous tissue to release it and provide pain relief and improved mobility instantaneously.”
Clatterbuck prefers cryotherapy because “whenever you can alter the pain response without having to externally intake any sort of drug or pathogen that will change your chemistry, you’re only going to come out more beneficial in the long term. A lot of the pain medications don’t offer good long-term results because there’s some underlying factor creating the pain.”
Serafini said cold laser therapy is an excellent alternative because it’s noninvasive. “Even if you have a cast on or something like that, you don’t have to take it off or anything like that, goes right through. Right through clothing.”
Robertson, however, said there may be times when medication might be necessary.
“There’s a time and place for everything,” Robertson said. “There are times you really need a pain med because it’s the big hammer to knock things down.”
Laser therapy allows for a treatment that only affects one area.
“With laser, you’re very focused,” Robertson said. “You’re just in the treatment area. You’re affecting that zone; you’re not going to affect the other systems in the body.”
Rash said she still takes a muscle relaxer when needed, but much less than before dry needling.
“In Canada we can buy muscle relaxers over the counter, and I was on a constant thing of those,” Rash said. “But, in the last three days, I’ve only taken two muscle relaxers and that’s it. Way less.”
Rash is happy she sought an alternate treatment. Without dry needling, she said she’d be a different person today.
“It’s like night and day for me. I know without it, I would’ve probably been walking with a cane for 10 years.”