Complementary medicine for dealing with chronic pain
Emerging research suggests that complementary medicine may enhance the efficacy or reduce the side effects of many conventional pain therapies.
Because chronic (long-term) pain can be resistant to many medical treatments and eventually lead to problems when not carefully monitored by an experienced physician, people who suffer from chronic pain often turn to complementary medicine for relief. In fact, pain is one of the most common conditions for which adults use complementary and alternative therapies.
Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.
Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation, chronic pain is very different. Chronic pain persists—often for months or even longer. (In a national survey, 26 percent of adults—an estimated 76.5 million Americans—reported experiencing pain that lasted more than 24 hours; of those reporting pain, 42 percent said it lasted more than a year). Chronic pain may arise from an initial injury such as a back sprain, or there may be an ongoing cause such as a disease, or there may be no evident cause. Other health problems—such as fatigue, sleep disturbance, mood changes, and mobility limitations—may also be associated with chronic pain.
Common chronic pain conditions include low-back pain, headache, arthritis pain, pain from nerve damage (e.g., diabetic neuropathy), cancer pain, fibromyalgia, facial pain, chronic prostatitischronic pelvic pain syndrome, menstrual cramps, elbow pain, carpal tunnel syndrome and more.
A person may have two or more co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, temporomandibular joint dysfunction, and vulvodynia (chronic vulvar pain). It is not known whether these disorders share a common cause. People who suffer from chronic pain take various prescription and nonprescription medications; often, these do not provide adequate relief and have unwanted side effects. Thus, complementary approaches have emerged as an option to enhance the efficacy and/or mitigate side effects of conventional pain management therapies.
Complementary pain therapies
The scientific evidence suggests that some complementary health approaches may help people manage chronic pain. However, in most instances, the amount of clinical evidence is too small to clearly show whether an approach is useful. Still, numerous case reports have shown clinical efficacy for complementary and alternative medicine for pain management. This section highlights the research status of some approaches used for common types of pain.
1. Studies of acupuncture for back pain that compared people who received acupuncture with those who did not receive it generally showed better relief in the acupuncture group. However, in back pain studies that compared actual or true acupuncture with simulated or sham acupuncture (procedures designed to mimic acupuncture by using needles that don’t penetrate the skin, penetrate it only slightly, or put the needles in places different from those used in actual acupuncture), there has been only a small difference in pain relief, if any, between people in the two groups.
2. Massage may be helpful for chronic low-back pain.
3. There is some evidence that progressive relaxation may help relieve low-back pain, but studies on this topic have not been of the highest quality.
4. Spinal manipulation can provide relief from low-back pain and appears to work at least as well as other treatments.
5. Studies have shown that yoga can be helpful for low-back pain.
6. A 2006 systematic review of research on herbal remedies for low-back pain found preliminary evidence that short-term use of three herbs—devil’s claw and white willow bark (taken by mouth) and cayenne (applied on the skin)—might be helpful for low-back pain, but it is not known whether these herbs are safe or effective when used for longer periods of time.
7. Studies of prolotherapy (a treatment involving repeated injections of irritant solutions) for low-back pain have had inconsistent results.
1. Studies of acupuncture for osteoarthritis have shown that people who receive acupuncture report better pain relief than those who don’t receive acupuncture, and people who receive actual acupuncture report better pain relief than those who receive simulated acupuncture. However, the difference between actual and simulated acupuncture is much smaller than the difference between acupuncture and no acupuncture.
2. A small amount of research on massage and tai chi suggests that both practices might help to reduce osteoarthritis pain.
3. Numerous natural products, including glucosamine, chondroitin, dimethyl sulfoxide (DMSO), methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe), and a variety of herbs, have been studied for osteoarthritis, but there is little conclusive evidence of benefit for symptoms.
1. Research results suggest that some mind and body practices, such as relaxation, mindfulness meditation, tai chi, and yoga, may be beneficial additions to treatment plans, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.
2. Omega-3 fatty acids of the types found in fish oil may have modest benefits in relieving symptoms in rheumatoid arthritis. No other dietary supplement has shown clear benefits for rheumatoid arthritis, but there is preliminary evidence for a few, particularly gamma- linolenic acid and the herb thunder god vine. However, serious safety concerns have been raised about thunder god vine.
1. Relaxation training may help to relieve chronic headaches and prevent migraines.
2. Biofeedback may be helpful for migraines and tension-type headaches.
3. Studies of acupuncture for headache have found that actual acupuncture was more
effective than either no acupuncture or simulated acupuncture in reducing headache frequency and severity; the difference in effectiveness between acupuncture and no acupuncture was greater than the difference between actual and simulated acupuncture.
4. Spinal manipulation may help people suffering from chronic tension-type or cervicogenic (neck-related) headaches and may also be helpful in preventing migraines.
5. 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.
1. Acupuncture hasn’t been studied as extensively for neck pain as for some other conditions such as back pain. However, the available evidence indicates that people who receive acupuncture for neck pain have better pain relief than those who don’t receive acupuncture. The small number of studies that have compared actual acupuncture with simulated acupuncture show that patients receiving actual acupuncture had better pain relief than those receiving simulated acupuncture.
2. There is some evidence that spinal manipulation or mobilization (movement imposed on joints and muscles) may help to relieve neck pain, but much of the research on these techniques has been of low quality.
1. It is uncertain whether acupuncture is helpful for fibromyalgia.
2. Some evidence suggests that tai chi may be helpful for fibromyalgia pain and other symptoms, but the amount of research on tai chi has been small.
3. Studies have found improvements in fibromyalgia symptoms from various meditation techniques, but much of the research on this topic has not been of the highest quality.
4. There is insufficient evidence that any natural products can help to relieve fibromyalgia pain.
5. Studies of homeopathy have not demonstrated that it is beneficial for fibromyalgia.
Irritable bowel syndrome
1. Although no complementary health approach has definitely been shown to be helpful for irritable bowel syndrome, some research results for hypnotherapy and probiotics have been promising.
2. A study of mindfulness meditation has indicated that it may help reduce the severity of irritable bowel syndrome in women.
3. Studies on peppermint oil have suggested that it may be helpful, but the quality of much of the research is poor.
4. Studies of acupuncture for irritable bowel syndrome have not found actual acupuncture to be more helpful than simulated acupuncture.