Chronic Pain: What You Need To Know
What’s the Bottom Line?
How much do we know about the effectiveness of complementary health approaches for chronic pain?
- A growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.
What do we know about the safety of complementary health approaches for chronic pain?
- Although the psychological and/or physical approaches (e.g., acupuncture, meditation, yoga, massage) studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches. If you’re considering nutritional approaches such as dietary supplements, remember that natural doesn’t always mean safe and that some dietary supplements may have side effects or interact with medications.
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 2019 National Health Interview Survey (NHIS) show that:
- About 20.4 percent of U.S adults had chronic pain (defined as pain on most days or every day in the past 3 months).
- About 7.4 percent of U.S. adults had high-impact chronic pain (defined as chronic pain that limited their life or work activities on most days or every day for the past 3 months).
Chronic pain becomes more common as people grow older, at least in part because some 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. Chronic pain is more common in rural areas than urban areas in the United States.
Analysis of data from the 2010–2017 NHIS Sample Adult Core and Adult Functioning and Disability Supplement show that prevalence of chronic pain varies by race and Hispanic origin, with a recent publication suggesting the highest percentage among non-Hispanic American Indian/Alaska Native respondents and the lowest among non-Hispanic Asians.
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 are low-back pain or osteoarthritis, according to a national survey. Other common diagnoses include rheumatoid arthritis, migraine, carpal tunnel syndrome, and fibromyalgia.
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 website.
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.
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.
Chronic Pain in General
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.
- Products containing substances from cannabis (marijuana), which typically include both tetrahydrocannabinol (THC) and cannabidiol (CBD), have been tested for their effects on chronic pain in short-term studies. Oral products with high THC/CBD ratios and sublingual (under-the-tongue) products with roughly equal amounts of THC and CBD may reduce chronic pain in the short term but may also have side effects including dizziness and sleepiness. Not much is known about other cannabinoid formulations or the effects of long-term use.
- Hypnosis may reduce chronic pain if patients participate in enough sessions (at least eight), according to a few studies.
- Studies on chronic pain showed that mindfulness-based interventions and cognitive behavioral therapy are both helpful in decreasing pain intensity and improving physical functioning, with no important difference between the two approaches. Cognitive behavioral therapy is the prevailing psychological intervention for chronic pain.
- Studies have shown that music-based interventions can reduce self-reported pain and depression symptoms in people with chronic pain. Effects were greater when the patient, rather than the researcher, chose the music.
Back and Neck Pain
- A large review of individual data from multiple studies showed that acupuncture was more effective than either no treatment or sham (fake) acupuncture for back or neck pain. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. 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.
- Evaluations of massage therapy for low-back pain have found weak evidence that it may be helpful. The ACP guideline recommends massage as an option for acute low-back pain, based on low-quality evidence, but does not recommend massage for chronic low-back pain. Massage therapy may be helpful for neck pain, but the benefits may only last for a short time.
- Studies show that mindfulness-based stress reduction is associated with a small improvement in chronic low-back pain. The ACP guideline recommends mindfulness-based stress reduction as an option for chronic low-back pain, based on moderate-quality evidence.
- Progressive muscle relaxation is one of several nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline. There is evidence that this technique can lead to moderate improvements in low-back pain and back function.
- Biofeedback may moderately improve low-back pain. It is one of the nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline.
- The 2017 ACP guideline includes spinal manipulation as an option for treating both acute and chronic low-back pain. There is low-to-moderate quality evidence that spinal manipulation can reduce pain and improve function in people with chronic nonspecific neck pain.
- Tai chi, either alone or in addition to physical therapy, may decrease the intensity of pain and improve everyday function in people with low-back pain. The ACP guideline includes tai chi as an option for treatment of chronic low-back pain.
- Studies of yoga for low-back pain have shown yoga to be helpful in both the short term (1 to just under 6 months) and intermediate term (6 to just under 12 months). The effects of yoga are similar to those of other types of exercise. The 2017 ACP guideline included yoga as an option for initial treatment of chronic but not acute low-back pain. Practicing yoga has been shown to reduce both the intensity of neck pain and disability related to neck pain.
