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6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices

  1. Reviews of research on acupuncture, massage, and spinal manipulation for chronic low-back pain have found evidence that these therapies may be beneficial. There is also some evidence that mindfulness-based stress reduction and cognitive behavioral therapy improves pain and functional limitation compared to usual care.

    • Spinal manipulation: The most recent guidelines from the American Pain Society and the American College of Physicians conclude that spinal manipulation is associated with moderate benefit for chronic low-back pain.
    • Acupuncture: In many studies, acupuncture has shown some benefit for low-back pain compared to conventional therapy, but simulated (placebo) acupuncture has also shown a similar benefit, suggesting that a component of any benefit from acupuncture may be due to patient expectation or practitioner attention. A 2018 review by the Agency for Healthcare Research and Quality (AHRQ) found that acupuncture was associated with slightly greater effects on chronic low-back pain and function at 1 to 6 months when compared with controls (i.e., simulated acupuncture or usual care).
    • Massage: Studies suggest that massage is associated with short-term beneficial effects in reducing pain and improving function compared to usual care in people with chronic low-back pain.
    • Yoga: Clinical guidelines issued in 2017 by the American College of Physicians strongly recommended yoga, based on low-quality evidence, as initial treatment for people with chronic low-back pain. 
    • Mindfulness-based stress reduction: A 2018 AHRQ review of nonpharmacologic treatment of chronic pain found that mindfulness-based stress reduction and other therapies improved function and/or pain for at least 1 month.
  2. Recent reviews and clinical trials provide encouraging evidence that practices such as tai chi, yoga, qi gong, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms.

  3. Clinical practice guidelines issued by the American College of Rheumatology conditionally recommend tai chi, along with other non-drug approaches such as self-management programs and walking aids, for managing knee osteoarthritis. 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.

  4. Available evidence indicates that acupuncture for neck pain may provide better pain relief compared to no treatment. There is also some evidence that spinal manipulation may help patients suffering from chronic tension-type or neck-related headaches.

  5. According to a 2016 review of studies performed in the United States, massage therapy may provide short-term relief from neck pain, especially if massage sessions are relatively lengthy and frequent.

  6. As with any treatment, it is important to consider safety before using complementary health products and practices. If you are considering a complementary health practice to help manage your chronic pain, talk with your health care providers first. You can get more information on NCCIH’s Web site about the safe use of complementary health products and practices.