Karen Le Jeal had heard all the press reports, and she was worried.

First, Merck and Co. withdrew its popular arthritis pain medication Vioxx from the market due to concerns it raised the risk of heart attack and stroke. Then, the federal government abruptly halted a study involving naproxen, the active ingredient in Aleve, because of safety concerns about it.

She'd taken them both, in fairly high doses, and was still looking for a treatment that would quell the chronic pain in her neck and arms. Ultimately, she found it not in the medicine cabinet, but at the chiropractor.

"You hear all these things and you say, 'Hey. What am I putting in my body?'" says the 42-year-old mother of three. "I'm very relieved to not be taking meds anymore."

In the wake of a highly publicized investigation into the safety of Cox-2 inhibitors, the class of painkillers that Vioxx belongs to, it appears more patients with arthritis and other forms of chronic pain are turning a curious eye to drug-free remedies, such as acupuncture, chiropractic, dietary supplements and exercise. Backed by a growing body of research, more doctors are too.

"Some people really need to take medication and I certainly don't want them to feel bad about that," stressed Andrea Montoya, a certified physician assistant with Boulder Valley Rheumatology in Longmont. "But I think in general, people have thought more about 'what else can I do in addition to taking medication for my pain.' I think that it's great. I definitely encourage it."

After news of the Vioxx concerns hit, subsequent studies cast doubt on the safety of similar drugs Celebrex and Bextra. Since then, area arthritis specialists have been inundated with questions from concerned patients, some asking to switch to older non-steroidal anti-inflammatory drugs, such as ibuprofen, and others asking for non-drug alternatives.

One remedy generating a lot of interest among researchers is acupuncture, which is believed to release the body's own feel-good chemicals, such as serotonin, while diminishing inflammation — a root cause of painful arthritis.

One study published in the December issue of the medical journal Annals of Internal Medicine, found that of 570 patients with osteoarthritis of the knee, those who received regular acupuncture treatment showed marked improvement over those who did not.

"It was to the point where I couldn't do anything without being in pain," said Molly Hauck, 24, who suffered post-traumatic arthritis in her hip after her car was hit by a drunk driver in August 2003. After trying six months of physical therapy and a list of pain medications, her doctor sent her to Yun Tao Ma, a Boulder acupuncturist who has written a clinical textbook on acupuncture for pain management. The results have been "wonderful," Hauck said.

"Now I can do what I need to get done, and I can ride my motorcycle again."

Other studies have suggested that supplementation with Omega 3 fatty acids, known for their anti-inflammatory properties, can help with arthritis pain. And some research has also shown that the supplements glucosamine and SAM-E can be effective, said Dr. Lisa Corbin, medical director for integrative medicine at the University of Colorado's Health Sciences Center in Denver.

Corbin also recommends mind-body work, such as biofeedback and relaxation training, for help with arthritis and other pain.

"Drugs help because of their anti-inflammatory effects or because they block the signal that gets to the brain," Corbin said. "You can also block the signal by teaching your brain new tricks."

Advice on using chiropractic services for arthritis pain is mixed. Corbin says she has seen little data to support it as an effective remedy for arthritis pain in particular. And for some patients, specifically those with rheumatoid arthritis, or older patients with more brittle bones, it can be dangerous. But many arthritis specialists, including Montoya, recommend it for some patients.

Boulder chiropractor Evan Katz says he won't treat some people with rheumatoid arthritis. But he sees many patients suffering from other forms of arthritis or chronic back pain and has had great success. By manipulating the joint and enabling it to move more freely, he says, he can prevent the onset of or further progression of mechanical problems that cause pain.

"Their body isn't hurting because they are lacking Vioxx in their system. Their body is hurting because their joint isn't healthy," he said. "The only way a joint gets healthy is through motion. If there isn't enough motion, the joint can't eat and it can't get the waste out."

Le Jeal was referred to Katz by her neurologist after all other attempts to treat her pain failed. "I would never in a million years have come to a chiropractor," she said. "I was very skeptical." Now she calls Katz her "miracle worker."

Dr. Kevin Deane, a rheumatologist with CU Medical Center, said that because arthritis so often strikes older people, many of the people taking Cox-2 inhibitors are the very people already at higher risk for cardiovascular disease. After explaining the risks and benefits to his patients, between 60 percent and 80 percent of them have opted to try other, older pain medications, such as ibuprofen, naproxen, or low-dose narcotics such as Vicodin.

But those too have their risks, such as liver damage, gastrointestinal problems and dependency, so some have opted for drug-free alternatives. He recommends physical therapy, stretching and strengthening, massage therapy, acupuncture, acupressure and chiropractic in younger patients.

In some ways, the Vioxx scare is subsiding.

Earlier this month, a Food and Drug Administration advisory panel narrowly voted to recommend that Merck and Co. be allowed to put Vioxx back on the market, possibly with a "black box" warning about its risks. The panel also recommended that Celebrex and Bextra remain on the market. The government also has stated recently that initial fears about the safety of naproxen were overstated.

But some patients aren't convinced.

"I don't want to medicate. I'm big on fixing, not medicating," Hauck said.

And some doctors say the events of the last six months will forever change the way they prescribe drugs.

"It will make me very cautious about who I use them with and how long and in what doses," Deane said. "New drugs can be approved, but still have side effects that are not noticed yet. So we are going to have to watch all drugs to make sure we are not prescribing something that is harmful."

Contact Camera Staff Writer Lisa Marshall at (303) 473-1357 or marshalll@dailycamera.com.
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