It wasn't but a few minutes after an alligator the size of an outboard motorboat tore off Don Goodman's right arm that he began to feel a curious pain. As he waited for an ambulance, the bloody stump above his now missing elbow didn't hurt much. Instead, he felt burning pain in his right hand which was, of course, inside the 11-ft. (3.4 m) alligator, a monster he and his staff at Kanapaha Botanical Gardens in Gainesville, Fla., had named Mojo. "I could feel every finger of the hand that had served me for 59 years and which now lay in the belly of an alligator 200 yards away," wrote Goodman, a zoologist, in his 2007 memoir, Summer of the Dragon. "And they all hurt!"
The attack occurred on Sept. 23, 2000. Within a couple of hours, Mojo was dispatched with a 12-gauge shotgun. But he exacts revenge every day: since the incident, Goodman has had to endure a particular agony known as phantom-limb pain. He described it to me this way: "It's a sensation of pressure, as if I had my right hand in a steel glove that's one size too small. And then that's overlaid by the type of tingling you get when a limb falls asleep multiplied by about 10." Goodman dulls the pain with his prescribed 5 mg of methadone three times a day. But the underlying hurt never really stops, and if he is idle, it's virtually all he thinks about.
How to manage chronic pain whether it's the exotic variety in the form of an agonizing phantom limb or the more familiar ache of lower-back pain is one of medicine's oldest puzzles. For much of the 19th and 20th centuries, opioids like morphine were the only weapons for killing serious pain. But opioids have many downsides, particularly for chronic-pain patients expected to live for years or decades. "They make people sleepy. They impair mentation. They're constipating. They deaden life in lots of ways," says Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine (NCCAM, pronounced N-cam) at the National Institutes of Health. "In addition, they're addictive."
Acetaminophen (now best known as Tylenol) came along in the 1950s, and ibuprofen (marketed as Advil) followed in the '60s. Both drugs are non-narcotic, but using them in large doses to treat chronic pain carries serious risks: high-dose acetaminophen is a leading cause of liver failure, and ibuprofen and other anti-inflammatories (including aspirin) can literally burn a hole in your stomach.
That's why, over the past three decades, pain specialists have begun investigating nondrug treatments for chronic pain. Massage, acupuncture, yoga, herbal remedies, meditation, tai chi, mindfulness-based psychotherapy and even mineral baths are being tested in clinical trials as treatments for chronic pain. So far the results are mixed, but the science is lagging well behind everyday use.
In 2007, the most recent year the federal government conducted its National Health Interview Survey of more than 20,000 Americans, nearly 40% of those responding reported using complementary or alternative medicine (CAM) in the previous 12 months. The distinction between complementary and alternative therapies lies in whether they are used in concert with mainstream medicine or instead of it. In the 1960s and '70s, physicians and nonmainstream practitioners viewed one another with deep suspicion. Today many physicians recommend nondrug approaches like massage and meditation. Similarly, most CAM practitioners recognize the need for medical intervention in serious cases.
In the National Health Interview Survey, pain was the most common reason cited for seeking CAM therapies. According to the survey, more than 8% of Americans said they had gotten a massage in the past year (usually for back or neck pain). Approximately 11% had used meditation or deep-breathing exercises for physical (and emotional) pain. And some 3.1 million Americans (1.4% of the population) had undergone acupuncture by far the highest proportion ever reported.
In other words, even in a world where we touch screens more often than we do people, we seem to be reaching back to rediscover folk remedies for pain. The encouraging news is that rigorous science is now showing that CAM therapies can work well to treat pain. In some cases, trials are demonstrating that CAM therapies reduce pain more effectively than standard drug treatments do.
With new NCCAM funding, researchers are learning more about how mind-body practices like yoga and acupuncture can instruct the brain to dial down pain signals. Founded just over 10 years ago, NCCAM spent much of its first half-decade debunking claims about the supposed healing power of supplements like echinacea and ginkgo. But in the past five years the center has begun to shift more of its $100 million grant budget to pain studies. Today about half of its grants go toward investigating mind-body practices, most of which are targeted at pain.
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