- Several types of herbal preparations have been evaluated for low-back pain. There is evidence that topical products containing the herb cayenne, such as creams and plasters, can reduce pain. Topical products that contain two other herbs, 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.
For more information, see the National Center for Complementary and Integrative Health (NCCIH) fact sheet on low-back pain.
- Acupuncture may be helpful for knee pain associated with osteoarthritis. There’s less evidence on whether it’s helpful for osteoarthritis of the hip. The 2019 clinical practice guideline from the American College of Rheumatology and the Arthritis Foundation conditionally (i.e., weakly) recommends the use of acupuncture for arthritis of the hand, hip, or knee but acknowledges that the evidence on acupuncture is controversial and that most of the studies that have shown beneficial effects have been for knee osteoarthritis.
- Low-to-moderate quality evidence suggests that massage may help reduce pain associated with arthritis; most of the research has been on osteoarthritis rather than rheumatoid arthritis. However, the guideline from the American College of Rheumatology and the Arthritis Foundation conditionally (i.e., weakly) recommends against the use of massage therapy for the management of osteoarthritis of the hip or knee because of weaknesses in the scientific evidence.
- In research studies, people with osteoarthritis who practiced tai chi experienced improvements in pain, stiffness, balance, and physical function. The guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends tai chi for the management of osteoarthritis of the knee or hip.
- A limited amount of research suggests that yoga may be helpful for improving pain, function, and stiffness in people with osteoarthritis of the knee. The guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends yoga for patients with knee osteoarthritis based on similarities to tai chi, which has been studied more extensively.
- In their guideline for the management of osteoarthritis of the hand, hip, and knee, the American College of Rheumatology and the Arthritis Foundation strongly recommend against the use of glucosamine for people with arthritis in any of these three body sites. The rationale is that studies with the lowest risk of bias have not shown glucosamine to work better than a placebo (an inactive substance). The guideline also recommends against the use of chondroitin or combination glucosamine/chondroitin products for osteoarthritis of the hip or knee. It conditionally recommends for the use of chondroitin for hand osteoarthritis, however, based on a single study that showed a pain-relieving effect, as well as chondroitin’s apparent safety.
- The guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends against the use of fish oil for osteoarthritis because only one study exists, and that study did not show efficacy of a higher dose of fish oil over a lower dose. The guideline conditionally recommends against the use of vitamin D for osteoarthritis because the overall evidence does not show a benefit.
- There isn’t enough research on dimethyl sulfoxide (DMSO) or methylsulfonylmethane (MSM) for osteoarthritis pain to allow conclusions to be reached. The evidence on S-adenosyl-L-methionine (SAMe) for osteoarthritis of the knee or hip is inconclusive.
For more information, see the NCCIH fact sheet on osteoarthritis.
- The term balneotherapy refers to bathing in mineral water for health purposes and related techniques such as mud packs. There’s evidence that balneotherapy may be helpful for improving quality of life in people with rheumatoid arthritis.
- Omega-3 fatty acids of the types found in fish oil may have beneficial effects on rheumatoid arthritis when used in addition to conventional drug therapy.
- No nutritional approach other than omega-3 fatty acids has shown clear benefits for rheumatoid arthritis, but there is preliminary evidence for a few dietary supplements, particularly gamma-linolenic acid (contained in evening primrose oil, borage seed oil, and black current seed oil) and the herb thunder god vine.
- A few small studies have evaluated tai chi in people with rheumatoid arthritis, but it’s uncertain whether this approach is helpful.
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. Studies that compared acupuncture with various drugs for preventing migraine found that acupuncture was slightly more effective and that study participants who received acupuncture were much less likely than those who received drugs to drop out of studies because of side effects.
- Studies of electromyography (EMG) biofeedback, a type of biofeedback involving measurements of muscle tension, have found this technique helpful for tension headaches.
- Some studies of relaxation techniques for migraines or tension headaches have shown improvements, including a reduction in headache frequency, in people who used the techniques. The evidence is strongest for relaxation techniques used in combination with cognitive behavioral therapy.
