A review published in Mayo Clinic Proceedings used U.S.-based clinical trial evidence to examine the efficacy of complementary health approaches for chronic pain management. Conducted by researchers at the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health, the review includes trials of pain management techniques such as acupuncture and yoga. The results show that some approaches have strong benefits for pain treatment and management.
“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects. As a result, many people may turn to non-drug approaches to help manage their pain,” said lead author Richard L. Nahin, Ph.D., in a press release.
Approximately 40 million adults in the U.S. experience severe pain, with about 25 million suffering from daily chronic pain. As the authors of this review note, pain is often undertreated and the care that is provided for it is not usually comprehensive. Mental health providers may play a pivotal role in the care of individuals suffering from chronic pain, as it often interferes with many aspects of daily life.
“Pain is often associated with poor general health, health-related disability, and increased health care utilization,” Nahin and his colleagues write.
Stigma and concerns of patient malingering can also contribute to the lack of adequate care for those experiencing daily pain. Chronic pain can at times be unexplained by most medical assessments, and even when provided with medications, these often don’t work to relieve the symptoms fully and can also result in unwanted side effects.
Although millions of Americans turn to complementary approaches – such as acupuncture and relaxation techniques – to treat pain conditions, these are not always part of treatment plans.
Researchers reviewed 105 studies of randomized controlled clinical trials (RCT) conducted in the last 50 years. These RCTs focused on the efficacy and safety of the following approaches for pain conditions such as back pain, osteoarthritis, neck pain, severe headaches and migraines, and fibromyalgia:
- Massage Therapy
- Relaxation Techniques
- Natural Supplements
- Tai Chi
The results were categorized by their impact on pain severity, pain-related disability, and function. In “positive trials”, complementary approach yielded statistically significant improvements compared with the control group. In “negative trials” no difference was found between the groups. Based on a higher prevalence of positive trials over negative trials, results suggest that there is relatively strong evidence of the efficacy of some complementary approaches (i.e. acupuncture, massage therapy, and relaxation techniques) for the examined conditions.
Although data on the safety of these approaches was limited, none of the RCTs identified a severe adverse event occurring as a result of the complementary approaches examined.
The researchers pointed out various limitations to their review, including homogeneous trial samples, and therefore limited generalizability, small trial sizes, and the high number of outcome measures used to assess pain and function.
“These data can equip providers and patients with the information they need to have informed conversations regarding non-drug approaches for the treatment of specific pain conditions,” stated David Shurtleff, Ph.D., deputy director of NCCIH.
Data from this study has the potential to influence the comprehensiveness of treatment plans, as it provides substantial evidence about the efficacy of non-drug approaches to pain management. The results confirm the importance of multi-modal approaches in the care of these pain conditions.
Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016, September). Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings, 91 (9), 1292-1306. (Full Text)