As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction
A recent review of clinical evidence published in Mayo Clinic Proceedings by National Institutes of Health (NIH) researchers suggests that complementary health techniques have a legitimate place in a physician’s pain relief toolkit—welcome news as health care professionals and agencies grapple with the crisis of opioid abuse.
Researchers led by Richard L. Nahin, PhD, MPH, lead epidemiologist at the NIH’s National Center for Complementary and Integrative Health (NCCIH), examined efficacy and safety evidence in 105 randomized controlled trials (RCTs) conducted between January 1966 and March 2016. The review—geared toward primary care physicians as part of the journal’s Symposium on Pain Medicine—focused on popular complementary approaches to common pain conditions.
Unlike a typical systematic review that assigns quality values to the studies, the investigators conducted a narrative review, in which they simply looked at the number of positive and negative trials. “If there were more positives than negatives then we generally felt the approach had some value,” Nahin explained. “If there were more negatives, we generally felt the approach had less value.” Trials that were conducted outside of the United States were excluded from the review.
Based on a “preponderance” of positive vs negative trials, complementary approaches that may offer pain relief include acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; massage therapy for neck pain; and relaxation techniques for severe headaches and migraine. Several other techniques had weaker evidence, according to the qualitative assessments, for specific pain conditions (see “Selected Complementary Health Approaches for Pain”). The treatments were generally safe, with no serious adverse events reported.
Among the popular complementary therapies that did not show benefit in the analysis were the dietary supplements glucosamine and chondroitin, commonly used for knee osteoarthritis. “Drug companies sell a whole lot of that stuff and it doesn’t seem to work all that well for arthritis and other things,” said David Spiegel, MD, medical director of the Center for Integrative Medicine at Stanford University School of Medicine, who was not involved in the study.
Spiegel said the review moves the field of integrative pain management forward by providing some guidance to physicians who lack a road map for using complementary health approaches. “Papers like this could help patients and clinicians select which among the integrative treatments is most likely to be helpful for which problems,” he said. “I don’t think we’re at the point where it’s an obvious science yet, but I think we’re heading in that direction.”
Pain Without Pills
Researchers at the NCCIH are investigating the mechanisms of pain and pain management and developing the evidence base for complementary health approaches to provide better care to the millions of people whose chronic pain is mistreated or undertreated. One hundred million US adults are living with chronic pain, much of which could be prevented or managed better, according to a 2011 Institute of Medicine (IOM) report.
Continue reading at The JAMA Network.
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