- Spinal manipulation may reduce the frequency and intensity of cervicogenic headaches (head pain that originates from a problem in the neck). Preliminary evidence suggests it may also be helpful for migraines.
- A small amount of research suggests that practicing yoga may reduce headache frequency, headache duration, and pain intensity, with beneficial effects seen primarily in tension headaches rather than migraines.
- Several dietary supplements have been studied for migraines. There is some evidence that coenzyme Q10, feverfew, magnesium, and the B vitamin riboflavin might help reduce the frequency of migraines. For all these supplements, the amount of evidence is small. The herb butterbur appears to reduce the frequency of migraines. However, serious concerns have been raised about possible liver toxicity from butterbur.
- The results of a recent study showed that diets high in omega-3 fatty acids may be helpful for migraines. Omega-3 supplements have not been shown to make migraines less frequent or severe, but a small amount of evidence suggests that they might reduce the duration of migraine attacks.
For more information, see the NCCIH fact sheet on headaches.
- Low-to-moderate quality evidence suggests that acupuncture is helpful for pain associated with fibromyalgia.
- Several studies show that massage therapy, if continued for 5 weeks or longer, may reduce pain and improve other symptoms in people with fibromyalgia.
- A small amount of research suggests that tai chi can help reduce pain and improve other symptoms in people with fibromyalgia.
- The term balneotherapy refers to bathing in mineral water for health purposes and related techniques such as mud packs. There’s evidence that balneotherapy may be helpful for some symptoms of fibromyalgia.
- The effectiveness of biofeedback, mindfulness, movement therapies, and relaxation-based therapies for fibromyalgia is unclear because the quality of the evidence on these approaches is low.
- Supplementation with vitamin D may reduce fibromyalgia pain, particularly in individuals with vitamin D deficiency.
- There is insufficient evidence that other dietary supplements can relieve fibromyalgia pain.
For more information, see the NCCIH fact sheet on fibromyalgia.
Irritable Bowel Syndrome
- The evidence suggests that acupuncture is no more effective than sham acupuncture for irritable bowel syndrome (IBS) symptoms, but it may be helpful when used in addition to other forms of treatment.
- The 2021 American College of Gastroenterology (ACG) guideline for treatment of IBS suggests that gut-directed hypnotherapy or other gut-directed psychotherapies can be used to treat global IBS symptoms in some patients, but the quality of the evidence is very low.
- Probiotics may be helpful for symptoms of IBS, but different strains of probiotics may have different effects. The 2021 ACG guideline suggests that probiotics should not be used for the treatment of IBS symptoms because the current evidence doesn’t clearly show which probiotics might be helpful.
- Studies on peppermint have suggested that it may be helpful for overall symptoms and abdominal pain in people with IBS, and the ACG guideline suggests that it can be used, although the evidence is not strong.
For more information, see the NCCIH fact sheet on irritable bowel syndrome.
Less-Studied Complementary Approaches
- Research on the plant product kratom is in its early stages, and much more needs to be learned about its effects in the body, its safety, and whether it may have therapeutic uses, including possible use in the treatment of pain.
- Reiki is a complementary health approach in which practitioners place their hands lightly on or just above the person, with the goal of facilitating the person’s own healing response. There isn’t enough high-quality research to evaluate whether Reiki is helpful for relieving pain.
- Magnets. Both static magnets and electromagnets have been studied as treatments for pain. Static magnets have magnetic fields that don’t change. They may be put into products such as wristbands, shoe insoles, bracelets, and bed pads. There’s not much research on static magnets for pain, and there’s no conclusive evidence that they’re helpful for any type of pain. Electromagnets become magnetic when an electrical current charges the metal. Current research suggests that electromagnetic field therapy can relieve pain and improve function in patients with various musculoskeletal pain conditions and some osteoarthritis conditions, although the data are mixed.
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.
Safety of Psychological and Physical Approaches
- Psychological and physical complementary health approaches, such as acupuncture, hypnosis, massage therapy, mindfulness/meditation, music-based interventions, relaxation techniques, spinal manipulation, tai chi, qigong, and yoga, are generally safe for healthy people if they’re performed appropriately.
