Alternative Approaches to the Treatment of Chronic Pain

In the 2-part series, “Chronic Pain Syndromes: How to Break the Cycle” by David A. Provenzano, MD, and Morris Levin, MD (CONSULTANT, April 1, 2008, page 297, and April 15, 2008, page 371), greater emphasis should have been given to physical therapy. As an osteopathic family physician, I have found manipulative medicine to be effective in many patients with chronic pain.

For example, I recently treated a 35-year-old woman with chronic pain in the upper right back that had been present for several weeks. She was also depressed and had not been sleeping well. I was able to locate the trigger point of her pain; I massaged the area (called “soft tissue relaxing”) and then performed a corrective manipulation. The patient called me the next morning to report that she had slept through the night and had no pain.

- Wilbur T. Hill, DO
    Liberty, Mo

Physical therapy is a valuable option for patients who have chronic pain. In our discussion of the treatment of osteoarthritis, we mentioned the importance of referring patients for physical therapy. We also discussed physical therapy for the management of lumbar radiculopathy. Although we did not devote a great deal of space to discussion of physical therapy options for the specific pain conditions, I do believe that this is an extremely important part of the multidisciplinary approach to treating chronic pain.

- David A. Provenzano, MD
     Medical Director
     Pain Treatment Center
     Ohio Valley General Hospital
     Kennedy Township
     McKees Rocks, Pa

I was disappointed that acupuncture was not included in the otherwise fine 2-part article on chronic pain syndromes by Drs Provenzano and Levin. As a practicing medical acupuncturist, I have successfully treated many patients with the conditions mentioned, including those with negative surgical outcomes. I would urge health care providers to consider referring patients who have either acute or chronic pain syndromes for treatment with acupuncture, especially when traditional modalities have had limited success.

-Lawrence Linett, MD
    Wilmington, NC

I agree with you that options may be limited for patients who have not achieved pain reduction with conventional management. However, there is insufficient long-term evidence of the efficacy of acupuncture for chronic nonmalignant pain to fully endorse this treatment. Some observational studies have shown that acupuncture is effective in relieving certain painful conditions; however, for low back pain and osteoarthritis, well-designed sham control trials are needed to determine the effect of this modality on specific clinical outcomes, including resumption of normal daily activities. Most of the data suggest that the efficacy of acupuncture is only short-lasting. I look forward to seeing well-designed studies that address the validity of this treatment.

-David A. Provenzano, MD