Guest guest Posted December 30, 2005 Report Share Posted December 30, 2005 Alternative Therapies for Arthritis http://www.healthology.com/webcast_transcript.asp?f=arthritis & c=bodyaches_alternativearth & spg=MTIHosted By: David R. Marks, MD, WNBC, New York Participants:Ifeoma Okoronkwo, MD - New York University School of MedicineAllan Gibofsky, MD, JD - New York Presbyterian-Weill Cornell Hospital Webcast Transcript: Recorded Live: June 8 2000 DAVID MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. Alternative or complementary medicine has become increasingly popular over the last few years, especially in the treatment of arthritis. What are these alternative therapies, and do they work? Joining us to answer these questions is Dr. Allan Gibofsky. He is Professor of Medicine and Public Health at Cornell, and a Rheumatologist at the Hospital for Special Surgery. Welcome. Next to him is Dr. Ifeoma Okoronkwo, or Dr. O., who is Clinical Instructor at NYU School of Medicine and is an attending physician at the Rusk Institute. Thanks for being here. What are the different types of alternative therapy that we have to deal with? IFEOMA OKORONKWO, MD: Well, there is really a broad spectrum of therapies and interventions. One could look at it as that there are mechanical interventions and there are non-mechanical interventions. Some of the more common mechanical interventions would be acupuncture, massage therapy, chiropractic. More esoteric ones would be healing touch, Reiki, etc. Some of the non-mechanical interventions include some of the oral modalities and medicines, such as herbs. Glucosamine is a very common vitamin or supplement. And also magnets. DAVID MARKS, MD: Let's talk about acupuncture to start. Does it work? IFEOMA OKORONKWO, MD: Yes it does. Every day I'm increasingly surprised as to how well it works, particularly to address pain issues and arthritis pain. As you may or may not know, acupuncture is a very old tradition, over 2,500 years old. It's roots lay in a philosophy based on Taoism. Taoism says, briefly, that we are one with nature. As one, as a unit, when there is a pathology or pathologic factor inside us or even outside of us, grief, trauma, this can translate into imbalance in that unity. Acupuncture seeks to diagnose the imbalance, and through stimulation of various points in the body, heals that imbalance. DAVID MARKS, MD: A lot of people, I think, may have the impression that acupuncture hurts because they are being stuck with needles. IFEOMA OKORONKWO, MD: I do have some tools here. I will say that no it doesn't hurt, but you do feel it. There is a sensation that we call "chi" that upon insertion of a needle into an acu-point, you feel the initial little prick. It's negligible for most. But then you feel a sensation, and that sensation can range anywhere from a warmth, an electricity, even an achy-ness. But ultimately, people feel this almost elation, and somewhat of a surprise based on the stimulation of that point, particularly important points to the Chinese diagnosis. ALLAN GIBOFSKY, MD: Quite frankly, the insertion of a acupuncture needle at the appropriate point or appropriate meridian, as I'm sure Dr. O. will teach us, really has no pain at all. I've had acupuncture performed on me. I would tell you that as an appropriate analgesic it worked. As an anesthetic it worked. There is also the use of acupuncture to change various behavioral habits, such as smoking and nail biting. In a number of instances, it works as well. The fact that we may not know exactly how it works is less important than the fact that in many people it does work. There have been control trial again and again that demonstrate clear advantages to appropriately performed acupuncture when compared to sham techniques. So I think we need to be exceptionally open minded to the use of this skill in our patients with painful conditions and debilitating conditions. DAVID MARKS, MD: When should it be used in arthritis? ALLAN GIBOFSKY, MD: I think that acupuncture is part of a physician's armamentarium and should be use, not instead of, but together with the various other modalities available such as physical therapy and medication. In some instances in my experience, patients who are receiving appropriate acupuncture therapy have been able to lessen their use of pain medications and other medications which have side effects. Dr. O., would you agree? IFEOMA OKORONKWO, MD: Indeed. In fact, that's exactly how we use it at NYU, where it is an integrative medicine rather than an alternative medicine to the traditional approaches. Particularly with analgesia or pain, the literature is very strong in the uses of acupuncture to address these pain syndromes. Where it has been shown that certain factors are released in the bloodstream, factors which mimic the effects of morphine, which is a opioid. In the brain. One study even showed that the effects of acupuncture analgesia or pain control are reversed by the same medicines that reverse the effects of morphine. That was a very important study, and brought acupuncture really to the forefront, in some ways, for traditional physicians to use it as a complement or as a form of medicine in their practice. DAVID MARKS, MD: Why don't you very quickly show us what you brought and tell us how it's used. IFEOMA