Chronic Pain: In Depth
What Is Chronic Pain and Why Is It Important?
Chronic pain is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2012 National Health Interview Survey show that:
- About 25.3 million U.S. adults (11.2 percent) had pain every day for the previous 3 months.
- Nearly 40 million adults (17.6 percent) had severe pain.
- Individuals with severe pain had worse health, used more health care, and had more disability than those with less severe pain.
Chronic pain becomes more common as people grow older, at least in part because health problems that can cause pain, such as osteoarthritis, become more common with advancing age. Military veterans are another group at increased risk for chronic pain; U.S. national survey data show that both pain in general and severe pain are more common among veterans than nonveterans.
Not all people with chronic pain have a health problem diagnosed by a health care provider, but among those who do, the most frequent conditions by far are low-back pain or osteoarthritis, according to a national survey. Other common diagnoses include rheumatoid arthritis, migraine, carpal tunnel syndrome, and fibromyalgia. The annual economic cost of chronic pain in the United States, including both treatment and lost productivity, has been estimated at up to $635 billion.
Chronic pain may result from an underlying disease or health condition, an injury, medical treatment (such as surgery), inflammation, or a problem in the nervous system (in which case it is called “neuropathic pain”); or the cause may be unknown. Pain can affect quality of life and productivity, and it may be accompanied by difficulty in moving around, disturbed sleep, anxiety, depression, and other problems.1
For more information about chronic pain, visit the National Institute of Neurological Disorders and Stroke.
What the Science Says About Complementary Health Approaches for Chronic Pain
The scientific evidence suggests that some complementary health approaches may help people manage chronic pain.
A comprehensive description of scientific research on all the complementary approaches that have been studied for chronic pain is beyond the scope of this fact sheet. This section highlights the research status of some approaches used for common kinds of pain.
Some recent research has looked at the effects of complementary approaches on chronic pain in general rather than on specific painful conditions.
- A 2017 review looked at complementary approaches with the opioid crisis in mind, to see which ones might be helpful for relieving chronic pain and reducing the need for opioid therapy to manage pain. There was evidence that acupuncture, yoga, relaxation techniques, tai chi, massage, and osteopathic or spinal manipulation may have some benefit for chronic pain, but only for acupuncture was there evidence that the technique could reduce a patient’s need for opioids.
- Research shows that hypnosis is moderately effective in managing chronic pain, when compared to usual medical care. However, the effectiveness of hypnosis can vary from one person to another.
- A 2017 review of studies of mindfulness meditation for chronic pain showed that it is associated with a small improvement in pain symptoms.
- Studies have shown that music can reduce self-reported pain and depression symptoms in people with chronic pain.
- A 2017 evaluation of the research on acupuncture found evidence that it has a small beneficial effect on acute low-back pain and a moderate beneficial effect on chronic low-back pain. Based on this evaluation, a 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for management of both acute and chronic low-back pain.
- Massage therapy might provide short-term relief from low-back pain, but the evidence is not of high quality. Massage has not been shown to have long-term benefits for low-back pain. The 2017 ACP guideline included massage therapy as an option for acute but not chronic low-back pain.
- A 2017 research review concluded that mindfulness-based stress reduction is associated with improvements in pain intensity and physical functioning in low-back pain, compared to usual care, but the effect may be small and short term. The 2017 ACP guideline included mindfulness-based stress reduction as an option for chronic but not acute low-back pain.
- There is some evidence that progressive relaxation may help relieve low-back pain, but studies on this topic have been small and not of the highest quality. The 2017 ACP guideline included progressive relaxation as an option for chronic but not acute low-back pain.
- Spinal manipulation appears to be as effective as other therapies commonly used for chronic low-back pain, such as physical therapy, exercise, and standard medical care. The 2017 ACP guideline included spinal manipulation as an option for both acute and chronic low-back pain.
- A 2018 evaluation of the research on yoga for low-back pain by the Agency for Healthcare Research and Quality (AHRQ) found that it improved pain and function in both the short term (1 to 6 months) and intermediate term (6 to 12 months). The effects of yoga were similar to those of exercise. The 2017 ACP guideline included yoga as an option for chronic but not acute low-back pain.
