Elsevier

Mayo Clinic Proceedings

Volume 91, Issue 9, September 2016, Pages 1292-1306
Mayo Clinic Proceedings

Symposium on pain medicine
Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States

https://doi.org/10.1016/j.mayocp.2016.06.007Get rights and content

Abstract

Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches—acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga—as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.

Section snippets

Acupuncture

We found 4 RCTs (total participants, 1092)15, 16, 17, 18 that assessed the clinical benefit of acupuncture for treatment of low back pain (LBP) (age range, 28-60 years; most participants were white) and used primary study outcomes of self-report of pain intensity (numeric rating scale or visual analog scale [VAS]) and/or functional disability (Roland-Morris Disability Questionnaire, Oswestry Disability Index [ODI], or Disability Rating Index). Cherkin et al15, 16 reported modest improvement in

Fibromylgia

All trials we reviewed for fibromyalgia used the 1990 American College of Rheumatology (ACR) classification criteria,63 except one64 that used an older definition.

Massage

Four randomized controlled trials examined whether massage could relieve symptoms associated with chronic neck pain.79, 80, 81, 82 One study did not report patient demographic characteristics, and the others studied patients aged 20 to 64 years. Primary outcomes included scores on the Neck Disability Index (NDI) (a 10-item neck pain questionnaire), the pain VAS, and range of motion. Sherman et al81 found significant improvement of the NDI score for those randomized to 10 massage therapy session

Acupuncture

Four RCTs examined whether acupuncture could relieve symptoms associated with OA of the knee.87, 88, 89, 90 These studies used similar definitions of knee OA. Participants were predominantly female, had mean ages between 60 and 65 years, and had knee pain for an average of 9 to 11 years. All studies incorporated either the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score or the WOMAC pain subscore as the primary outcomes. In 2 of the trials,89, 90 no difference

Severe Headache and Migraine

Most of the studies we reviewed defined cervicogenic headache, migraine, and tension-type headache with criteria from the International Classification of Headache Disorders, second edition.109, 110

Overall Summary of RCT Data

Tables 3 and 4 provide concise summaries of the reviewed clinical trial data for each complementary approach stratified by painful health conditions and various control groups. In these tables, positive trials are those in which the complementary approach provided statistically significant improvements in pain severity or pain-related disability or function compared with the control group. Negative trials are those in which no difference was seen between groups. Based on a preponderance of

Safety

Generally, the reporting of safety data in the reviewed RCTs was minimal. For those trials that did report safety data, we have summarized this information in the text for each painful health condition. In no case did an RCT identify a serious adverse event associated with any of the complementary approaches examined. The most common adverse events (gastrointestinal distress) were noted in trials of dietary supplements (glucosamine, chondroitin, MSM, SAMe). In some trials, tai chi and yoga were

References (133)

  • G. Bronfort et al.

    Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial

    Spine J

    (2011)
  • C. Cook et al.

    Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial

    Man Ther

    (2013)
  • J.W. George et al.

    A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy

    Am J Obstet Gynecol

    (2013)
  • M. Haas et al.

    Dose-response for chiropractic care of chronic low back pain

    Spine J

    (2004)
  • M. Haas et al.

    Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial

    Spine J

    (2014)
  • K.T. Hoiriis et al.

    A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain

    J Manipulative Physiol Ther

    (2004)
  • M.A. Hondras et al.

    A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain

    J Manipulative Physiol Ther

    (2009)
  • J. Nyiendo et al.

    Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians

    J Manipulative Physiol Ther

    (2001)
  • K.A. Williams et al.

    Effect of iyengar yoga therapy for chronic low back pain

    Pain

    (2005)
  • R.E. Harris et al.

    Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs)

    Neuroimage

    (2009)
  • D.P. Martin et al.

    Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial

    Mayo Clin Proc

    (2006)
  • G. Liptan et al.

    A pilot study of myofascial release therapy compared to Swedish massage in fibromyalgia

    J Bodyw Mov Ther

    (2013)
  • J.W. Carson et al.

