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NCCIH Clinical Digest

for health professionals

Complementary Health Approaches for Chronic Pain: What the Science Says

September 2016

Clinical Guidelines, Scientific Literature, Info for Patients: 
Complementary Health Approaches for Chronic Pain



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 suggest that these approaches may help relieve headaches and may be helpful for migraines.

Irritable Bowel Syndrome (IBS)

Although no complementary health approach has definitively been shown to be helpful for irritable bowel syndrome (IBS), some studies on hypnotherapy and probiotics have been promising.

Low-Back Pain

Evidence-based clinical practice guidelines from the American College of Physicians and the American Pain Society (ACP/APS) provide a useful algorithm for diagnosis and treatment of patients with chronic low-back pain. In general, the guidelines recommend a conservative approach to diagnosis and treatment, except when patients have progressive neurologic deficits or cauda equina syndrome, or are suspected of having underlying conditions requiring urgent intervention (e.g., vertebral infection or cancer with impending spinal cord compression).

  • The systematic review supporting these recommendations (Chou and Huffman, Ann Intern Med. 2007;147(7):492–504) 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.
    • 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-pharmacologic interventions as appropriate options when treating patients whose low-back pain does not improve with more conservative self-care.
  • It is important to know that interpreting and summarizing current evidence about diagnosis and treatment of chronic low-back pain is particularly challenging because of major differences in patient populations, eligibility criteria, diagnostic studies, treatments, and outcome measures across different studies, and the variety of health care professions involved in care of patients.
  • Read more on the current evidence about spinal manipulation, acupuncture, massage, and yoga—the complementary approaches most often used by people for chronic low-back pain.

Neck Pain

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.


Clinical practice guidelines issued by the American College of Rheumatology recommend aerobic exercise and/or strength training, weight loss (if overweight), and a number of pharmacologic and non-pharmacologic modalities for treating osteoarthritis (OA) of the knee, hip, or hand. 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.

Rheumatoid Arthritis

While conventional medical therapies such as biologic agents or disease-modifying antirheumatic drugs (DMARDs) are able to modify the disease course of rheumatoid arthritis (RA) and prevent erosions, no natural product has been shown to alter the course of the disease. Omega-3 fatty acids found in fish oil may have modest benefits in relieving RA pain symptoms. 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. However, 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.


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 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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