- A 2016 evaluation of the research on herbal products for low-back pain found evidence that cayenne, administered topically (applied to the skin) can reduce pain. Two other herbal products used topically, comfrey and lavender essential oil, and two herbs used orally, white willow bark and devil’s claw, may also be helpful, but the evidence for these herbs is not as strong as that for cayenne.
- Studies of prolotherapy (a treatment involving repeated injections of irritant solutions) for low-back pain have had inconsistent results.
- For more information, see the National Center for Complementary and Integrative Health (NCCIH) webpage on low-back pain.
- There’s evidence that acupuncture has short-term benefits in relieving knee pain caused by osteoarthritis. Acupuncture hasn’t been shown to be helpful for osteoarthritis of the hip.
- A small amount of research suggests that massage may help reduce osteoarthritis symptoms.
- A 2017 review of the evidence by the AHRQ concluded that tai chi has short-term (up to 12 weeks) and medium-term (12 to 26 weeks) benefits on pain for people with knee osteoarthritis. There hasn’t been enough research to show whether it’s helpful for longer periods of time. Qi gong may have similar benefits, but little research has been done on it.
- Little research has been done on yoga for osteoarthritis; there’s only weak evidence of a possible benefit.
- The 2017 AHRQ report concluded that one type of electromagnetic therapy, called pulsed electromagnetic field therapy, may have a short-term beneficial effect on knee osteoarthritis pain, but the strength of the evidence for an effect was low.
- The 2017 AHRQ report evaluated whole-body vibration (an approach in which a person does exercises on a vibrating platform) for knee osteoarthritis and found that its effects on pain were inconsistent.
- Studies of glucosamine, chondroitin, and S-adenosyl-L-methionine (SAMe) for knee osteoarthritis pain have had conflicting results.
- There isn’t enough research on dimethyl sulfoxide (DMSO) or methylsulfonylmethane (MSM) for osteoarthritis pain to allow conclusions to be reached.
- For more information, see the NCCIH fact sheet on osteoarthritis.
- The amount of research on mind and body practices for rheumatoid arthritis pain is too small for conclusions to be reached about their effectiveness.
- Dietary supplements containing omega-3 fatty acids, gamma-linolenic acid (GLA), or the herb thunder god vine may help relieve rheumatoid arthritis symptoms.
- For more information, see the NCCIH fact sheet on rheumatoid arthritis.
- There’s moderate-quality evidence that acupuncture may reduce the frequency of migraines and moderate-to-low quality evidence that it may reduce the frequency of tension headaches.
- Because not much research has been done or because research results are inconsistent, it’s uncertain whether biofeedback, massage, relaxation techniques, spinal manipulation, tai chi, and yoga are helpful for headaches.
- Guidelines from the American Academy of Neurology and the American Headache Society classify butterbur as effective; feverfew, magnesium, and riboflavin as probably effective; and coenzyme Q10 as possibly effective for preventing migraines.
- For more information, see the NCCIH fact sheet on headaches.
- Acupuncture hasn’t been studied as extensively for neck pain as for some other pain conditions. However, the studies that have been done suggest that acupuncture is helpful for neck pain, although its effect may not persist for long.
- Massage therapy may provide short-term relief from neck pain, especially if massage sessions are relatively lengthy and frequent, but it doesn’t appear to be more effective than other therapies.
- Spinal manipulation may be helpful for short-term relief of neck pain, but the evidence favoring it is not of high quality.
- It’s uncertain whether acupuncture is helpful for fibromyalgia pain.
- Although some studies of tai chi, yoga, mindfulness, and biofeedback for fibromyalgia symptoms have had promising results, the evidence is too limited to allow definite conclusions to be reached about whether these approaches are helpful.
- There is insufficient evidence that any natural products can relieve fibromyalgia pain, with the possible exception of vitamin D supplements, which may reduce pain in people with fibromyalgia who have low vitamin D levels.
- Studies of homeopathy have not demonstrated that it is beneficial for fibromyalgia.
- For more information, see the NCCIH fact sheet on fibromyalgia.
- Hypnotherapy may be helpful for irritable bowel syndrome, but the quality of the evidence is not high.