OKORONKWO, MD: Indeed, Allan mentioned the use of acupuncture for some additions; not just drug addiction or nicotine addiction, i.e., smoke cessation, but also for weight loss. Some of the tools that we use for that might be these tiny little needles, which are millimeters in length, placed in the ear. That's called auricular or ear acupuncture. Oftentimes combined with this, we might use electrical stimulation to the acu-points, known as electrical acupuncture. This device, you can have various intensities of electricity to stimulate the points. So you have to be very careful. Acupuncture is not a benign intervention. Believe it or not, people can get worse. So you have to really integrate the Chinese tradition with the traditional medicine to get effective results. DAVID MARKS, MD: What about the glass jars that you have? IFEOMA OKORONKWO, MD: Well, I brought these really to show that there are even esoteric methods. These are cups. We can use a method of cupping also in acupuncture. While this is not puncturing the skin, it is stimulating along the meridian. These are, again, used as all needling techniques, based on the Chinese medicine diagnosis. I said that term a lot, but I go back to concept of imbalance. When we see a patient, we find out what their imbalance is, and based on that imbalance, we then proceed with our diagnosis and our intervention. DAVID MARKS, MD: Let's move on to chiropractic. How good is that for arthritis? Is there a place for it? ALLAN GIBOFSKY, MD: There is a place for it. Again, the word arthritis needs to be recognized as a word that has a broad use in common discussion. The word arthritis is like the word automobile; what make, what model, what color, what options. There are various kinds of arthritis that lend themselves very nicely to massage and adjustment. I think to the extent that massage and adjustment are provided by skilled chiropractors who recognize the limitations on the joints, and the limitations and differences between exercise and rest, a chiropractor can be quite helpful, particularly in those forms of arthritis that are caused by overuse resulting in degeneration. DAVID MARKS, MD: There is some controversy about chiropractic care amongst the medical community, correct? ALLAN GIBOFSKY, MD: There is a great deal of controversy. I'll defer to Dr. O. in terms of her opinion as well, but it usually arises out of the use of any modality beyond its indication. When it comes to the treatment of musculoskeletal conditions by manipulation and dealing with the manipulation of the parts of the body, I believe chiropractics is an appropriate adjunct. But when some go to claims about the use of chiropracty in stimulating insulin release or the use of chiropracty in stimulating hormone release, I think that's where we're looking more for evidence to demonstrate its efficacy. Dr. O., your feeling? IFEOMA OKORONKWO, MD: Indeed, I agree. I think that's actually very well said. It's important, once again, to use your physician as springboard to integrate these alternative forms into their practice. For example, in many arthritic forms, the joints are unstable and chiropractic manipulation can frankly be quite dangerous. So it is really at the approval, so to speak, and agreement as a team between the physician and the patient that you should embark on some of these other therapies. Chiropractic, as Allan mentioned, does use the concept of manipulation to stimulate the nerves and align the body. It is said to release muscle tension, increase blood flow at times. DAVID MARKS, MD: And that leads to massage; talking about stimulating blood flow. Is that how it works for arthritis? IFEOMA OKORONKWO, MD: Well, how does it work is an interesting concept. That is certainly the theory. The deep massage of the tissues in various ways - I say deep massage, but that's only one approach. You can have gentle massage that can also, according to massage therapists, lead to a good therapeutic result. But yes, the increase in blood flow, the drainage of lymphatic system is all sort of said to be part of the efficacy of massage therapy. ALLAN GIBOFSKY, MD: An integral part to all of the therapies and probably one of the factors involved in their success is the fact that in all of the things that we have been talking about so far, the physician puts her hands on the patient. There is no substitute for putting your hand on the patient and reassuring the patient with your compassion, with your concern, with the gentleness of your touch that you're going to be personally involved in her care. To the extent that chiropracty does this, it is part of the efficacy. To the extent that massage does this, it is part of the efficacy. There are other reason that these things work, but I believe that part of the reasons that they work is because we're putting the hands of the healer on the patient. DAVID MARKS, MD: We've been talking really about some of the mechanical treatments. Let's move on to some of the non-mechanical ones. Glucosamine is very hot these days. What's the glucosamine story? ALLAN GIBOFSKY, MD: Glucosamine is a substance that is ingested, sometimes by itself and sometimes with another substance called chondroitin. These are substances, which either by themselves or together or as alternative forms, may be present in cartilage or