Analysis Supports Alternative Therapies for Common Pain Problems
One criticism of alternative therapies has often been—show me the evidence. A recent study published by research funded by the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, has done just that.1
“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 nondrug approaches to help manage their pain,” said Richard L. Nahin, PhD, NCCIH’s lead epidemiologist and lead author of the analysis. “Our goal for this study was to provide relevant, high-quality information for primary care providers and for patients who suffer from chronic pain.”
To conduct the study, researchers reviewed 105 randomized controlled trials that were relevant to patients with chronic pain in the United States. Although the reporting of safety information was low overall, none of the clinical trials reported significant side effects due to the interventions, noted NCCIH in a press release.2
The review focused on alternative approaches used for 1 or more of the following painful conditions: back pain, osteoarthritis, neck pain, fibromyalgia, and severe headaches and migraine. The researchers sought evidence on the efficacy, effectiveness, and safety of 7 widely-used complementary approaches: acupuncture; spinal manipulation or osteopathic manipulation; massage therapy; tai chi; yoga; relaxation techniques including meditation; and selected natural product supplements, including chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe), and omega-3 fatty acids.
A treatment was considered positive if the complementary approach led to statistically significant improvements in pain severity, pain-related disability, and/or function, compared to the control group. A negative result meant that there was no difference between the intervention and control groups.The results found promise in the following for safety and effectiveness in treating pain:
- Acupuncture and yoga for back pain
- Acupuncture and tai chi for osteoarthritis of the knee
- Massage therapy for neck pain with adequate doses and for short-term benefit
- Relaxation techniques for severe headaches and migraine.
Though the evidence was weaker, the researchers also found that massage therapy, spinal manipulation, and osteopathic manipulation may provide some help for back pain, and relaxation approaches and tai chi might help people with fibromyalgia.
“These data can equip providers and patients with the information they need to have informed conversations regarding non-drug approaches for treatment of specific pain conditions,” said David Shurtleff, PhD, deputy director of NCCIH. “It’s important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”
The researchers’ findings were generally consistent with those of recent systematic reviews. They noted some methodological limitations to their review, including small trial sizes, uncertain clinical relevance even if statistical superiority was present, or differences in the interventions provided in each study.