- Probiotics may be helpful for irritable bowel syndrome, but it’s still uncertain which types of probiotics are most likely to be effective and which symptoms they may relieve.
- The small amount of research on peppermint oil suggests that at least some formulations might be helpful for irritable bowel symptoms.
- Studies of acupuncture for irritable bowel syndrome have not found actual acupuncture to be more helpful than simulated acupuncture.
- For more information, see the NCCIH fact sheet on irritable bowel syndrome.
- Various complementary approaches have been studied for other types of chronic pain, such as nerve pain, chronic pelvic pain, pain associated with endometriosis, carpal tunnel syndrome, pain associated with gout, and cancer pain. There’s promising evidence that some complementary approaches may be helpful for some of these types of pain, but the evidence is insufficient to clearly establish their effectiveness.
- There’s some evidence that cannabis (marijuana)-based medicines (i.e., cannabinoids) may be helpful for chronic nerve (neuropathic) pain and perhaps other types of chronic pain, but it’s unclear whether the potential benefits are greater than the potential harms. Further research is needed that meets U.S. Food and Drug Administration (FDA) requirements for determining the safety and efficacy of cannabinoids for the management of pain.
- It’s unclear whether kratom has an effect on chronic pain because of a lack of studies of this substance in people.
- There’s a lack of high-quality research to definitively evaluate whether Reiki is of value for pain relief.
- Although static magnets are widely marketed for pain control, the evidence does not support their use.
What the Science Says About Safety and Side Effects
As with any treatment, it’s important to consider safety before using complementary health approaches. Safety depends on the specific approach and on the health of the person using it. If you’re considering or using a complementary approach for pain, check with your health care providers to make sure it’s safe for you.
- Mind and body practices, such as acupuncture, hypnosis, massage therapy, mindfulness/meditation, relaxation techniques, spinal manipulation, tai chi/qi gong, and yoga, are generally safe for healthy people if they’re performed appropriately.
- People with medical conditions and pregnant women may need to modify or avoid some mind and body practices.
- Like other forms of exercise, mind and body practices that involve movement, such as tai chi and yoga, can cause sore muscles and may involve some risk of injury.
- It’s important for practitioners and teachers of mind and body practices to be properly qualified and to follow appropriate safety precautions.
- See the Health Topics A–Z list on the NCCIH website for resources about specific mind and body practices, including information about their safety.
- "Natural” doesn’t always mean “safe.” Some natural products (dietary supplements) may have side effects and may interact with medications.
- The U.S. Food and Drug Administration has warned the public about several dietary supplements promoted for arthritis or pain that were tainted with prescription drugs.
- See the Health Topics A–Z list on the NCCIH website for resources about specific natural products, including information about their safety. For information on dietary supplements in general, see NCCIH’s webpage Dietary and Herbal Supplements.
NCCIH is part of the National Institutes of Health (NIH) Pain Consortium, which coordinates pain research across NIH. NCCIH-supported studies are helping to build an evidence base on the effectiveness and safety of complementary modalities for treating chronic pain.
NCCIH is also the lead agency in the Pain Management Collaboratory, an initiative jointly supported by NIH, the Department of Defense, and the Department of Veterans Affairs. The goal of the collaboratory is to develop the capacity to implement cost-effective large-scale pragmatic clinical research in military and veteran health care delivery organizations focusing on nonpharmacologic approaches to pain and other conditions that may occur along with it.
NCCIH-supported studies in progress are investigating a variety of topics related to chronic pain, including the following:
- Whether tai chi is helpful for chronic low-back pain in older adults
- The potential value of probiotics for relieving pelvic pain associated with interstitial cystitis/bladder pain syndrome
- Whether progressive muscle relaxation is helpful for patients who visit emergency departments because of migraine
- The relationship between the availability of chiropractic care and the use of health services for back pain by older adults.
NCCIH’s Division of Intramural Research conducts research focusing on the role of the brain in perceiving, modifying, and managing pain. Research topics 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.