- People with medical conditions and people who are pregnant may need to modify or avoid some of these practices.
- Like other forms of exercise, complementary health 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.
Safety of Nutritional Approaches
- “Natural” doesn’t always mean “safe.” Some 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 general information on dietary supplements, see NCCIH’s webpage Dietary and Herbal Supplements.
Guidelines for the Treatment of Chronic Pain Conditions
National health professional organizations have issued guidelines for treating several chronic pain conditions that address the use of complementary health approaches.
- A clinical practice guideline from the American College of Physicians encourages the use of nonpharmacologic approaches as initial treatment for chronic low-back pain. The options they suggest include several complementary approaches—acupuncture, mindfulness-based stress reduction, tai chi, yoga, progressive relaxation, biofeedback, and spinal manipulation—as well as conventional methods such as exercise and cognitive behavioral therapy.
- The American College of Rheumatology and the Arthritis Foundation have published a guideline for the management of osteoarthritis of the hand, hip, or knee that includes recommendations for or against the use of a variety of complementary health approaches. For example, the guideline strongly recommends for the use of tai chi for osteoarthritis of the hip or knee and strongly recommends against the use of glucosamine for osteoarthritis at any of the three body sites. The guideline’s recommendations are discussed in more detail in the Osteoarthritis section of this fact sheet.
- The American College of Gastroenterology clinical guideline for irritable bowel syndrome includes conditional (weak) recommendations in favor of peppermint and gut-directed psychotherapies (a group of therapies that includes gut-directed hypnotherapy). The guideline includes a conditional recommendation against the use of probiotics.
- The 2022 Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain concludes: “Evidence exists that multiple noninvasive nonpharmacologic interventions improve chronic pain and function, with small to moderate effects in specific pain conditions, and are not associated with serious harms.” Several of the nonpharmacologic approaches discussed in this fact sheet, such as acupuncture, massage therapy, mindfulness-based interventions, tai chi, and yoga, are mentioned in the CDC practice guideline as being appropriate for some types of chronic pain. The guideline recommends maximizing pain treatment with nonpharmacologic and nonopioid pharmacologic treatments as appropriate.
For more information, see NCCIH’s webpage Pain Information for Health Professionals.
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 U.S. Department of Veterans Affairs. The Collaboratory is conducting clinical trials of nondrug approaches for the management of pain and co-occurring conditions in the military and veterans health care systems.
NCCIH is playing a major role in the Helping to End Addiction Long-term Initiative®, or NIH HEAL Initiative®, an NIH-wide effort focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management. NCCIH is leading or co-leading several NIH HEAL Initiative programs that focus on pain management.
NCCIH is leading the Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM) program within the NIH HEAL Initiative. PRISM supports pragmatic trial research projects embedded in health care systems. These trials will determine the effectiveness of multiple nonpharmacologic and nonopioid interventions for treating pain and assess the impact of implementing interventions or guidelines to improve pain management and reduce reliance on opioids.
More About NCCIH-Funded Pain Research
NCCIH-supported studies in progress are investigating a variety of topics related to chronic pain, including:
- The effect of a combination of chiropractic care and tai chi in people with chronic neck pain
- The brain mechanisms by which mindfulness meditation may help to relieve chronic pain
- The feasibility of a group-based yoga intervention for women with chronic pelvic pain
- The possible effects of light at night and disrupted circadian rhythms on pain
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.
If You're 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.
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
Telecommunications relay service (TRS): 7-1-1
Email: firstname.lastname@example.org (link sends email)
Know the Science
NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.
Explaining How Research Works (NIH)
Know the Science: 9 Questions To Help You Make Sense of Health Research
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.
Complementary Health Approaches for Chronic Pain—Randomized Controlled Trials
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.
- Cheng C-A, Chiu Y-W, Wu D, et al. Effectiveness of tai chi on fibromyalgia patients: a meta-analysis of randomized controlled trials. Complementary Therapies in Medicine. 2019;46:1-8.
