Clinical trial evidence on complementary approaches for five painful conditions

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Clinical trial evidence on complementary approaches for five painful conditions

A number of complementary health approaches have been reviewed from evidence from clinical trials which include acupuncture, yoga, tai chi, massage therapy and relaxation techniques which hold promise for helping to manage the pain. A review was conducted by the National Center for Complementary and Integrative Health and was published in the Journal Mayo Clinic Proceedings.

About 40 million American adults experience severe pain in any given year and they spend more than $14 billion out-of-pocket on complementary approaches for the management of such painful conditions like back pain, neck pain and arthritis. Databases for randomized, controlled clinical trials were searched through MEDLINE which was published from 1966 through March 2016 and conducted in the US. This approach was chosen due to the particular nature of the U.S health-care system which were relevant to the “standard care” or “usual care” in trials and also to licensing the requirements for complementary therapies.

Seven widely-used complementary approaches were selected on the sought of evidence by researchers for efficacy, effectiveness and safety which are: acupuncture; spinal manipulation or osteopathic manipulation; massage therapy; tai chi; yoga; relaxation techniques including meditation and selected natural product supplements including chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe) and omega-3 fatty acids.

In primary care settings, five pain conditions were often seen and treated for the trial: back pain, osteoarthritis, neck pain, severe headaches and migraine and fibromyalgia. Further, if the complementary approach led to statistically significant improvements in pain severity, pain related disability, and/or function which were included in the trial for efficacy or effectiveness for the comparison to the control group, the trial is considered or termed as positive. A negative result meant that there was no difference between the intervention and control groups.

Researchers found that the following complementary approaches had more positive than negative results and may help some patients manage certain painful health conditions:

  • Acupuncture and yoga for back pain

  • Acupuncture and tai chi for osteoarthritis of the knee

  • Massage therapy for neck pain- with adequate doses and for short-term benefit

  • Relaxation techniques for severe headaches and migraine.

Researchers found that massage therapy, spinal manipulation and osteopathic manipulation may aid some people with back pain and tai chi may help people with fibromyalgia, but evidence was weaker. Reporting of safety information was low and most common adverse events were gastrointestinal problems from glucosamine, chondroitin, MSM, or SAMe. Some trials showed minor muscle or joint soreness from tai chi and yoga, or minor pain and/or bruising at acupuncture needling sites.

The findings were generally consistent with those of recent systematic reviews. Researchers noted some methodological limitations to their review, including small trial sizes, uncertain clinical relevance even if statistical superiority was present, or differences in the interventions provided in each study.

National Center for Complementary and Integrative Health
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