A variety of complementary and alternative health practices — including meditation and relaxation techniques, manual therapies such as massage and spinal manipulation, meditative exercise forms such as yoga, Tai Chi, and ancient health practices such as acupuncture — show promise for contributing to the management of pain according to research presented today at the Annual Scientific Meeting of the American Pain Society.
In her keynote address to pain clinicians attending the APS conference, Josephine Briggs, MD, director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health said that these approaches are widely used by Americans as part of management of painful conditions including headache, back or neck pain, and arthritic, or other musculoskeletal pain.
“Much of health care involves helping people find solutions for tough problems like pain. I think all physicians are well aware of how difficult it is to manage chronic pain patients,” said Briggs. “For example, with back pain we see that large numbers of patients are turning to these approaches with the hope of decreasing discomfort, improving function and quality-of-life, and minimizing side effects of pharmacologic treatments.”
Research and Real-World CAM Use: Self-care/Bench to Bedside
According to a nationwide government survey released in December 2008, approximately 38 percent of U.S. adults aged 18 years and over and approximately 12 percent of children use some form of complementary and alternative medicine. This survey also found that back pain is the most common condition for which adults use CAM.
“With such a large number of people using these techniques, there are opportunities for us to develop real-world evidence regarding the application of specific approaches to symptom management and health and wellness,” said Briggs.
Published studies in this field include tai chi for fibromyalgia, as well as meditation, yoga, and acupuncture for low back pain. Briggs emphasized that symptom management is where National Center for Complementary and Alternative Medicine’s (NCCAM) research can have the greatest impact. In NCCAM’s most recent strategic plan released this past February, building a strong evidence base — for pain management, in particular — is a primary focus moving forward. NCCAM is part of the National Institutes for Health (NIH).
“At NCCAM we are working to strengthen our portfolio of research on non-pharmacologic pain management, addressing both safety and efficacy” said Briggs. “Building an evidence base is not just about efficacy in the setting of controlled clinical trials—we must also address whether the treatment works in a real-world setting.”
The integration of certain CAM therapies with conventional medicine for pain management is being actively pursued in a number of military health care settings. For example, there are now new military guidelines, released by the Office of The Army Surgeon General, that include select CAM modalities for treating pain.
Dr. Briggs concluded her talk with an invitation to the APS community to continue to work with NCCAM on future pain initiatives.
Material adapted from American Pain Society.