other structures of the body. The theory is that ingestion of these substances somehow gets to the site of damage and helps repair it. I think that there are some studies which are suggestive and promising about the ingestion of these, as well as other kinds of what we refer to as nutriceuticals, may play a beneficial role in the treatment of patients with arthritis. DAVID MARKS, MD: I detect some hedging there. ALLAN GIBOFSKY, MD: That's why I use the word "now." What I was getting to is the fact that there is also a well-known phenomenon in medicine called the placebo effect. A certain percentage of the time when you do nothing to a patient but give them a sugar pill, they will respond to it. So I think what we need are very carefully designed studies to demonstrate the efficacy of these substances over a placebo, over a sugar pill, in studies where neither the patient nor the doctor knows what it is that is being given. Until sufficient numbers of what we call double-blind studies are done, one has to treat the anecdotes that we hear with a healthy degree of skepticism. I'm not saying that they don't work, but skeptical as to why they do. DAVID MARKS, MD: Dr. O., are there any other vitamins or herbs that can be used for arthritis? IFEOMA OKORONKWO, MD: Allan mentioned chondroitin, which is often combined with glucosamine. Unfortunately, the literature on chondroitin is very limited, and less randomized or even close to being randomized studies have been done. But there, again, may be some efficacy to its usage. All of these medicines are not without side effect. So once again, it's important that you integrate your physician into your decision process as to what you choose to use. Having said that, we as physicians must also remember that, as David Eisenburg (?) showed in his study, up to one third of our patients are using some form of integrative medicine on their own. So it's important for us to ask them what are they using, what are their interests, what are their questions so that we can be part of their decision making process. ALLAN GIBOFSKY, MD: Absolutely critical. I think our patients are asking us and challenging us to learn as much as we can, not just about what we're comfortable with, but also the kinds of things that we may be a little bit uncomfortable with because we're always uncomfortable when we're not knowledgeable. The concept of cupping that we talked about earlier, is not some arcane Eastern philosophy. Cupping was practiced at the time of the American revolution here by such paragons of medicine as Benjamin Rush, one of the signers of the Declaration of Independence. We're just now beginning to reintroduce the kinds of techniques that we abandoned with laughter because we're now learning that they worked. Many of my colleagues who are plastic surgeons have gone back to the use of leeches in patients who have had amputations to parts of their bodies. The leeches will eat away the bad flesh, allowing a better graft of the part that's been severed. So I think we need to be aware of more than just what we've learned, and to continue to learn from our patients, from our colleagues and from others about the newer techniques or the newer applications of the older ones. IFEOMA OKORONKWO, MD: Exactly. One such technique actually is the use of magnet therapy. DAVID MARKS, MD: Does it work? IFEOMA OKORONKWO, MD: Once again, I have to sort of agree with Allan that the trials are out there. They are not as stringent as perhaps we would like, but they are very promising. Magnets do appear, in some cases and in one study in particular, to have relieved some pain associated with what we call neuropathy or nerve ending pain. Anecdotally, people use it for arthritic pain all the time. Patrick Ewing, I think, even used it in a basketball game to help with his elbow pain. DAVID MARKS, MD: But some of these things may work for some people. The story is that we really need to study them further to see really which ones are more effective and which ones aren't. ALLAN GIBOFSKY, MD: And when they do work, or when our patients think they work, as long as they are not harming the patient, we need to keep an open mind. I have patients who ask me, "Should I wear a copper bracelet." My response to them is "Absolutely wear a copper bracelet, and remember to put it on when you're reaching for the medication that I prescribed to you." If a medication is working, fine. But if an integrative therapy - and I really love that word. I'm going to begin using it more and more. If an integrative therapy does no harm - and that's the first rubric of our profession, above all do no harm - we really need to be more open-minded and to encourage our patients to make use of what works for them. DAVID MARKS, MD: Well that's going to be the last word. Thank you both for joining us. And thank you for joining our webcast. I'm Dr. David Marks. Goodbye. © 2005 Healthology, Inc. “New opinions often appear first as jokes and fancies, then as blasphemies and treason, then as questions open to discussion, and finally as established truths.” – George Bernard Shaw. Photos Ring in the New Year with Photo Calendars. Add photos, events, holidays, whatever. Quote Link to comment Share on other sites More sharing options...
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