Medical news from American Academy of Pain Medicine (AAPM) meeting.
by Ed Susman, Contributing Writer, MedPage Today
Kissimmee, Fla., Feb. 18 — Two minutes of pressure on the path of the sciatic nerve appears to bring up to an hour’s relief of pain and discomfort for people with a variety of symptoms.
Pain relief averaged 43.5% (P<0.001) for emergency department patients, Jiman He, Ph.D., a visiting scholar at Brown University in Providence, R.I., told attendees at the American Academy of Pain Medicine meeting here.
Significant pain relief (P<0.001) was also achieved during an hour-long observation for a combined group of dental, renal, and cancer patients, Dr. He said.
“We really don’t know why this works,” said Dr. He, who used aspects of traditional Chinese medicine to determine pressure sites that give relief even if a clinician does not have expertise in acupuncture.
In a separate presentation, Dr. He noted that pressure on the sciatic pathway also brought relief of nonpainful discomfort, including fullness, bloating, nausea, and vomiting, among cancer patients (51.9%, P<0.001) and patients at an internal medicine clinic (37.3%, P<0.05).
Dr. He determined that pressure on the sciatic nerve in the back of the thigh appears to be part of a feedback mechanism that relieves discomfort in diverse areas of the body.
“Overall, about 43.5% of pain in 65 patients was relieved by the sciatic press,” Dr. He, whose permanent residence is in Beijing, said. “About 80% of patients with dental pain get relief from the sciatic press and about 60% of patients with kidney pain achieve some relief.”
Another 70 patients underwent a placebo press point on the front of the legs. Their pain scores on a visual analog scale decreased from 7 to about 4.5 over the course of one hour. The patients who received the sciatic press saw their pain scores drop from 7 to about 3 after one hour. That difference reached statistical significance (P<0.001), Dr. He said.
Dr. He, who is now recruiting 2,000 patients for a definitive test of the press, explained that the press is performed with the patient lying on his or her stomach. With the palms or the fist, a clinician presses on the general area of the sciatic nerve from the buttocks to mid thigh.
By exerting 11 kg to 20 kg pressure on the area for two minutes, the patient’s discomfort is relieved, Dr. He said.
“We found that there are about 30% of people for whom the technique fails to work at all,” he said. The long-term study will attempt to figure out for whom the press works and for whom other techniques are required.
“We are also going to attempt to determine the mechanism of action for the pain relief that we see,” Dr. He said.
“This is a fascinating study,” said Joel Konikow, M.D., a private practice pain medicine specialist in Seattle. “I might try it in some of my patients with acute pain. I am concerned about its long-term utility with chronic pain patients because, as Dr. He said, repeated use of the technique results in diminished length of time of relief.”
Dr. Konikow, who discussed the treatment with Dr. He at the poster presentation said, “This paper is intellectually challenging in that it has a lot to teach us about how to heal pain. It shows us that pain is nonlinear. Just because it hurts in one place doesn’t mean that treating that area will heal the pain.”
Dr. He said that applying pressure anywhere along the sciatic nerve will relieve the pain, but pressing on the sciatic nerve in the calf, for example, has less of an effect than pressure in the area higher on the leg.
Pressing on the leg for less than two minutes will also bring relief, He said, but it is less long acting. He said that pressing on the leg for more than three minutes does not add to pain control.
He also said that use of fingers or the thumb to press on the nerve may cause the practitioner to miss the nerve, and not enough pressure can be exerted with the fingers.
Dr. He and Dr. Konikow reported no financial conflicts of interest.
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Reviewed by Zalman S. Agus, MD; Emeritus Professor, University of Pennsylvania School of Medicine
American Academy of Pain Medicine
He J, “An immediate, broadly useful method, two-minute sciatic nerves press for rapid relief of pain in man: a randomized trial” AAMP Meeting 2008; Abstract 134.