Nontraditional treatment versus pain meds

DEAR DR. ROACH»

At least three times a year I suffer from a pinched nerve. According to my physician, it is due to osteoarthritis and/or stress and bad posture. The pain can make me nauseated. Once, it drove me to go to an emergency clinic. The physician prescribed gabapentin. After researching the side effects, I decided not to take the pharmaceutical.

Recently, a pinched nerve started in my neck, then moved to my left shoulder and down my left arm. Relief came in the form of massage and two shots of tequila, which had fewer ill effects than the gabapentin was reported to.

What is your position on folk or nontraditional remedies versus medical fixes?

— S.M.

ANSWER» The most important two requirements for a treatment are that it be effective and safe. Whether it’s a prescription medication, supplement, folk remedy, food or exercise. For reasons including the profit motive, much of the best studies are done on patent-protected pharmaceuticals. However, some studies look at other kinds of therapies. Sometimes remedies that don’t have great evidence work nonetheless.

In the case of a “pinched nerve” massage sometimes can be helpful. It depends on the underlying cause. Often, the problem is muscle spasm, which can be caused by stress and bad posture. In that case, a massage certainly might be effective.

There are no known treatments to fix or even slow down osteoarthritis, but many different types of treatment can offer relief, including massage. Massage has fewer side effects than just about any medication you could think of, and if it works for an individual, I support it.

Alcohol and gabapentin are both substances that should be used with caution, for different reasons. Alcohol can cause some short-term muscle relaxation, but it has well-known toxicities. Whatever benefit it may have can be lost with repeated use. I don’t recommend alcohol as a treatment for any medical condition you are likely to have.

Gabapentin, which is approved by the Food and Drug Administration for seizures and treatment of the pain syndrome following shingles, is frequently used off-label for many kinds of pain due to nerve damage. Its side effects, especially sedation, limit its use unless the dose is brought up very slowly.

It is not a good choice for most types of acute pain.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.