The Great Med Off 2: Musculoskeletal related pain conditions

In today’s post we are carrying on where we left off last time: trying to compare Chinese Medicine (CM) and Western Medicine (WM), from the point of view of effectiveness of treatment. In this post I am going to discuss a very common group of ailments- musculoskeletal related pain. Musculoskeletal conditions are probably the type of conditions most frequently seen in my Clinic. They are generally very common and are often poorly understood and treated by GPs. Musculoskeletal conditions include any pain that originates from the bones, muscles, ligaments, tendons and joints. Common manifestations are lower/middle/upper back pain, sciatica, neck pain, hip, knee, shoulder and other joints pain. Although there are a lot of different conditions in this category, the general treatment principles for the various Musculoskeletal conditions are pretty much the same (in both Western and in Chinese medicine). We’ll start with Western Medicine.

Generally speaking musculoskeletal related pain is, in my opinion, very poorly understood and treated by WM Doctors. However, in some situations, WM is superior to CM. I’ll try and explain. The WM treatment offered to people in these conditions is the usual sliding scale approach. Let’s take lower back pain as our example. A patient who presents at the GP with this complaint will usually be prescribed a course of painkillers or the so-called anti inflammatory drugs, which are painkillers with a different name. If these don’t achieve the desired results then the next step will be a course of Physiotherapy. Next will be the steroid injection and, if this fails, an operation will usually be offered. This is generally the flowchart with some small variations according to the individual circumstances. Let’s look at it stage by stage.

Stage one: painkillers/anti-inflammatory drugs. The case here is similar to the criminal overuse of antidepressants by GPs. The problem is the same: these medicines do not treat the problems that cause the pain, they only treat the pain itself. The problem here is that since the original condition hasn’t been resolved then the patient will become dependant on their painkillers. The longer the drugs are used the higher the risk of side effects. Possible side effects from the use of anti-inflammatory drugs and painkillers vary from digestive problems to stomach bleeds and kidney failure. Another problem is that after a while the body develops tolerance towards the medicine and its effect lessens. The patient will then need a bigger dose or even another type of medicine (often stronger). It is not unusual for people who struggle with chronic pain to be on two, three, or even four types of medicine to deal with the pain. Of course, the more medicines you take the greater the risk of side effects. I have to clarify here-I am not completely opposed to the use of pain medication. Just as in the case with antidepressants it has its place and should be used in some cases-mainly for short term help and when all else has failed. In any other cases we should surely try and treat the condition with safer and healthier methods and should always aspire to a long term relief whenever possible.

Stage two: If painkillers are found to not be enough then we move to a course of Physiotherapy. Physiotherapy, when it is being done properly, is an important part of effective treatment for musculoskeletal conditions. In the U.K. at the moment, unfortunately, the Physiotherapy available on the NHS is very limited.

Stage three: Steroid injections. A mix of steroids, painkillers and local anaesthetics is injected directly into the painful area. The results are mixed. While in some cases quite a quick reduction in pain can be achieved this tends to be only temporary. Within a few weeks to a few months the pain is often back. The injection can only be repeated two or three times as more than this can start to cause damage to the structure that has been injected.

Stage four: Operation. I am often amazed how quickly patients with musculoskeletal problems are offered an operation to solve the problem. Of course, in some cases an operation is needed. If the cartilage is torn or the joint is completely worn out then no amount of Acupuncture or Osteopathy can help. However, in many cases, operating on a musculoskeletal problem is like using a sledgehammer to kill a fly. Usually there is no need to apply an expensive and possibly dangerous procedure, with questionable success rate, when you can almost always cure the problem with a simple and safe method like Acupuncture.

I am aware that I am generalizing here…there are a lot of different causes of musculoskeletal pain…but the general principle still applies: why use heavy handed methods (painkillers, steroid injections, operation) with possible dangerous side effects when you can sort out the problem with Acupuncture. Acupuncture is extremely safe and very effective in treating most musculoskeletal pain conditions, particularly when the pain is arising from ligaments or tendons, strains or inflammation, arthritic joints and muscle problems. Another major advantage of Acupuncture is that in many cases we can achieve a long term relief and even a cure. Unlike the opinion prevalent among Doctors and Physiotherapists, Acupuncture is definitely not just pain relief. In most cases it can create a better condition for healing by improving blood circulation, relaxing the muscles and reducing inflammation.

So, when it comes to musculoskeletal pain conditions, who is the winner? Western Medicine has the stronger ability to reduce pain with powerful pain killers. It can also replace the whole joint when the old one is beyond repair. However, in the great majority of musculoskeletal pain conditions Acupuncture will be more effective, much safer, and will achieve long standing results without developing a dependency on the treatment. It’s also important to say that in some situations a combination of Western and Chinese medicine will achieve the best results.

In the next post I’ll be concentrating on Gastrointestinal conditions. I will discuss Inflammatory Bowel Diseases such as Crohn’s Disease and Ulcerative Colitis as well as IBS (Irritable Bowel Syndrome) and others. I am looking forward to this one as it is going to be a particularly interesting one. Now I just have to find the time to write it!

Best of health to everyone.

Dr Ilan Shahor