Everybody hurts: the natural alternative to prescription pain relief.

Severe pain--caused by everything from lower back problems and migraines to a common toothache--sends most of us running to the doctor for a quick fix. Often, that relief comes in the form of a potent pain pill, such as OxyContin or Percocet. But those drugs work their magic with a price. For one thing, they can be highly addictive.

And that's not all: "A lot of prescription drugs for pain have serious side effects," says Mary Beth Watkins, director of research and development for Botanical Laboratories, a Seattle-area supplement manufacturer. "They don't allow you to drive a car and they cause drowsiness." And if used on a long-term basis, painkillers can cause kidney and liver damage. Certain arthritis drugs, such as the non-steroidal anti-inflammatories (NSMDS), also cause ulcers.

New research shows many of these powerful pharmaceuticals also cause problems for the environment. When they are flushed down the toilet, they dissolve into microscopic particles. Fish and wildlife living in streams polluted by these compounds can develop health problems. So can human beings who drink tap water from municipal water plants that do not yet screen out the particles.

Given those risks, it makes sense to look for natural alternatives. Treatments such as herbs and acupuncture can achieve the same result without causing side effects. They also dump fewer toxic byproducts into the water. Luckily, the natural health care market is full of options. Here's a look at some of the most promising therapies:

Herbs

Pain relief patches are among the hot new products on display at natural products trade shows. Some, such as the Tiger Balm patch, contain the herbs camphor and oil of clove, which are absorbed through the skin. These herbs, originally used in Chinese medicine, have anti-inflammatory properties to ease back pain and muscle aches. Some patches discreetly warm or cool affected areas such as the lower back, or the abdomen (for menstrual cramps).

According to the American Botanical Council, arnica is one of the most popular herbs used by homeopathic practitioners for pain. It is especially effective for reducing bruising and muscle soreness. "If you broke your leg in a snowboarding accident, arnica would be a great thing to take to relieve pain and support the healing process," Watkins says.

Meanwhile, several research studies have shown capsaicin, an extract of cayenne pepper, offers significant arthritis relief when used as a topical cream. Janet Zand, a Los Angeles naturopathic physician, licensed acupuncturist and Doctor of Oriental Medicine (DOM), prefers to help arthritis patients address the underlying cause of their pain with diet and exercise as well as herbs. "If you strengthen and balance the entire body, then pain is often reduced," she says. Zand, who has her own line of herbal products, suggests tumeric for arthritis pain. "It's a natural anti-inflammatory and strengthens immune function" she says.

Feverfew is a useful herb for migraines. Herbalists have relied on it since the Middle Ages, but recent studies confirm that it works by decreasing the flow of pain-causing prostaglandins.

Since herbal remedies are not as strictly regulated as conventional drugs, it pays to be cautious before using them. Research shows a wide variation in purity, so choose a reputable manufacturer.

The USP logo on the label proves the ingredients meet the quality standards of the U.S. Pharmacopeia (an industry trade group). Watkins suggests checking out the product on the federal Food and Drug Administration's consumer website to be sure the company has a good reputation. The safest bet is to go with a well-known national retailer such as Whole Foods Market, she adds. Since many herbs interact with other medicines, check with your doctor before using them. And do not take them if pregnant or trying to conceive.

Acupuncture

With its roots in traditional Chinese medicine, this alternative treatment is gaining in popularity for its ability to bring significant relief without side effects. Conditions that benefit from acupuncture include neck pain, menstrual cramps, migraines, carpal tunnel syndrome and kidney stones.

While objective research studies are hard to design for acupuncture, many scientists believe it works by stimulating the body's natural pain killers, called endorphins.

In some cases, painful conditions can be resolved in .just a few sessions. Others need regular visits on a long-term basis. Patients typically pay for acupuncture out of pocket, but some insurance companies will cover it if a physician with an MD degree performs the treatment. The American Academy of Medical Acupuncture offers a referral service of such practitioners.

Acupuncture is safe for most people, says Jim Dowden, executive director of the American Academy of Medical Acupuncture. "In most cases, the worst that will happen is you won't get better," he says. "There is some potential for minor bleeding or infection, but that is very rare."

As with herbal use, consumers considering acupuncture need to shop around for the right fit. Dowden suggests looking for an experienced acupuncturist who is board certified and has a medical degree.

Massage

Massage, also known as the healing touch, is one of the most popular forms of non-prescription pain relief. Different types of massage are better suited to different forms of chronic pain, but overall, it can be extremely helpful.

Physicians from Seattle's Beth Israel Hospital published a report that showed massage to be highly effective for chronic lower hack pain. Several other studies have shown massage helps breast cancer patients reduce pain and swelling caused by a build up of lymphatic fluid. At Cedars-Sinai Medical Center in Los Angeles, researchers found massage reduced muscle spasms in patients who had just undergone heart surgery.

"About 80 percent of my clients come to me because they are in pain," says Kathleen Miller-Read, a licensed massage therapist from Seattle.

Miller-Read relies on a combination of approaches to help her sore clients, from Swedish massage to deep-tissue techniques, acupressure and reflexology, a form of body work derived from Asian medicine. She can ease headaches by pressing on certain points around the sinuses or the base of the skull. By encouraging a variety of other lifestyle changes, from diet and exercise to aromatherapy or switching sleep positions, Miller-Read helps her clients avoid potent pain pills for good.

Suzan Walter, president of the American Holistic Health Association, encourages people to listen to their intuition about a particular therapy or practitioner. "This is a journey and not everything is going to work," Walter says. "But if you stick with it, eventually you will find the answer." CONTACT: American Academy of Medical Acupuncture, [phone], www.medicalacupuncture.org; American Botanical Council, [phone], www.herbalgram.org; American Holistic Health Association, [phone], www.ahha.org; American Massage Therapy Association, [phone].

MELISSA KNOPPER is a freelance writer specializing in health and science.