In light of the human and economic costs of chronic pain, as well as evidence that many people who have chronic pain turn to complementary health approaches for relief, NCCIH places a high priority on pain-related research. Researchers in this area face unique challenges: much remains to be understood about the nature of chronic pain and about the best ways of studying its many causes, people’s different responses, and the value of various treatment approaches—complementary and conventional. The ultimate goal 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 minimize pain, carry out everyday activities, and improve their quality of life.
While building an evidence base to help people with chronic pain and their health care providers make decisions about pain management, research on complementary health approaches is also helping to close gaps in our basic understanding of pain mechanisms.
If You Are Considering Complementary Health Approaches for Chronic Pain
- Don’t use an unproven product or practice to postpone seeing a health care provider about chronic pain or any other health problem.
- Learn about the product or practice you are considering, especially the scientific evidence on its safety and whether it works.
- Talk with the health care providers you see for chronic pain. Tell them about the product or practice you’re considering and ask any questions you may have. They may be able to advise you on its safety, use, and likely effectiveness.
- If you’re considering a practitioner-provided complementary health approach such as spinal manipulation, massage, or acupuncture, ask a trusted source (such as your health care provider or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. Ask whether the practitioner has experience working with your pain condition.
- If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider. To learn more, visit NCCIH’s webpage on dietary supplements.
1Certain chronic conditions, several of which cause pain, may occur together; some individuals have two or more of these problems. These conditions include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, temporomandibular joint dysfunction, and vulvodynia (chronic vulvar pain). It is not known whether these disorders share a common cause.
For More Information
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
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National Institute of Neurological Disorders and Stroke (NINDS)
NINDS conducts and supports research on how the brain and nervous system function and on treatments for neurological diseases.
Toll-free in the U.S.: 1-800-352-9424
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
Toll-free in the U.S.: 1-877-22-NIAMS
A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.
Cochrane Database of Systematic Reviews
The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews produced by the Cochrane Library, an international nonprofit organization. The reviews summarize the results of clinical trials on health care interventions. Summaries are free; full-text reviews are by subscription only.
NIH Clinical Research Trials and You
The National Institutes of Health (NIH) has created a website, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
- Agency for Healthcare Research and Quality. Treatment of Osteoarthritis of the Knee: An Update Review. Comparative Effectiveness Review no. 190. Rockville, MD: Agency for Healthcare Research and Quality; 2017.
- Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine. 2017;166(7):493-505.
- Ford AC, Moayyedi P, Chey WD, et al. American College of Gastroenterology monograph on management of irritable bowel syndrome. American Journal of Gastroenterology. 2018;113(Suppl 2):1-18.
- Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;(9):CD001929. Accessed at www.cochranelibrary.com on July 20, 2018.
- Garza-Villareal E, Pando V, Vuust P, et al. Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis. Pain Physician. 2017;20(7):597-610.
- Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews. 2015;(9):CD004249. Accessed at www.cochranelibrary.com on July 20, 2018.
- Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management – an overview of systematic reviews. European Journal of Pain. 2018;22(3):455-470.
- Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research. 2012;64(4):465-474.
- Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press website. Accessed at https://www.nap.edu/catalog/13172/relieving-pain-in-america-a-blueprint-for-transforming-prevention-care on July 25, 2018.
- Lin Y-C, Wan L, Jamison RN. Using integrative medicine in pain management: an evaluation of current evidence. Anesthesia and Analgesia. 2017;125(6):2081-2093.
- Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2012;(5):CD005111. Accessed at www.cochranelibrary.com on July 20, 2018.
- Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. 2016;91(9):1291-1306.
- Nahin RL. Estimates of pain prevalence and severity in adults: United States. 2012. Journal of Pain. 2015;16(8);769-780.
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.
- Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews. 2011;(2):CD008112 [edited 2013]. Accessed at www.cochranelibrary.com on July 24, 2018.
- Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. Journal of Pain. 2018;19(5):455-474.
- Adachi T, Fujino H, Nakae A, et al. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. International Journal of Clinical and Experimental Hypnosis. 2014;62(1):1-28.
- Adams D, Cheng F, Jou H, et al. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011;128(6):e1575-1587.
- Andrés M, Sivera F, Falzon L, et al. Dietary supplements for chronic gout. Cochrane Database of Systematic Reviews. 2014;(10):CD010156. Accessed at www.cochranelibrary.com on July 24, 2018.
