An alternative route

An increasing demand for alternative pain relief is highlighting an integration between mainstream medicine and alternative therapies

The first time Evon Toh’s pain got really bad, she couldn’t get up. She ended up having to go to the emergency ward because of the excruciating pain, a result of her scoliosis.

She had ignored the pain for nearly a decade. Toh had been sedentary and never really exercised; her desk-bound job as a course coordinator meant that there was a lot of pressure on her spine.

“I always thought that back pain was a normal thing,” Toh says.

Toh has tried several forms of therapy, going to a chiropractor, acupuncture and acupoint massages, as well as yoga therapy, which has helped her manage the pain.

When her yoga therapy didn’t go well, she would feel frustrated; Toh says that she can’t do more strenuous poses as her core muscles were weak.

Her knees also injure easily, and when they act up, it would feel like “all the hard work in training goes to waste.”

Toh is one of an increasing number of sufferers who are looking for alternatives to pain relief, including traditional Chinese medicine and acupuncture.

Four integrated hospitals now offer acupuncture services in-house, including NUH, SGH, TTSH, and Khoo Teck Puat Hospital (KTPH).

Added demand for alternative medicine has powered growth in the private sector too — an estimated 100 chiropractors now operate in Singapore, with 86 chiropractic-related businesses registered in the country.

Practitioners of these treatments, seen by some as psuedoscience, do rely on mainstream medical techniques, like X-rays and MRI scans, according to Lim Yin Jia, a physician at the NTU Chinese Medicine Clinic. “We would read the reports, ask for patient history — so we do not just view pain as something that is very simple… we will ask the patient to go and get the necessary checks done.”

Melissa Ong, an acupuncturist at KTPH’s sports medicine clinic, says that she would also refer to modern medical imaging techniques when a sufferer is referred to her. “Sometimes when we communicate with the patient, it is important to let them understand their condition in terms of Western medicine and the TCM point of view,” Ong says.

In the traditional Chinese medicine (TCM) model, emotions and pain are intricately related to the body’s qi, or vital force.

Pain occurs when there is a blockage in one of the body’s meridians or channels, according to Lim; chronic pain occurs when the blockages are not cleared.

Some studies support the idea that acupuncture can help in releasing neurochemicals like endorphins that block pain messages.

A group of patients with depression-related pain in a University of York study saw the most improvement with their pain and depression after acupuncture therapy compared to those who only underwent counselling or mainstream pain relief.

Why alternatives?

Sufferers often opt for TCM treatment when they find that it is not a long-term solution for their pain, says Lim. Often, they are averse to more invasive methods, like surgery — or find the side effects of painkillers hard to deal with.

“Others find that they need a larger dose of painkillers after a period of time,” Lim adds.

“People find that TCM treatment is actually simple and safe and effective, unlike the stigma that some might have,” says Lim. “If the pain is already hindering their daily activities, I’m pretty sure they are willing to give any sort of treatment a try.”

The same goes for chiropractic treatment, according to Dr Terrence Yap, a chiropractor at Atlas Chiropractic Clinic.

He adds that chronic pain sufferers who come to him often say they want natural care, instead of long-term medication and surgery, which may come with side effects.

Dr Yap has seen a 15 percent increase in senior patients in the past two years. “The public is averse to long term medication, and sufferers who have seen their friends and family undergo surgery with disappointing results are less likely to opt for them,” he adds.

Nearly 80 percent of patients who see Ong have chronic pain, and the number of patients she sees each day has risen from 5-10 since the clinic’s inception at KTPH three years back, to 10-18 today.

Ong says that acupuncture is increasingly being accepted, even among younger patients and other races.

“When they are more aware of something, they tend to be more open to trying it,” she says.

Still, this doesn’t mean that acupuncture is used as a sole treatment method. “Sometimes they work hand-in-hand with existing therapies, like surgery,” she adds. Other times, they would complement physiotherapy, and are used in some cases to manage post-operative pain.

Ong says that before acupuncture clinics started becoming popular, patients often used it as a supplement to mainstream regimes, which piqued the interest of physicians.

“Gradually, doctors who are exposed to this kind of patient frequently enough, they might develop an interest in acupuncture, especially when it could be helpful for their patients.” she adds.

For NUH’s Prof Lee Tat Leang, the clinic’s existence is attributed to only one thing — demand.

NUH averaged 11,000 patient visits annually in the last five years — which Prof Lee says translates to a “few thousand” cases per year.

Both KTPH and NUH see referrals from other departments — like the orthopaedic clinic or sports medicine departments — and around 80 percent of patients who come to each clinic experience chronic pain.

Prof Lee doesn’t see the rise in the number of acupuncture clinics as a sign that alternative treatments have gone mainstream.

Acupuncture “is just offered as a treatment choice”, he says, as a result of TCM practitioners being regulated since 2000.

I want to believe

Most patients who see Prof Lee want to try alternatives, and have tried other pain relief methods before coming to them, he says.

The whole problem of treating pain is that no one is the same, Prof Lee adds. “Many times it’s trial and error, that’s why a lot of patients come here, they have failed many rounds of treatment.”

Joan Young, who suffers from fibromyalgia, made the switch to TCM in 2015, after trying a litany of pain relief medication, all of which had a number of side effects like memory loss, drowsiness and mood issues.

“I was not improving, and the medications were very very expensive,” Young says. “I don’t mind paying if I’m getting better, but the fact was that I am paying so much and I’m not getting any better.”

Switching to TCM had not been easy for Young — she had to experience withdrawal symptoms, and her pain got worse when she went cold turkey.

But after eight months of acupressure and acupuncture sessions, she says she felt better.

She no longer goes for acupuncture sessions, but still goes to acupressure massages. “I was more comfortable and I wasn’t feeling depressed anymore.”

Patient perception is an influential factor in determining treatment effectiveness, so much so that doctors and practitioners of alternative treatments both want to maximise the placebo effect — where the patient’s belief in treatment helps them get better.

While the mechanisms of action for acupuncture are not known, clinical studies on acupuncture have indicated a sizable placebo effect, Prof Lee says.

But when patients say that a treatment is their last resort, it might exacerbate their belief that treatment might not work.

Shawn Danker, a 39-year-old freelance photographer, was referred to the acupuncture clinic at SGH while he was serving National Service, to help with his back pain.

“It was a very funny experience, because I got to the point where I had acupuncture so many times where the pain relief would wear off very quickly,” he says. “That was when I decided acupuncture was not for me.”

Eventually, relief occurred when he left National Service, which he says was a main trigger. “I had enough time where I could recover, and manage and get used to it,” Danker adds.

Toh says that while chiropractic treatment usually works well for her, there are days where her body simply doesn’t respond well because of stress.

“But I trust in my chiropractor, I don’t feel bad if the pain doesn’t ease,” she adds. “I just have to go back again.”

Up next