Efficacy of Selected Complementary and Alternative Medicine Interventions For Chronic Pain
Gabriel Tan, PhD, ABPP, Michael H. Craine, PhD,
Matthew J. Bair, MD, MS,
M. Kay Garcia, DrPH, MSN, RN, LAc,
James Giordano, PhD, Mark P. Jensen, PhD,
Shelley M. McDonald, MD
Department of Anesthesiology,
Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center (VAMC),
2002 Holcombe Blvd,
Houston, TX 77030, USA
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, therapies, and products that are not presently considered part of conventional medicine. This article provides an up-to-date review of the efficacy of selected CAM modalities in the management of chronic pain. Findings are presented according to the classification system developed by the National Institutes of Health National Center for Complementary and Alternative Medicine (formerly Office of Alternative Medicine) and are grouped into four domains: biologically based medicine, energy medicine, manipulative and body-based medicine, and mind-body medicine. Homeopathy and acupuncture are discussed separately as “whole or professionalized CAM practices.” Based on the guidelines of the Clinical Psychology Division of the American Psychological Association, findings indicate that some CAM modalities have a solid track record of efficacy, whereas others are promising but require additional research. The article concludes with recommendations to pain practitioners.
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Definition of Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, therapies, and products that are not presently considered part of conventional medicine. They are not generally provided by U.S. hospitals and clinics or widely taught in medical schools .
Prevalence and Popularity of Complementary and Alternative Medicine Use
CAM modalities are widely used by the U.S. public. According to the Centers for Disease Control and Prevention (CDC), 62 percent of adults used some form of CAM during the past 12 months when the definition of CAM included prayer specifically for health reasons and 36 percent when prayer was excluded . The most frequent conditions associated with CAM use included back pain, neck pain, joint pain, stiffness, anxiety, and depression (the latter two are commonly associated with chronic pain). CAM use increased substantially during the 1990s. The U.S. public spent an estimated $36 to $47 billion on CAM in 1997 alone ; between $12.2 and $19.6 billion were paid out-of-pocket for the services of CAM providers such as chiropractors, acupuncturists, and massage therapists. These fees are more than the U.S. public paid out-of-pocket for all hospitalizations in 1997 and half the amount of all out-of-pocket physician services for traditional care .
Purpose of This Article
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Despite the immense popularity of CAM, its efficacy is controversial. Many view CAM as encompassing unproven therapies of questionable efficacy. This article comprehensively reviews the efficacy of various CAM modalities in the management of chronic pain. The review has been restricted to chronic pain because of the wider availability of efficacious traditional interventions for acute pain. However, as our effort progressed, we realized that the relevant literature encompasses a wide range of CAM modalities and a large variety of chronic pain conditions. Thus, great variation exists regarding the number, type, and quality of trials for each specific CAM approach, with some modalities (e.g., acupuncture) possessing a large literature and many other modalities (e.g., craniosacral therapy) having been the subject of very few trials. Certain specific pain complaints (e.g., low back pain [LBP]) have been extensively investigated, whereas other chronic pain conditions (e.g., complex regional pain syndrome [CRPS]) have only been studied in a handful of trials. In light of the inherent inconsistencies and vastness of the extant literature, we modified the aim of this article to a more conservative and manageable goal: to summarize the evidence for selected CAM modalities that have been applied to the management of a wide range of chronic pain complaints, highlight areas for future study, and provide general guidelines for clinicians. Thus, we reviewed and summarized the empirical evidence for each selected modality.