Acupuncture, massage, meditation—what does the latest research say about these and other popular alternative therapies for pain management?
In 2018 the opioid crisis led to over 67 000 deaths, and while improvements have been made, it is still a leading cause of death nationwide. Being on the front lines is where we can have the biggest impact. Florida, where I practice pharmacy, now even requires patients to be given a handout discussing alternative treatment options for pain each time they are prescribed an opioid.
For many patients, complementary and alternative medicine (CAM) can reduce their opioid use and improve their pain control. In the slides below, we will dig into the most recent evidence for popular CAM therapies in the management of chronic, non-malignant pain.
Acupuncture. A 2018 meta-analysis that included >20 000 patients from 39 trials found acupuncture to be effective for nonspecific back or neck pain, shoulder pain, chronic headache, and osteoarthritis.
Acupuncture (cont.). The eligible trials in the 2018 meta-analysis must have had measured pain relief at least 4 weeks after acupuncture began and compared acupuncture to no acupuncture or "sham" acupuncture. Results showed that acupuncture was superior to both no acupuncture and sham acupuncture and relief persisted over time.
Where to refer: Acupuncturists must be licensed by the state and typically operate as independents. Consider talking to several local clinics and find one you can trust and build a good working relationship with. You can search for practitioners here.
Meditation. A 2016 analysis of mindfulness mediation by the RAND Corporation that included 28 randomized controlled trials found that:
• Meditation might result in small improvement in pain symptoms, but the quality of evidence is low.
• There is high-quality evidence that meditation to treat chronic pain reduced depressive symptoms.
• There is moderate-quality evidence that meditation to treat chronic pain improved mental and physical health-related quality-of-life.
Meditation (cont.). The 2016 analysis included 28 randomized controlled clinical trials and interventions lasted between 3-12 weeks (median of 8 weeks).
Massage. In 2019, an evidence map was developed to compile all evidence exploring the efficacy of massage therapy for different types of pain that included 58 publications, of which 49 were systematic reviews. None of the publications described moderate- or high-strength findings, 14 high-quality reviews described low-strength findings, 18 high-quality reviews described very low-strength findings, and 17 reviews were low quality.
Massage (cont.). The types of pain for which massage is potentially better than the comparator in the evidence map included arthritis, various types of musculoskeletal pain, postoperative pain, and labor and delivery pain.
Where to refer: The Associated Bodywork and Massage Professionals has an online tool to find a massage therapist.
Physical therapy and exercise. In 2017, an overview of Cochrane Reviews was published that included 381 studies, of which 264 compared exercise to minimal exercise or no intervention in adults with chronic pain. Various pain conditions were included such as fibromyalgia, OA, RA, and LBP, among others.
Physical therapy and exercise (cont.). Key points of the 2017 review include:
• Overall, the level of evidence was low, mostly from small sample sizes (resulting in reduced power).
• There were some reductions in pain, but not a large effect and not consistent across trials.
• Further studies are needed, but few adverse events (and none serious) were reported.
Where to refer: You can find physical therapists, by practice focus, here.
Herbal supplements: Turmeric. A meta-analysis published in 2016 that included 8 papers found that there was insufficient evidence to conclude efficacy in treating arthritis with turmeric. Although some papers found a treatment effect, further studies are needed.
Herbal supplements: Fish oil. According to a 2017 review, some trials have demonstrated a treatment effect for RA, OA, SLE, and lupus nephritis. Overall, fish oil is safe and might be effective, but more studies are needed.
Herbal supplements: Willow bark. Willow bark contains salicin, which eventually led to the development of aspirin. Other compounds are hypothesized to enhance pain relief, but data on the use of willow bark for the treatment of pain is limited.