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NCCIH Clinical Digest

for health professionals

Mind and Body Approaches for Health Problems in Military Personnel and Veterans: What the Science Says

February 2017

Clinical Guidelines, Scientific Literature, Info for Patients: 
Mind and Body Approaches for Health Problems in Military Personnel and Veterans

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Pain

Research on complementary health approaches for chronic pain in military populations is currently being conducted, but very little data about the efficacy of these approaches specifically for chronic pain in military populations exists. However, there is published efficacy data on complementary health approaches for chronic pain in the general population.

The scientific evidence suggests that some complementary health approaches may provide modest effects that may help individuals in the general population manage the day-to-day variations in their chronic pain symptoms. In general populations, some complementary approaches do show modest benefit depending on the approach and pain condition; however, in most instances, the amount of evidence is too small to clearly show whether an approach is useful.

Low-Back Pain

Evidence-based clinical practice guidelines from the American College of Physicians issued in 2017 recommend (Grade: strong recommendation) for patients with chronic low-back pain that clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive-behavioral therapy, or spinal manipulation (low-quality evidence). For patients with chronic low-back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive-behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

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 across studies 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.

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.

Headaches

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.

Complex Regional Pain Syndrome (CRPS) or Phantom Limb Pain

There is some limited evidence that mind and body practices such as progressive relaxation, hypnosis, imagery, biofeedback, and visual mirror feedback may be useful in reducing phantom limb pain and sensation, although most studies have been small and of low quality.

Fibromyalgia

Prevalence rates of fibromyalgia in the military health system have been increasing. Findings from some studies of tai chi, yoga, mindfulness training, and biofeedback for fibromyalgia symptoms suggest beneficial effects, but the evidence is too limited to draw definitive conclusions about whether these approaches are helpful.

Post-Traumatic Stress Disorder (PTSD)

Recent research has shown that PTSD is highly prevalent among soldiers returning from combat duty. Veterans and service members who have sustained a concussion/mild traumatic brain injury (mTBI) in the combat environment are often at significantly greater risk of PTSD. Moreover, the diagnosis of either condition may be complicated by the fact that PTSD is associated with generalized health symptoms, including neurocognitive impairment and other symptoms in the persistent post-concussion syndrome definition.

Clinical practice guidelines on the management of post-traumatic stress issued in 2010 by the Department of Veterans Affairs and the Department of Defense indicate that relaxation techniques be considered as a component of treatment approaches for acute stress disorder or PTSD in alleviating symptoms associated with physiological hyper-reactivity. Relaxation techniques may provide some benefit on symptoms of post-traumatic stress disorder, including sleep disturbance, anger, pain, and hyper-arousal.

Stress/Anxiety

There is some limited evidence that some mind and body approaches may have the potential for modest beneficial effects on stress and anxiety in military populations; however, many of the studies have used small sample sizes.

Insomnia

There is some evidence to suggest that relaxation techniques, along with behavioral therapies, can be helpful components of a successful strategy to improve sleep, but there have only been a few small studies conducted in military populations. There is some limited evidence that imagery rehearsal therapy may improve insomnia in nonveteran populations, but only a few small studies have examined imagery rehearsal therapy in combat veterans or active duty military personnel.

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 Web site 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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