Flipping The Script For Unconventional Remedies?

The consumer ads for pain management pharmaceuticals keep coming fast and furious. In one ad, you may see a woman standing at a window grimacing, clutching her painful knee as she watches her children play in the back yard. In the next scene, you see her smiling and pushing her daughter on a swing. You hear the voiceover come in: “Ask your physician about (fill in the name of the medication here).” Then there’s the obligatory close-up shot of the product with a rosy glow behind it and perhaps a brief hushed warning about possible side effects. Imagine flipping the script on the voiceover, something to the effect of “Ask your physician about medical leeches” and flashing to a shot of four to six leeches biting and engorging themselves on a certain area of skin. All right, maybe the leeches aren’t ready for their primetime debut, but they are being reconsidered in the armamentarium for pain management. As reported recently in the Annals Of Internal Medicine, a randomized and controlled trial involving 51 patients with osteoarthritis of the knee found intriguing results with leech therapy. Comparing a single treatment of four to six locally applied leeches versus a 28-day regimen of the topical diclofenac, the researchers found a significantly greater reduction of pain seven days in for the leech therapy group. The researchers also reported “differences for function, stiffness and total symptoms remained significant” at the study’s final measurement 91 days out from the initial treatment. In this month’s issue of Podiatry Today, Nicholas A. Grumbine, DPM, further explores the use of this modality (see “Reviving An Ancient Therapy To Manage Chronic Pain” on page 46). He explains that leech saliva contains several biological ingredients that help promote pain relief. In particular, one anesthetic effect from leech saliva that affects “C” nerve fibers and small “B” nerve fibers can “last several months and provide long-term relief from sympathetic mediated pain,” according to Dr. Grumbine. He says the indications for leeching range from painful subcutaneous lesions and hypertrophic scars to severe hyperesthesia and reflex sympathetic dystrophy. In a study of 67 patients who had previously failed traditional care for painful conditions, Dr. Grumbine found that treating them with the leeching procedure significantly reduced their pain. According to Dr. Grumbine, patients who experienced a “burning” pain of four weeks to years in duration went from a 7.6 out of 10 on the pain scale preoperatively to a 1.3 out of 10 on the pain scale after undergoing the leeching procedure. Speaking of unconventional modalities, our cover story emphasizes the importance of asking about herbal medications and supplements during patient history (see “Are Your Patients Taking Herbal Meds?” on page 28). While these medications continue to surge in popularity, they are not FDA-regulated and can have serious side effects and interactions with other drugs. With this in mind, Donald Green, DPM, and Kathleen Halat, DPM, provide a closer look at the potential effects of the commonly used gingko biloba, garlic, St. John’s Wort, echinacea and ginseng. While our initial impulse to “alternative” and “natural” remedies may be one of disdain and skepticism, it would be a mistake to be entirely dismissive of their impact. Perhaps future research will be able to harness the effects and ingredients of leech saliva into a more conventional treatment for pain management. In the case of herbal remedies, education about the potential risks is clearly essential for patients and the physicians who provide their care.