- Anheyer D, Haller H, Barth J, et al. Mindfulness-based stress reduction for treating low back pain: a systematic review and meta-analysis. Annals of Internal Medicine. 2017;166(11):799-807.
- Astin JA, Shapiro SL, Eisenberg DM, et al. Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice. 2003;16(2):131-147.
- Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20(6):E755-E796
- Brien S, Prescott P, Bashir N, et al. Systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis. Osteoarthritis and Cartilage. 2008;16(11):1277-1288.
- Brien S, Prescott P, Lewith G. Meta-analysis of the related nutritional supplements dimethyl sulfoxide and methylsulfonylmethane in the treatment of osteoarthritis of the knee. Evidence–Based Complementary and Alternative Medicine: eCAM. 2011;2011:528403.
- Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2011;(2):CD002948. Accessed at www.cochranelibrary.com on July 20, 2018.
- Carinci AJ, Pathak R, Young M, et al. Complementary and alternative treatments for chronic pelvic pain. Current Pain and Headache Reports. 2013;17:316
- Carlson LE, Zelinski E, Toivonen K, et al. Mind-body therapies in cancer: what is the latest evidence? Current Oncology Reports. 2017;19:67.
- Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. Journal of Headache and Pain. 2012;13(5):351-359.
- Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. Journal of Headache and Pain. 2011;12(2):127-133.
- Chyu M-C, von Bergen V, Brismée J-M, et al. Complementary and alternative exercises for management of osteoarthritis. Arthritis. 2011;2011:364319.
- Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One. 2013;8(10):e75515.
- Cramer H, Lauche R, Langhorst J, et al. Yoga for rheumatic diseases: a systematic review. Rheumatology. 2013;52(11):2025-2030.
- Cramer H, Ostermann T, Dobos G. Injuries and other adverse events associated with yoga practice: a systematic review of epidemiological studies. Journal of Science and Medicine in Sport. 2018;21(2): 147-154.
- Cramer H, Ward L, Saper R, et al. The safety of yoga: a systematic review and meta-analysis of randomized controlled trials. American Journal of Epidemiology. 2015;182(4):281-293.
- Creswell JD. Mindfulness interventions. Annual Review of Psychology. 2017;68:491-516.
- Dagenais S, Yelland MJ, Del Mar C, et al. Prolotherapy injections for chronic low-back pain. Cochrane Database of Systematic Reviews. 2007;(2):CD004059 [edited 2010]. Accessed at www.cochranelibrary.com on June 25, 2018.
- Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews. 2013;(5):CD007070. Accessed at www.cochranelibrary.com on July 24, 2018.
- Debbi EM, Agar G, Fichman G, et al. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC Complementary and Alternative Medicine. 2011;11:50.
- Demir Do?an M. The effect of reiki on pain: a meta-analysis. Complementary Therapies in Clinical Practice. 2018;31:384-387.
- Derry S. Rice ASC, Cole P, et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017;(1):CD007393. Accessed at www.cochranelibrary.com on July 11, 2018.
- De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology. 2010;49(6):1063-1068.
- De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology. 2011;50(5):911-920.
- Didari T, Mozaffari S, Nikfar S, et al. Effectiveness of probiotics in irritable bowel syndrome: updated systematic review with meta-analysis. World Journal of Gastroenterology. 2015;21(10):3072-3084.
- Dissanayake RK, Bertouch JV. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review. International Journal of Rheumatic Diseases. 2010;13(4):324-334.
- Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Supportive Care in Cancer. 2009;17(4):333-337.
- Flower A, Liu JP, Lewith G, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews. 2012;(5):CD006568. Accessed at www.cochranelibrary.com on July 20, 2018.
- Gagnier JJ, Oltean H, van Tulder MW, et al. Herbal medicine for low back pain: a Cochrane review. Spine. 2016;41(2):116-133.
- Hall A, Copsey B, Richmond H, et al. Effectiveness of tai chi for chronic musculoskeletal pain conditions: updated systematic review and meta-analysis. Physical Therapy. 2017;97(2):227-238.
- Happe S, Peikert A, Siegert R, et al. The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study. Neurological Sciences. 2016;37(10):1627-1632.