    A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia

    Pain

    (2010)
  • A.J. Cook et al.

    Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes

    Spine J

    (2015)
  • T. Field et al.

    Neck arthritis pain is reduced and range of motion is increased by massage therapy

    Complement Ther Clin Pract

    (2014)
  • M. Maiers et al.

    Spinal manipulative therapy and exercise for seniors with chronic neck pain

    Spine J

    (2014)
  • T. McAlindon et al.

    Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an Internet-based randomized double-blind controlled trial

    Am J Med

    (2004)
  • S.P. Messier et al.

    Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study

    Osteoarthritis Cartilage

    (2007)
  • J.L. Zenk et al.

    The effects of milk protein concentrate on the symptoms of osteoarthritis in adults: an exploratory, randomized, double-blind, placebo-controlled trial

    Curr Therapeutic Res

    (2002)

  • Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

    (2011)
  • M. Lethbridge-Cejku et al.

    Summary health statistics for U.S. adults: National Health Interview Survey, 2002

    Vital Health Stat 10

    (2004)
  • J.R. Pleis et al.

    Summary health statistics for U.S. adults: National Health Interview Survey, 2007

    Vital Health Stat 10

    (2009)
  • D.L. Blackwell et al.

    Summary health statistics for U.S. adults: National Health Interview Survey, 2012

    Vital Health Stat 10

    (2014)
  • B. Walitt et al.

    The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey

    PLoS One

    (2015)
  • P.M. Barnes et al.

    Complementary and alternative medicine use among adults and children: United States, 2007

    Natl Health Stat Report

    (2008)
  • P.M. Barnes et al.

    Complementary and alternative medicine use among adults: United States, 2002

    Adv Data

    (2004)
  • T.C. Clarke et al.

    Trends in the use of complementary health approaches among adults: United States, 2002-2012

    Natl Health Stat Report

    (2015)
  • D.M. Eisenberg et al.

    Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey

    JAMA

    (1998)
  • D.M. Eisenberg et al.

    Unconventional medicine in the United States: prevalence, costs, and patterns of use

    N Engl J Med

    (1993)
  • B.J. Stussman et al.

    Wellness-related use of common complementary health approaches among adults: United States, 2012

    Natl Health Stat Report

    (2015)
  • D.M. Upchurch et al.

    The importance of wellness among users of complementary and alternative medicine: findings from the 2007 National Health Interview Survey

    BMC Complement Altern Med

    (2015)
  • D.C. Cherkin et al.

    Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain

    Arch Intern Med

    (2001)
  • D.C. Cherkin et al.

    A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

    Arch Intern Med

    (2009)
  • D.C. Cherkin et al.

    A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial

    Ann Intern Med

    (2011)
  • D.M. Eisenberg et al.

    Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial

    Spine (Phila Pa 1976)

    (2007)
  • M. Hernandez-Reif et al.

    Lower back pain is reduced and range of motion increased after massage therapy

    Int J Neurosci

    (2001)
  • E.E. Jacobson et al.

    Structural integration as an adjunct to outpatient rehabilitation for chronic nonspecific low back pain: a randomized pilot clinical trial

    Evid Based Complement Alternat Med

    (2015)
  • E. Wilson et al.

    Muscle energy technique in patients with acute low back pain: a pilot clinical trial

    J Orthop Sports Phys Ther

    (2003)
  • G.B. Andersson et al.

    A comparison of osteopathic spinal manipulation with standard care for patients with low back pain

    N Engl J Med

    (1999)
  • dA. Cruser et al.

    A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel

    J Man Manip Ther

    (2012)

    • Cited by (0)

    The Symposium on Pain Medicine will continue in an upcoming issue.

    Individual reprints of this article and a bound reprint of the entire Symposium on Pain Medicine will be available for purchase from our website www.mayoclinicproceedings.org.

    View full text
    © 2016 Mayo Foundation for Medical Education and Research