Alternative Medicine

Complementary and Alternatives Medicine (CAM)

Pain is one of the most common conditions for which adults use complementary and alternative therapies. Because chronic pain can be resistant to many medical treatments and people who suffer from chronic pain often turn to alternative medicine (AM) for relief. This fact sheet provides basic information on chronic pain and "what the science says" about the effectiveness of AM therapies. If you are considering an AM therapy for chronic pain, talk with your health care provider first.
CAM Use for Chronic Pain.

In the 2007 American Health Interview Survey, back pain was by far the most common condition cited as a reason for using AM, followed by neck pain, joint pain/stiffness, and arthritis; other musculoskeletal pain and severe headache also ranked among the top 10 reasons. Another survey of more than 400 patients at a chronic pain clinic found that almost 40 percent used at least one form of AM.
People seeking relief from chronic pain use a variety of AM therapies. Examples include dietary supplements, such as glucosamine, chondroitin, and various herbs, and mind and body approaches, such as acupuncture, guided imagery, hypnotherapy, massage, meditation, relaxation therapy, spinal manipulation, tai chi, and yoga.

What the Science Says About AM and Chronic Pain

In spite of the widespread use of AM therapies for chronic pain, scientific evidence on whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for CAM therapies that many people use for common kinds of pain.

About Scientific Evidence on CAM Therapies

Scientific evidence on AM therapies includes results from laboratory research (e.g., animal studies) as well as clinical trials (studies in people). It encompasses both "positive" findings that a therapy may work and "negative" findings that it probably doesn’t work or it may be unsafe.
This section highlights the research status of some of the therapies used for pain.

• Low-back pain. Reviews of research on acupuncture, massage, and spinal manipulation for chronic low-back pain have found evidence that these therapies may be beneficial. Clinical practice guidelines issued by the American Pain Society in 2007 recommend these therapies and five other nondrug approaches for patients with back pain who do not improve with medication, education, and self-care. The other recommended approaches are cognitive-behavioral therapy, exercise therapy, progressive relaxation, intensive interdisciplinary rehabilitation, and yoga. Reviews of research on other AM therapies that people sometimes use for chronic low-back pain, such as various herbal remedies and prolotherapy injections, generally have found limited or no evidence to support their use for this purpose, or the evidence is mixed.

• Arthritis. Among AM approaches that have been studied for pain relief in osteoarthritis are acupuncture, glucosamine/chondroitin, herbal remedies, mineral baths, and tai chi. Many of these approaches have also been studied for rheumatoid arthritis. Overall, although some studies of AM practices for arthritis have had promising results, the evidence generally is limited or mixed. A systematic review of acupuncture for osteoarthritis concluded that it may lead to small improvements in pain and function. However a clinical study, known as GAIT (Glucosamine/chondroitin Arthritis Intervention Trial), the popular dietary supplements glucosamine and chondroitin sulfate alone or in combination did not significantly relieve knee osteoarthritis pain among all participants, although the combination did help a subgroup who had moderate-to-severe pain. Reviews have found evidence that gamma linolenic acid (GLA, from evening primrose and certain other plant oils) may relieve rheumatoid arthritis pain, although further research is needed. Reviews have also noted evidence that dietary supplements known as ASUs (avocado-soybean unsaponifiables) and devil's claw may provide relief from osteoarthritis pain.

• Headaches. Reviews of research on acupuncture for reducing the frequency and intensity of migraine and tension-type headaches conclude that patients may benefit from acupuncture therapy. One review found evidence that spinal manipulation may help patients suffering from chronic tension-type or neck-related headaches. Some research suggests that the herb feverfew may prevent migraine attacks, but results from clinical trials are mixed, and additional research is needed.

• Neck pain. Research Reviews on manual therapies, primarily manipulation or mobilization, and acupuncture for chronic neck pain have found mixed evidence regarding potential benefits and have emphasized the need for additional research. One review noted that clinical guidelines often endorse the use of manual therapies for neck pain, although there is no overall consensus on the status of these therapies.

• Other types of pain. Various AM approaches have also been studied for other types of chronic pain, such as facial pain, including from (temporomandibular joint) (jaw disorder; nerve pain associated with diabetes and other conditions; cancer pain; and pain experienced by people with fibromyalgia. For example, a small study found that people with fibromyalgia may benefit from practicing Tai chi. Most research reviews found promising evidence of effectiveness for some AM therapies, but often emphasize that additional research is needed before treatment recommendations can be made.

• Others. Chronic pain sufferers sometimes turn to other AM practices, such as hypnotherapy, meditation, or qi gong. Reviews of the research on these therapies have found some evidence of effectiveness but note the need for further studies. Although static magnets are widely marketed for pain control, a review the research concludes that magnets DO NOT work.

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