Mind and Body Approaches for Chronic Pain
This issue of the digest summarizes current scientific research about mind and body approaches for chronic pain, including fibromyalgia, headache, low-back pain, neck pain, osteoarthritis, and rheumatoid arthritis.
The scientific research to date suggests that some mind and body approaches may provide modest effects that help individuals manage the day-to-day variations in their chronic pain symptoms. However, in some instances, the amount of evidence is too small to clearly show whether an approach is useful.
What the Science Says:
Mind and Body Approaches for Chronic Pain
Conditions and Summary of Current Research
Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive-behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.
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.
For patients with chronic low-back pain, recent evidence-based clinical practice guidelines from the American College of Physicians gave a strong recommendation based on moderate-quality evidence that clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or mindfulness-based stress reduction. The guidelines also strongly recommend, based on low-quality evidence, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.
Available evidence indicates that acupuncture for neck pain may provide better pain relief compared to no treatment. There have been studies suggesting that spinal manipulation may help relieve neck pain, but much of the research has been of low quality.
In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for osteoarthritis (OA) of the hand, hip, and knee. The guidelines conditionally recommend tai chi, along with other nondrug 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.
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.
- Chiropractic Management of Fibromyalgia Syndrome: Summary of Clinical Practice Recommendations (Council on Chiropractic Guidelines and Practice Parameters) [21 KB PDF]
- Migraine Headaches in Children and Adolescents (Journal of Pediatric Health Care)
- Practice Parameter: Evidence-based Guidelines for Migraine Headache (Neurology)
- Nonpharmacologic and Pharmacologic Therapies for Osteoarthritis of the Hand, Hip, and Knee (American College of Rheumatology)
- 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]
- Osteopathic Manipulative Treatment for Low-Back Pain (Journal of the American Osteopathic Association)
- Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health (Journal of Orthopaedic and Sports Physical Therapy)
- Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline (Annals of Internal Medicine)
- Diagnosis and Treatment of Low Back Pain (Annals of Internal Medicine)
Information for Your Patients
- 6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices
- Low-Back Pain and Complementary Health Approaches: What You Need To Know
- Yoga: What You Need To Know
- Osteoarthritis: In Depth
- Rheumatoid Arthritis: In Depth
- Headaches: In Depth
- Massage Therapy: What You Need To Know
- Complementary Health Practices for U.S. Military, Veterans, and Families
- Fibromyalgia: In Depth
- Spinal Manipulation: What You Need To Know
- Acupuncture: In Depth
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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