Dr. Roach: Nontraditional treatment versus pain meds

Keith Roach
To Your Health

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 at times. On one occasion, 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.

Dear S.M.: The most important two requirements for a treatment are that it be effective and safe. That’s what really matters, 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” — an imprecise term that refers to any pain or numbness that occurs when a nerve is compressed — 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. It is slow to take effect, and 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.

Dear Dr. Roach: I know several people who donate plasma and get paid $500 per month if they donate two times per week. Wouldn’t that be wearing on your body?

— I.E.

Dear I.E.: You can’t be paid to donate blood. Volunteer donors have the safest blood, so they are the only source of whole blood. Paid donors are only allowed to donate plasma (the proteins in blood), which can be thoroughly sterilized.

Plasma proteins can be rapidly replaced, mostly by the liver, so some centers allow donation up to twice weekly, though the American Red Cross allows donation only once a month. Whole blood may be donated every eight weeks, as replacing the cells and the iron that goes with them takes more time.

Plasma donation is safe. The major risks are damage to the vein, irritation or, rarely, damage to a nerve. A few people faint with any kind of needle, even just seeing one.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.