- Häuser W, Hagl M, Schmierer A, et al. The efficacy, safety and applications of medical hypnosis. Deutsches Arzteblatt International. 2016;113(17):289-296.
- Hedborg K, Muhr C. Multimodal behavioral treatment of migraine: an Internet-administered, randomized, controlled trial. Upsala Journal of Medical Sciences. 2011;116(3):169-186.
- Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews. 2010;(7):CD002014 [edited 2011]. Accessed at www.cochranelibrary.com on July 20, 2018.
- Hilton L, Hempel S, Ewing BA, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Annals of Behavioral Medicine. 2017;51(2):199-213.
- Jensen MP, Patterson DR. Hypnotic approaches for chronic pain management: clinical implications of recent research findings. American Psychologist. 2014;69(2):167-177.
- Johannes CB, Le TK, Zhou Z, et al. The prevalence of chronic pain in United States adults: results of an Internet–based survey. Journal of Pain. 2010;11(11):1230-1239.
- Ju ZY, Wang K, Cui HS, et al. Acupuncture for neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017;(12):CD012057. Accessed at www.cochranelibrary.com on July 11, 2018.
- Kim S-D. Effects of yoga exercises for headaches: a systematic review of randomized controlled trials. Journal of Physical Therapy Science. 2015;27(7):2377-2380
- Kong LJ, Zhan HS, Cheng YW, et al. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2013;2013;613279.
- Lauche R, Cramer H, Häuser W, et al. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evidence-Based Complementary and Alternative Medicine: eCAM. 2015;2015:610615.
- Leong FC. Complementary and alternative medications for chronic pelvic pain. Obstetrics and Gynecology Clinics of North America. 2014;41(3):503-510.
- Lin X, Huang K, Zhu G, et al. The effects of acupuncture on chronic knee pain due to osteoarthritis. A meta-analysis. Journal of Bone and Joint Surgery. American Volume. 2016;98(18):1578-1585.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews. 2016;(6):CD001218. Accessed at www.cochranelibrary.com on June 25, 2018.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews. 2016;(4):CD007587. Accessed at www.cochranelibrary.com on June 25, 2018.
- Lipton L. Using yoga to treat disease: an evidence-based review. JAAPA. 2008;21(2):34-36, 38, 41.
- Lustyk MK, Chawla N, Nolan RS, et al. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine. 2009;24(1):20-30.
- Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews. 2018;(5):CD13010. Accessed at www.cochranelibrary.com on June 25, 2018.
- Mazurak N, Broelz E, Storr M, et al. Probiotic therapy of the irritable bowel syndrome: Why is the evidence still poor and what can be done about it? Journal of Neurogastroenterology and Motility. 2015;21(4):471-485.
- Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. British Journal of Nutrition. 2012;107(suppl 2):S171-S184.
- Moran JM, Puerto-Parejo LM, Leal-Hernández O, et al. Misinterpretation of the results from meta-analysis about the effects of reiki on pain. Complementary Therapies in Clinical Practice. 2018;32:115
- Moraska AF, Stenerson L, Butryn N, et al. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clinical Journal of Pain. 2015;31(2):159-168.
- Mücke M, Phillips T, Radbruch L, et al. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2018;(3):CD012182. Accessed at www.cochranelibrary.com on July 12, 2018.
- Nahin RL. Severe pain in veterans: the impact of age and sex, and comparisons with the general population. Journal of Pain. 2017;18(3):247-254.
- National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids. The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press, 2017. Accessed at http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis… on July 19, 2018.
- Nelson NL, Churilla JR. Massage therapy for pain and function in patients with arthritis. A systematic review of randomized controlled trials. American Journal of Physical Medicine and Rehabilitation. 2017;96(9):665-672.
- Nestoriuc Y, Martin A, Rief W, et al. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Applied Psychophysiology and Biofeedback. 2008;33(3):125-140.
- Nielsen SM, Tarp S, Christensen R, et al. The risk associated with spinal manipulation: an overview of reviews. Systematic Reviews. 2017;6(1):64.
