LIFE AFTER VIOXX

Plenty of patients panicked last fall when Vioxx was pulled from the market and questions began swirling around the related drugs Celebrex and Bextra. Peg Cushman, 56, of Freeport, Maine, didn't need to fret. She had tried Celebrex for a back problem, and though it worked fine, she didn't like the idea of relying on it. Thumbing through a book called "Dr. Duke's Essential Herbs," she read that the curry spice turmeric possessed anti-inflammatory powers and decided to give it a try. She switched to a gram a day and never looked back. That was six years ago. "Is it perfect?" she says. "No. In our culture, we want all the pain to go away. But it's worked well enough that I don't see a need to use anything invasive or more risky."

Turmeric isn't likely to achieve the blockbuster status that Vioxx and the other Cox-2 inhibitors have enjoyed in recent years ($5.7 billion in combined annual sales)--especially since there is not a single clinical trial showing that it works as a pain reliever. But for millions of Americans now wondering where to turn for relief, Cushman's experience may hold a valuable lesson. If you're worried about the heart risks of the Cox-2 drugs, but want to avoid the stomach-shredding side effects of the older anti-inflammatories, there are still many options to explore. A smart doctor can help you adjust doses or mix medications for maximum benefit and minimum risk. Patches and creams can help, too. And though most physicians still reach for a prescription pad, nonpharmaceutical interventions--including exercise, supplements and dietary changes--can combat less severe forms of pain. "Then, if you still need conventional therapy, you can often use less of it," says Dr. James Nicolai, medical director of the Franciscan Center for Integrative Health in Indianapolis.

No single medical intervention will work for everyone. But many patients are achieving the dual benefits of Cox-2s--pain relief without gastric injury--by combin-ing older anti-inflammatories such as ibuprofen with drugs like Prilosec that reduce stomach acid. Other patients are staying on low-to-standard doses of Celebrex and Bextra if they have a low risk of heart attack and stroke--the problems that surfaced in high-dose studies of the pills.

But it makes sense to look beyond drugs. Many arthritis sufferers swear by the dietary supplements glucosamine and chondroitin. They don't damage the heart or the digestive tract--and unlike pharmaceutical treatments, they may actually help maintain and repair your cartilage. "More than 40 trials have demonstrated their efficacy," says Dr. Jason Theodosakis, assistant pro-fessor of medicine at the University of Arizona and author of "The Arthritis Cure"-- although he admits that finding reliable brands can be a problem. He revised his book last year to include another promising supplement called ASU, a natural anti-inflammatory derived from avocado and soybean oils. It works in weeks, instead of two to three months for glucosamine and chondroitin. "There's enough medical evidence that it's prescribed as a drug in Europe," he says.

Even food can help ease pain and inflammation, particularly in people with rheumatoid arthritis. The effects are usually modest, but so are the costs and the risks. Experts recommend cutting back on omega-6 polyunsaturated oils (found in corn and sunflower oil), while loading up on omega-3 polyunsaturates (found in cold-water fish like wild salmon, sardines and mackerel, as well as walnuts, flax-seed and dark leafy greens). The two oils function as a dietary yin and yang. The omega-6 fats provide the building blocks for many pro-inflammatory compounds in the body, while omega-3s help make anti-inflammatory ones.

You should also go easy on refined sugar and flour, since high blood sugar promotes inflammation, and eat fruits and vegetables, which can help combat inflammatory enzymes. There are more than 20 anti-inflammatory compounds in celery alone, says James Duke, a retired USDA botanist and author of "Dr. Duke's Essential Herbs." Turmeric, ginger and rosemary are other rich sources. "Think of it as big farms instead of Big Pharma," says Tufts University scientist James Joseph, who studies blueberries.

Exercise is no picnic when your joints ache, but staying active is one of the best remedies for arthritis. It keeps your joints well lubricated, and strong muscles reduce the pressure on vulnerable spots. "You can reduce the pain of osteoarthritis in the hips and knees significantly if you strengthen the muscles around them," says Dr. Elizabeth Tindall, president of the American College of Rheumatology. Losing weight has benefits, too. "There's a multiplier effect, so that losing 10 pounds takes 30 pounds of pressure off the knee joint," says exercise physiologist Miriam Nelson at Tufts, coauthor of "Strong Women and Men Beat Arthritis."

What can one realistically expect from all these measures? They will not provide the dramatic relief we've come to expect from pills. But taken together, they can make a difference--and you're not likely to wake up one morning to discover they've been pulled from the market.

LIFE AFTER VIOXX | News