- 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.
- Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic nonspecific neck pain: a systematic review and meta-analysis for an appropriateness panel. Pain Physician. 2019;22(2):E55-E70.
- Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR. Morbidity and Mortality Weekly Report. 2022;71(3):1-95.
- Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;(9):CD001929. Accessed at cochranelibrary.com on November 8, 2022.
- Garza-Villareal EA, 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.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press website. Accessed at nap.edu/catalog/13172/relieving-pain-in-america-a-blueprint-for-transforming-prevention-care on November 8, 2022.
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72(2):220-233.
- Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. American Journal of Gastroenterology. 2021;116(1):17-44.
- 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.
- 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.
- Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headache. 2019;59(4):532-542.
- 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.
- Adams D, Cheng F, Jou H, et al. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011;128(6):e1575-1587.
- Agency for Healthcare Research and Quality. Noninvasive Treatments for Low Back Pain. AHRQ Publication No. 16-EHC004-EF. February 2016. Agency for Healthcare Research and Quality website. Accessed at https://effectivehealthcare.ahrq.gov/products/back-pain-treatment/research on December 5, 2022.
- American Academy of Pediatrics Section on Integrative Medicine. Mind-body therapies in children and youth. Pediatrics. 2016;138(3):e20161896.
- 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.
- Baldwin AL, Vitale A, Brownell E, et al. The touchstone process: an ongoing critical evaluation of Reiki in the scientific literature. Holistic Nursing Practice. 2010;24(5):260-276.
- Bradt J, Dileo C, Magill L, et al. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database of Systematic Reviews. 2021;(10):CD006911. Accessed at cochranelibrary.com on December 8, 2022.
- Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews. 2013;(6):CD006908. Accessed at cochranelibrary.com on December 8, 2022.
- 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 cochranelibrary.com on June 10, 2022.
- Chang P-S, Knobf T, Oh B, et al. Physical and psychological health outcomes of qigong exercise in older adults: a systematic review and meta-analysis. American Journal of Chinese Medicine. 2019;47(2):301-322.
- Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Physical Therapy. 2007;87(12):1697-1715.
- 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, 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.
- Cui H, Wang Q, Pedersen M, et al. The safety of tai chi: a meta-analysis of adverse events in randomized controlled trials. Contemporary Clinical Trials. 2019;82:85-92.
- 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.
- Farias M, Maraldi E, Wallenkampf KC, et al. Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica. 2020;142(5):374-393.
- Fernandez M, Moore C, Tan J, et al. Spinal manipulation for the management of cervicogenic headache: a systematic review and meta-analysis. European Journal of Pain. 2020;24(9):1687-1702.
- Fernandez-Gonzalez M, Fernandez-Lao C, Martin-Martin L, et al. Therapeutic benefits of balneotherapy on quality of life of patients with rheumatoid arthritis: a systematic review. International Journal of Environmental Research and Public Health. 2021;18(24):13216.
- Giovanardi CM, Cinquini M, Aguggia M, et al. Acupuncture vs. pharmacological prophylaxis of migraine: a systematic review of randomized controlled trials. Frontiers in Neurology. 2020;11:576272.
- Gioxari A, Kaliora AC, Marantidou F, et al. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a systematic review and meta-analysis. Nutrition. 2018;45:114-124.
- Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017;67(3):194-232.
- Häuser W, Hagl M, Schmierer A, et al. The efficacy, safety and applications of medical hypnosis. Deutsches Arzteblatt International. 2016;113(17):289-296.
- Hirshberg MJ, Goldberg SB, Rosenkranz M, et al. Prevalence of harm in mindfulness-based stress reduction. Psychological Medicine. 2022;52(6):1080-1088.
- Hu L, Wang Y, Liu X, et al. Tai chi exercise can ameliorate physical and mental health of patients with knee osteoarthritis: systematic review and meta-analysis. Clinical Rehabilitation. 2021;35(1);64-79.
- Johannes CB, Le TK, Zhou X, 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.
