Anti-inflammatory drug Vioxx: OMT, DOs, Pain, osteoarthritis and why many physicians consider OMT before and after surgery.

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IN THE WAKE of the withdrawal of the popular anti-inflammatory drug Vioxx, patients with arthritis are scrambling to find alternatives. Drug companies are stepping up to pitch any number of painkillers, both prescription and over the counter, to cash in on the $2.5 billion market left by Vioxx. But patients, worried about side effects or who have found pills to be ineffective, are now investigating non-pharmaceutical solutions.

The most extreme remedy is surgery to replace joints no longer able to function. Alternative medicine treatments including osteopathic manipulative treatment and acupuncture are less well established, but recommended by some doctors. Many arthritis patients also respond well to weight loss and exercise.

The Vioxx withdrawal is expected to spark additional interest in hyaluronic acid, an injectable painkiller. Two brands approved by the FDA to lubricate the joints and relieve pain are Hyalgan and Synvisc. The benefits of the injections last six months to a year. Patients receive a series of shots over three to five weeks.

The FDA approval was for treatment of the knee. But John Vecchione, 60, of Fairview, N.J., has osteoarthritis in his ankles, and has gotten relief from exercise and two rounds of shots of Hyalgan. He has stopped taking Celebrex, a similar drug to Vioxx in that it's an anti-inflammatory pain reliever considered to have less risk of damaging the gut than painkillers such as aspirin or ibuprofen.

Before treatment, Mr. Vecchione's wife would sometimes push him in a wheelchair when they went out. But now he rides a stationary bike every day for about 15 minutes. Hyalgan is extracted from rooster combs, and patients who are allergic to feathers or eggs may suffer an allergic reaction.

Doctors of osteopathic medicine (D.O.s) say that osteopathic manipulative treatment (OMT) can be affective for arthritis symptoms. Like medical doctors, D.O.s complete four years of osteopathic medical school plus residency. They may specialize and are board-certified to practice. OMT is a combination of techniques in which a D.O. uses his or her hands to move muscles and joints through stretching, gentle pressure and resistance to remove restrictions and restore normal motion to the joints and muscles.

There has been little large-scale clinical research to demonstrate the effectiveness of osteopathy. Research is now in the works, including some at the University of North Texas in Fort Worth. OMT can cost $75 to $120 on top of office visits, depending on how many areas of the body are treated. Insurance coverage varies by region. Insurance carriers in states where there are large populations of D.O.s, such as Pennsylvania and Michigan, tend to offer better coverage. In many areas, D.O.s ask that patients pay upfront and seek reimbursement.

William Morris, associate professor at the University of New England College of Osteopathic Medicine in Biddeford, Maine, said a D.O. looks for asymmetries in the musculoskeletal system that might cause overuse or tension.

Ruth Aldridge, 66, of Arlington, Texas, has had rheumatoid arthritis since she was 17. She now gets OMT along with physical therapy, exercise, weights, electrical stimulation, and two powerful prescription drugs, methotrexate and Remicade. Ms. Aldridge said for the first time in her life, she is lifting weights and building muscle, and is able to drive for as long as three hours.

Patients who are chronically debilitated by pain or who lose the ability to do certain physical activities can consider joint-replacement surgery. Knees and hips are the most commonly replaced joints for both types of arthritis. Metal or plastic prostheses for some or all of the joints are either cemented in place or inserted so that bone grows around the prostheses.

Mark Figgie, chief of surgical arthritis service at Hospital for Special Surgery in New York, says studies have shown that after 15 to 20 years, 90% of replacement joints are still in place and functioning. But joint-replacement surgery isn't cheap: Knees and hips range in cost from $25,000 to $40,000. Insurance coverage varies.