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12 Articles in Volume 13, Issue #1
A Modest Proposal (Thanks to Jonathan Swift—1667-1745)
Chronic Pain: Study of Complementary and Alternative Treatments
Decompression Surgery to Reduce Diabetic Peripheral Neuropathy
Extracorporeal Shock Wave Therapy—Application for Trigger Points
Improving a Practice Model for Prescribing Opioids
Interpretations and Actions Following Cytochrome P450 Testing
Is It Safe to Restart an NSAID Following an Endoscopically Confirmed NSAID-Induced GI Bleed?
January/February 2013 Pain Research Updates
Massage Therapy in an Ambulatory Pain Clinic
Practical Tips in the Treatment of Osteoarthritis of the Hip
Quantum Theory Underpins Electromagnetic Therapies for Pain Management
When a Pain Patient Insists on Alternative Treatments Alone

Chronic Pain: Study of Complementary and Alternative Treatments

Thirty-eight percent of Americans use some sort of complementary and alternative medicine (CAM) treatments to manage their chronic pain.

Bob Stockfield Photo/NCCAM, NIHDespite improved research over the past decade, pain remains a major cause of disability in America. According to the Institute of Medicine, more than 100 million people in the United States suffer from chronic pain. Pain stemming from arthritis, back and other musculoskeletal conditions, and headache costs US businesses more than $61 billion per year in lost worker productivity.1

While tremendous progress has been made in drug treatment of acute pain, there are pressing needs for better understanding and better treatments for chronic pain. Because chronic pain can be resistant to many medical treatments, people who suffer from chronic pain often turn to complementary and alternative medicine (CAM) for relief (Table 1).2

Table 1. Use of Complementary and Alternative Medicine (a)

In spite of the widespread use of CAM therapies for chronic pain, scientific evidence on whether the therapies help the conditions for which they are used is, for the most part, limited. The National Center for Complementary and Alternative Medicine (NCCAM) was established in 1998 to “define, through rigorous scientific investigation, the usefulness and safety of CAM interventions and their roles in improving health and health care.”3

Last year, NCCAM launched a new multidisciplinary pain program focusing on the role of the brain in perceiving, modifying, and managing pain.4 Catherine Bushnell, PhD, a pain and neuroscience researcher, was appointed scientific director of the new program, which will complement basic science and clinical research efforts of other National Institutes of Health (NIH) intramural programs in neuroscience, imaging, and mental and behavioral health. Dr. Bushnell comes to NIH from McGill University in Montréal, where she was the Harold Griffith Professor of Anesthesia and professor in dentistry and neurology.

“Dr. Bushnell’s work has profoundly changed the ways in which we understand and study this very important problem,” said NCCAM Director Josephine P. Briggs, MD, in a press release announcing her appointment.4 “Under her leadership, this program will continue to work toward the development of better ways to safely and more effectively treat chronic pain, and advance research on the intersection and integration of pharmacological and non-pharmacological approaches.”

Research projects will include investigating the role of the brain in pain processing and control, and how factors such as emotion, attention, environment, and genetics affect pain perception. The program will also explore how chronic pain produces changes in the brain that can modify how the brain reacts to pain medications like opioids. 

In an interview with NIH Radio, Dr. Bushnell noted that there are many modalities people are using to try to help control their pain—yoga, meditation, exercise—and “we’re trying to understand the mechanisms as well as the efficacy of these various techniques, and also how these complementary techniques can interact with pharmacological techniques.”5

NCCAM-supported studies are helping to build an evidence base on the efficacy and safety of CAM modalities for treating chronic pain (See special section below:  What the Science Says about CAM and Chronic Pain). Recent NCCAM-supported studies have been investigating:

  • CAM therapies for chronic low back pain, including acupuncture, massage, spinal manipulation, and yoga
  • CAM therapies for osteoarthritis pain, including prolotherapy, tai chi, and yoga
  • Massage for chronic neck pain
  • Acupuncture and spinal manipulation for chronic headaches
  • Acupuncture and tai chi for fibromyalgia pain

In addition, NCCAM is supporting a yearlong Internet-based survey of people with chronic pain and other chronic conditions to study CAM effectiveness as well as interactions among stress and coping, pain, and treatment outcomes. The survey is called PROCAIM—Patient-Reported Outcomes from Complementary, Alternative, and Integrative Medicine.

CAM Research Challenges and Opportunities

In light of the human and economic costs of chronic pain, as well as evidence that many people who suffer from chronic pain turn to CAM for relief, NCCAM places a high priority on pain-related research. However, researchers in this area face unique challenges in that much remains to be understood about the nature of chronic pain and about the best approaches to studying its many different causes, people’s different responses, and the value of various treatment approaches—CAM and conventional. The ultimate goal of chronic pain research is to build an evidence base that can guide pain management decisions tailored to individuals. These decisions often involve combining treatment approaches in cost-effective ways that do the best possible job of helping people with chronic pain minimize pain, maximize function, and improve quality of life.

