Stroked, Poked and Hypnotized in the Search for Relief

By DONNA WILKINSON
The New York Times
June 23, 2002

OT long ago, the idea of treating pain with acupuncture or hypnosis would have raised many an eyebrow within the medical mainstream. But now a growing number of hospitals are offering patients alternative or complementary therapies, combined with traditional medicine.

A big reason for the trend is consumer demand. A 1997 Harvard study reported that Americans made 629 million visits to alternative practitioners compared with 386 million visits to primary care doctors, spending $27 billion (a good part of it out of pocket) on alternative treatments.

Attitudes are also changing. Though nontraditional medicine has many skeptics, some techniques have gained credence among pain specialists. Dr. Daniel Handel, a clinician at the Pain and Palliative Medicine Service at the National Institutes of Health in Bethesda, Md., uses biofeedback, hypnosis, acupuncture and other techniques to aid patients on drug protocols.

"If what you do shows efficacy —even at a place like the N.I.H., which everyone would think would be conservative —doctors will embrace it," Dr. Handel said.

Pain specialists emphasize that treatments are used as complements to, not substitutes for, traditional medicine. In fact, they prefer to call them just that: "complementary" or "integrative," rather than "alternative." "Alternative therapies, particularly in cancer, are offered as alternatives to mainstream care, and complementary therapies are used along with mainstream care," said Dr. Barrie Cassileth, the chief of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in Manhattan, which offers acupuncture and guided imagery, among other therapies.

Proponents say complementary techniques, particularly mind-body therapies, offer many benefits: they are not invasive and have no side-effects. And they tap into the healing power of the mind.

"We know from a significant body of research going back many years that we can use our minds to control pain," said Dr. James S. Gordon, the chief of the White House Commission on Complementary and Alternative Medicine Policy, which did a study on nontraditional medicine.

Complementary experts say some therapies promote relaxation, which can be beneficial in healing. "The kinds of pain management techniques we offer frequently reduce the amount of pain medication that patients need to take," Dr. Cassileth said.

The fact that patients can use many techniques on their own can give them a sense of control. "One of the problems of pain is that you feel helpless and dependent on doctors and medication," Dr. Gordon said. "When people understand that they can do something to make a difference, it's the beginning of making a difference."

Here are some complementary techniques being offered in hospitals:

HYPNOSIS A mind-body technique in which the patient becomes deeply relaxed; in this state the power of suggestion is used to ease symptoms of pain. Applications: acute and chronic pain, cancer pain, nausea, asthma, irritable bowel syndrome. "The key component in hypnosis seems to be the ability to focus and separate from your environment and self," Dr. Handel said. "In that state, you can attain significant psycho-physiologic changes."

BIOFEEDBACK A mind-body technique that uses sensors to measure physiological functions like muscle tension or gastrointestinal activity; as patients watch the "feedback" on a monitor, they become aware of how their bodies respond and learn how to control that response. Applications: headaches, chronic pain, irritable bowel syndrome. "You learn how to make a change even when you're not in front of the machine," Dr. Handel said.

ACUPUNCTURE According to this ancient Chinese technique, each person has an energy force called Qi (pronounced chee), which travels through channels in the body. Pain or illness results when channels become blocked. To restore flow, fine needles are inserted at specific points on the skin's surface. Applications: postoperative and chemotherapy nausea, dental pain, headaches, myofascial pain, osteoarthritis, back pain, carpal tunnel syndrome. A 1997 N.I.H. study suggests that acupuncture releases pain-relieving endorphins.

MASSAGE THERAPY Complementary care uses variations of touch, from gentle stroking to deep tissue manipulation. The most common technique is Swedish massage, in which the muscles are stroked or kneaded with varying amounts of pressure. Applications: muscle pain, acute and chronic pain. "Massage in general creates a state of relaxation, which may help to relieve many types of pain," Dr. Gordon said.

RELAXATION THERAPY Complementary techniques include guided imagery, a form of self-hypnosis in which the patient visualizes positive images to ease pain; progressive muscle relaxation, in which the patient tenses, holds and then releases muscle groups; and meditation, in which the patient tries to clear the mind by focusing on a word or sound. Applications: chronic pain, cancer-related pain and nausea. "You can use your mind to affect your experience of pain in a very significant way," Dr. Gordon said.