- Nugent SM, Morasco BJ, O’Neil ME, et al. The effects of cannabis among adults with chronic pain and an overview of general harms. A systematic review. Annals of Internal Medicine. 2017;167(5):319-331.
- Paley CA, Johnson MI, Tashani OA, et al. Acupuncture for cancer pain in adults. Cochrane Database of Systematic Reviews. 2015;(10):CD007753. Accessed at www.cochranelibrary.com on July 24, 2018.
- Perry R, Leach V, Davies P, et al. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. Systematic Reviews. 2017;6(1):97.
- Phang JK, Kwan YH, Goh H, et al. Complementary and alternative medicine for rheumatic diseases: a systematic review of randomized controlled trials. Complementary Therapies in Medicine. 2018;37:143-157.
- Pittler MH, Brown EM, Ernst E. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ. 2007;177(7):736-742.
- Posadzki P, Ernst E. Spinal manipulations for cervicogenic headaches: a systematic review of randomized clinical trials. Headache. 2011;51(7):1132-1139.
- Posadzki P, Ernst E. Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials. Cephalalgia. 2011;31(8):964-970.
- Posadzki P, Ernst E. Spinal manipulations for tension-type headaches: a systematic review of randomized controlled trials. Complementary Therapies in Medicine. 2012;20(4):232-239.
- Rodriguez MA, Afari N, Buchwald DS. Evidence for overlap between urological and nonurological unexplained clinical conditions. Journal of Urology. 2009;182(5):2123-2131.
- Rutjes AWS, Nüesch E, Reichenbach S, et al. S-Adenosylmethionine for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews. 2009;(4):CD007321. Accessed at www.cochranelibrary.com on June 26, 2018.
- Senftleber NK, Nielsen SM, Andersen JR, et al. Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. Nutrients. 2017;9(1):E42.
- Sharma M. Yoga as an alternative and complementary approach for arthritis: a systematic review. Journal of Evidence-Based Complementary & Alternative Medicine. 2014;19(1):51-58.
- Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Comparative Effectiveness Review no. 209. Rockville, MD: Agency for Healthcare Research and Quality; 2018. AHRQ publication no. 18-EHC013-EF.
- Sim H, Shin B-C, Lee MS, et al. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. Journal of Pain. 2011;12(3):307-314.
- Stubberud A, Varkey E, McCrory DC, et al. Biofeedback as prophylaxis for pediatric migraine: a meta-analysis. Pediatrics. 2016;138(2):e20160675.
- Swain TA, McGwin G. Yoga-related injuries in the United States from 2001 to 2014. Orthopaedic Journal of Sports Medicine. 2016;4(11):2325967116671703.
- Theadom A, Cropley M, Smith HE, et al. Mind and body therapy for fibromyalgia. Cochrane Database of Systematic Reviews. 2015;(4):CD001980. Accessed at www.cochranelibrary.com on July 24, 2018.
- Uhlig T. Tai chi and yoga as complementary therapies in rheumatologic conditions. Best Practice & Research. Clinical Rheumatology. 2012;26(3):387-398.
- Ulbricht C, Costa D, Dao J, et al. An evidence-based systematic review of kratom (Mitragyna speciosa) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2013;10(2):152-170.
- vanderVaart S, Gijsen VM, de Wildt SN, et al. A systematic review of the therapeutic effects of Reiki. Journal of Alternative and Complementary Medicine. 2009;15(11):1157-1169.
- Verhagen AP, Damien L, Berger JY, et al. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neuroscience & Therapeutics. 2009;15(2):183-205.
- Wayne PM, Berkowitz DL, Litrownik DE, et al. What do we really know about the safety of tai chi? A systematic review of adverse event reports in randomized trials. Archives of Physical Medicine and Rehabilitation. 2014;95(12):2470-2483.
- Wepner F, Scheuer R, Schuetz-Wieser B, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014;155(2):261-268.
- Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine: eCAM. 2013;2013:581203.
- Yin P, Gao N, Wu J, et al. Adverse events of massage therapy in pain-related conditions: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2014;480956.
- Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis. Cochrane Database of Systematic Reviews. 2011;(9):CD007864. Accessed at www.cochranelibrary.com on July 24, 2018
NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2018 update of this publication.
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