While building an evidence base to help people with chronic pain and their health care providers make decisions about specific therapies, CAM research is also helping close gaps in our basic understanding of pain mechanisms. For example, researchers are using state-of-the-art imaging technology to see how acupuncture affects brain activity. One study’s finding that demonstrated how changes in brain activity during acupuncture are different for people with chronic pain compared with healthy people is important for understanding not only how acupuncture might work but also pain processes in general.

Source: This article was written based on information provided by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health.

Acknowledgments
NCCAM thanks the following individuals for their technical expertise and review of the information presented in this article: Micke Brown, BSN, RN, American Pain Foundation; Daniel Cherkin, PhD, Center for Health Studies, Group Health Cooperative, Seattle; Scott Haldeman, DC, MD, PhD, Department of Neurology, University of California, Irvine; John W. Kusiak, PhD, National Institute of Dental and Craniofacial Research; John Glowa, PhD, NCCAM; and Partap Khalsa, DC, PhD, NCCAM.

Special Section:  What the Science Says about CAM and Chronic Pain

Low Back Pain
Reviews of research on acupuncture, massage, and spinal manipulation for chronic low back pain have found evidence that these therapies may be beneficial. Clinical practice guidelines issued by the American College of Physicians/American Pain Society in 2007 recommend these therapies and five other non-pharmacologic approaches for patients with back pain who do not improve with medication, education, and self-care (the other recommended approaches are cognitive-behavioral therapy, exercise therapy, progressive relaxation, intensive interdisciplinary rehabilitation, and yoga). Reviews of research on other CAM therapies that people sometimes use for chronic low back pain, such as various herbal remedies and prolotherapy injections, generally have found limited or no evidence to support their use for this purpose, or the evidence is mixed.

Arthritis
Among CAM approaches that have been studied for pain relief in osteoarthritis are acupuncture, glucosamine/chondroitin, herbal remedies, mineral baths (balneotherapy), and tai chi. Many of these approaches have also been studied for rheumatoid arthritis. Overall, although some studies of CAM practices for arthritis have had promising results, the evidence generally is limited or mixed. A systematic review article on acupuncture for osteoarthritis concluded that acupuncture may lead to small improvements in pain and function. However, in a large clinical study, known as GAIT (Glucosamine/chondroitin Arthritis Intervention Trial), the popular dietary supplements glucosamine and chondroitin sulfate alone or in combination did not significantly relieve knee osteoarthritis pain among all participants, although the combination did help a subgroup of participants who had moderate-to-severe pain. Reviews have found evidence that γ-linolenic acid (from evening primrose and certain other plant oils) may relieve rheumatoid arthritis pain, although further research is needed. Reviews have also noted evidence that dietary supplements known as avocado-soybean unsaponifiables and devil’s claw may provide relief from osteoarthritis pain.

Headache
Reviews of research on acupuncture for reducing the frequency and intensity of migraine and tension-type headaches conclude that patients may benefit from acupuncture therapy. One review found evidence that spinal manipulation may help patients suffering from chronic tension-type or cervicogenic (neck-related) headaches. Some research suggests that the herb feverfew may prevent migraine attacks, but results from clinical trials are mixed, and additional research is needed.

Neck Pain
Reviews of research on manual therapies (primarily manipulation or mobilization) and acupuncture for chronic neck pain have found mixed evidence regarding potential benefits and have emphasized the need for additional research. One review noted that clinical guidelines often endorse the use of manual therapies for neck pain, although there is no overall consensus on the status of these therapies.

Other Pain
Various CAM approaches also have been studied for other types of chronic pain, such as facial pain, including from temporomandibular joint disorder; diabetic neuropathy and postherpetic neuropathy; cancer pain; and fibromyalgia. For example, a small study found that people with fibromyalgia may benefit from practicing tai chi. In general, research reviews have found some promising evidence of effectiveness for some CAM therapies but often emphasize that additional research is needed before treatment recommendations can be made.

Other CAM Approaches
People suffering from various types of chronic pain sometimes turn to other CAM practices, such as hypnotherapy, meditation, or qigong. Again, reviews of the research on these therapies have found some evidence of effectiveness but note the need for further studies. Although static magnets are widely marketed for pain control, a review of the related research concludes that the evidence does not support this practice.

Scientific Evidence on CAM for Pain

Last updated on: April 15, 2015
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