- Khoo E-L, Small R, Cheng W, et al. Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: a systematic review and network meta-analysis. Evidence-Based Mental Health. 2019;22(1):26-35.
- 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: eCAM. 2013;2013;613279.
- Kravits K. Hypnosis: adjunct therapy for cancer pain management. Journal of the Advanced Practitioner in Oncology. 2013;4(2):83-88.
- Kumar LS, Pugalenthi LS, Ahmad M, et al. Probiotics in irritable bowel syndrome: a review of their therapeutic role. Cureus. 2022;14(4):e24240.
- Kundakci B, Kaur J, Goh SL, et al. Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials. Pain. 2022;163(8):1432-1445.
- Langlois P, Perrochon A, David R, et al. Hypnosis to manage musculoskeletal and neuropathic chronic pain: a systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews. 2022;135:104591.
- Lauche R, Hunter DJ, Adams J, et al. Yoga for osteoarthritis: a systematic review and meta-analysis. Current Rheumatology Reports. 2019;21(9):47.
- Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain. A PRISMA systematic review and meta-analysis. Medicine. 2019;98(8):e14649.
- Li Y-H, Wang F-Y, Feng C-Q, et al. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e89304.
- 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 cochranelibrary.com on October 17, 2022.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews. 2016;4(4):CD007587. Accessed at cochranelibrary.com on October 17, 2022.
- Lombardo M, Feraco A, Ottaviani M, et al. The efficacy of vitamin D supplementation in the treatment of fibromyalgia syndrome and chronic musculoskeletal pain. Nutrients. 2022;14(15):3010.
- Lopresti AL, Smith SJ, Drummond PD. Herbal treatments for migraine: a systematic review of randomised-controlled studies. Phytotherapy Research. 2020;34(10):2493-2517.
- Lowry E, Marley J, McVeigh JG, et al. Dietary interventions in the management of fibromyalgia: a systematic review and best-evidence synthesis. Nutrients. 2020;12(9):2664.
- Maghsoumi-Norouzabad L, Mansoori A, Abed R, et al. Effects of omega-3 fatty acids on the frequency, severity, and duration of migraine attacks: a systematic review and meta-analysis of randomized controlled trials. Nutritional Neuroscience. 2018;21(9):614-623.
- Malone M, Tsai G. The evidence for herbal and botanical remedies, part 1. Journal of Family Practice. 2018;67(1):10-16.
- Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews. 2018;5(5):CD013010. Accessed at cochranelibrary.com on October 11, 2022.
- Mattsson M-O, Simkó M. Emerging medical applications based on non-ionizing electromagnetic fields from 0 Hz to 10 THz. Medical Devices (Auckland, NZ). 2019;12:347-368.
- McDonagh MS, Morasco BJ, Wagner J, et al. Cannabis-based products for chronic pain. A systematic review. Annals of Internal Medicine. 2022;175(8):1143-1153.
- McFarland LV, Karakan T, Karatas A. Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. EClinicalMedicine. 2021;41:101154.
- Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017;357:j1805.
- 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.
- Mudano AS, Tugwell P, Wells GA, et al. Tai chi for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2019;9(9):CD004849. Accessed at cochranelibrary.com on November 11, 2022.
- Nahin RL. Pain prevalence, chronicity and impact within subpopulations based on both Hispanic ancestry and race: United States, 2010-2017. Journal of Pain. 2021;22(7):826-851.
- Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. Journal of Pain. 2017;18(3):247-254.
- National Institute on Drug Abuse. Kratom. Accessed at nida.nih.gov/research-topics/kratom on November 8, 2022.
- 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.
- Oltean H, Robbins C, van Tulder MW, et al. Herbal medicine for low-back pain. Cochrane Database of Systematic Reviews. 2014(12):CD004504. Accessed at cochranelibrary.com on June 13, 2022.
- Paolucci T, Pezzi L, Centra AM, et al. Electromagnetic field therapy: a rehabilitative perspective in the management of musculoskeletal pain—a systematic review. Journal of Pain Research. 2020;13:1385-1400.
- Physical activity and exercise during pregnancy and the postpartum period: ACOG committee opinion, Number 804. Obstetrics and Gynecology. 2020;135(4):e178-e188.
