Complementary Health Approaches for Chronic Pain
This issue of the digest summarizes current scientific evidence about the complementary health approaches most often used by people for chronic pain, including fibromyalgia, headache, irritable bowel syndrome, low-back pain, neck pain, osteoarthritis, and rheumatoid arthritis.
The scientific evidence to date suggests that some complementary health approaches may provide modest effects that may help individuals manage the day-to-day variations in their chronic pain symptoms. While some complementary approaches do show modest benefit depending on the approach and pain condition, in most instances, though, the amount of evidence is too small to clearly show whether an approach is useful.
What the Science Says:
Complementary Health Approaches for Chronic Pain
Pain Conditions and Current Evidence of Complementary Health Approaches
In general, research on complementary health approaches for fibromyalgia must be regarded as preliminary. However, recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, massage therapy, acupuncture, and balneotherapy may help relieve some fibromyalgia symptoms.
Several dietary supplements, including riboflavin, coenzyme Q10, and the herbs butterbur and feverfew, have been studied for migraine, with some promising results in preliminary studies.
Results of research on mind and body practices such as relaxation training, biofeedback, acupuncture, and spinal manipulation for headaches suggests that these approaches may help relieve headaches and may be helpful for migraines.
Irritable Bowel Syndrome
Although no complementary health approach has definitively been shown to be helpful for irritable bowel syndrome, some studies on hypnotherapy and probiotics have been promising.
Evidence-based clinical practice guidelines from the American College of Physicians and the American Pain Society (ACP/APS) found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks duration) low back pain.
The guidelines found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain.
*The guidelines recommend that practitioners consider these non-pharmacological interventions as appropriate options when treating patients whose low-back pain does not improve with more conservative self-care.
Available evidence indicates that acupuncture for neck pain may provide better pain relief compared to no treatment. There is some evidence that spinal manipulation may help relieve neck pain, but much of the research on has been of low quality.
The preponderance of evidence on glucosamine and chondroitin sulfate—taken separately or together—indicates little or no meaningful effect on pain or function. Independent clinical practice guidelines published in 2012 by the American College of Rheumatology (ACR), and in 2010 by the American Academy of Orthopaedic Surgeons (AAOS) recommend not using glucosamine or chondroitin for OA. Recommendations from Osteoarthritis Research Society International (OARSI) published in 2014 conclude that current evidence does not support use of glucosamine or chondroitin in knee OA for disease-modifying effects, but leave unsettled the question of whether either may provide symptomatic relief.
In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee. The guidelines conditionally recommend tai chi, along with other non-drug approaches such as self-management programs and walking aids, for managing knee OA. Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but can’t or won’t undergo the procedure.
Omega-3 fatty acids found in fish oil may have modest benefits in relieving rheumatoid arthritis (RA) symptoms; however, omega-3s do not prevent ongoing joint damage or modify disease course. No other dietary supplement has shown clear benefits for RA, but there is preliminary evidence for a few, particularly fish oil, gamma-linolenic acid, and the herb thunder god vine. Serious safety concerns have been raised about thunder god vine.
Results from clinical trials suggest that some mind and body practices—such as relaxation, mindfulness meditation, tai chi, and yoga—may be beneficial additions to conventional treatment plans, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.
- Osteopathic Manipulative Treatment for Low-Back Pain (Journal of the American Osteopathic Association)
- Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline (Annals of Internal Medicine)
- Practice Guidelines for Chronic Pain Management (Anesthesiology) [699 KB PDF]
- Guidelines for the Non-Surgical Management of Knee Osteoarthritis (Osteoarthritis and Cartilage) [5.2 MB PDF]
- Treatment of Osteoarthritis of the Knee (American Academy of Orthopaedic Surgeons)
- Practice Parameter: Evidence-based Guidelines for Migraine Headache (Neurology)
- Chiropractic Management of Fibromyalgia Syndrome: Summary of Clinical Practice Recommendations (Council on Chiropractic Guidelines and Practice Parameters) [21 KB PDF]
- Diagnosis and Treatment of Low Back Pain (Annals of Internal Medicine)
- Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health (Journal of Orthopaedic and Sports Physical Therapy)
- Nonpharmacologic and Pharmacologic Therapies for Osteoarthritis of the Hand, Hip, and Knee (American College of Rheumatology)
- Migraine Headaches in Children and Adolescents (Journal of Pediatric Health Care)
Information for Your Patients
- 6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices
- Rheumatoid Arthritis: In Depth
- Osteoarthritis: In Depth
- Massage Therapy: What You Need To Know
- Headaches: In Depth
- Fibromyalgia: In Depth
- Spinal Manipulation: What You Need To Know
- Chronic Pain: In Depth
- Acupuncture: In Depth
- Complementary Health Practices for U.S. Military, Veterans, and Families
NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.
The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
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