- 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.
- Prozialeck WC, Jivan JK, Andurkar SV. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic, and opioid-like effects. Journal of the American Osteopathic Association. 2012;112(12):792-799.
- Qin J, Zhang Y, Wu L, et al. Effect of tai chi alone or as additional therapy on low back pain: systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(37):e17099.
- Ramsden CE, Zamora D, Faurot KR, et al. Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. BMJ. 2021;374:n1448.
- Rist PM, Buring JE, Cook NR, et al. Effect of vitamin D and/or marine n-3 fatty acid supplementation on changes in migraine frequency and severity. American Journal of Medicine. 2021;134(6):756-762.e5.
- Rubio-Ochoa J, Benítez-Martínez J, Lluch E, et al. Physical examination tests for screening and diagnosis of cervicogenic headache: a systematic review. Manual Therapy. 2016;21:35-40.
- 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 cochranelibrary.com on October 17, 2022.
- Sazali S, Badrin S, Norhayati MN, et al. Coenzyme Q10 supplementation for prophylaxis in adult patients with migraine—a meta-analysis. BMJ Open. 2021;11(1):e039358.
- Sigaux J, Mathieu S, Nguyen Y, et al. Impact of type and dose of oral polyunsaturated fatty acid supplementation on disease activity in inflammatory rheumatic diseases: a systematic literature review and meta-analysis. Arthritis Research & Therapy. 2022;24(1):100.
- Singh D, Narayanan S, Vicknasingam B. Traditional and non-traditional uses of mitragynine (kratom): a survey of the literature. Brain Research Bulletin. 2016;126(Pt 1):41-46.
- 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.
- Sullivan A, Cousins S, Ridsdale L. Psychological interventions for migraine: a systematic review. Journal of Neurology. 2016;263(12):2369-2377.
- Swain TA, McGwin G. Yoga-related injuries in the United States from 2001 to 2014. Orthopaedic Journal of Sports Medicine. 2016;4(11):2325967116671703.
- Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropractic & Manual Therapies. 2017;25:37.
- Theadom A, Cropley M, Smith HE, et al. Mind and body therapy for fibromyalgia. Cochrane Database of Systematic Reviews. 2015;(4):CD001980. Accessed at cochranelibrary.com on November 11, 2022.
- Thompson DF, Saluja HS. Prophylaxis of migraine headaches with riboflavin: a systematic review. Journal of Clinical Pharmacy and Therapeutics. 2017;42(4):394-403.
- Thrane S, Cohen SM. Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations. Pain Management Nursing. 2014;15(4):897-908.
- van der Steen JT, Smaling HJA, van der Wouden JC, et al. Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews. 2018;(7):CD003447. Accessed at cochranelibrary.com on December 8, 2022.
- vanderVaart S, Gijsen VMGJ, 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.
- von Luckner A, Riederer F. Magnesium in migraine prophylaxis—is there an evidence-based rationale? A systematic review. Headache. 2018;58(2):199-209.
- Wang H-L, Zhao Q, Li W, et al. A systematic review and network meta-analysis about the efficacy and safety of Tripterygium wilfordii Hook F in rheumatoid arthritis. Evidence-Based Complementary and Alternative Medicine: eCAM. 2022;2022:3181427.
- 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.
- 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: eCAM. 2014;2014:480956.
- Zelaya CE, Dahlhamer JM, Lucas JW, et al. Chronic pain and high-impact chronic pain among U.S. adults, 2019. NCHS Data Brief. 2020;(390):1-8.
- Zhang X, Yarema K, Xu A. Biological Effects of Static Magnetic Fields. Singapore: Springer Nature; 2017.
- Zhang X-C, Chen H, Xu W-T, et al. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Journal of Pain Research. 2019;12:527-542.
- Zheng H, Chen R, Zhao X, et al. Comparison between the effects of acupuncture relative to other controls on irritable bowel syndrome: a meta-analysis. Pain Research & Management. 2019;2019:2871505.
NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2023 update of this publication.
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