ARRA IMPACT REPORT:
Complementary and Integrative Health Approaches for Managing Chronic Pain


Public Health Burden
Millions of Americans suffer from pain that is chronic (long-term), severe, and not easily managed. According to the Institute of Medicine, chronic pain affects more than 100 million Americans. Although the human costs of chronic pain are incalculable, its annual economic cost—including health care expenses, lost income, and lost productivity—is estimated to be $100 billion. Because chronic pain can be resistant to many medical treatments and can cause serious problems, people who suffer from chronic pain often turn to complementary and alternative medicine (CAM) for relief. Learning about the safety and effectiveness of these therapies helps to address a major public health burden.

Using Existing Medical Records to Study CAM Effectiveness for Treating Painful Conditions
Comparative effectiveness research, which uses data from real-world settings to compare strengths and weaknesses of various medical interventions, holds great promise for evaluating CAM therapies and determining how they might best be combined with conventional care. Investigators who received an ARRA grant utilized existing medical records to study the effectiveness of complementary and integrative health approaches for management of chronic pain conditions.

Using electronic medical records from a clinic that offers both conventional and complementary therapies, researchers evaluated and compared conventional medical care and integrative/complementary approaches for specific chronic pain conditions, including irritable bowel syndrome, fibromyalgia, and back pain. Their goal was to identify best practices that will enable patient-centered, evidence-based recommendations that can be used in treatment settings. The principal investigator has published a review article on the importance of comparative effectiveness research in complementary and alternative medicine. In addition, several other publications are in preparation.1

CAM for Common Types of Chronic Pain: Low-Back Pain, and Osteoarthritis
Two of the most common forms of chronic pain are low-back pain and the joint pain associated with osteoarthritis. Several ARRA grants explored potential CAM options for treating these conditions.

Massage Therapy
A recent study found that a 60-minute “dose” of Swedish massage therapy delivered once a week for pain due to osteoarthritis of the knee was both optimal and practical, establishing a standard for use in future research. This trial builds on an earlier pilot study of massage for knee osteoarthritis pain, which had promising results but provided no data to determine whether the dose was optimal. (The researchers defined an optimal, practical dose as producing the greatest ratio of desired effect compared to costs in time, labor, and convenience.) Osteoarthritis, a degenerative disease of the joints, is the most common type of arthritis, affecting approximately 27 million Americans.

The researchers noted that there is promising potential for the use of massage therapy for osteoarthritis of the knee and that future, larger trials should use this dose as a standard. Further, they suggest that more definitive research is needed on massage for osteoarthritis of the knee, in terms of efficacy, how it may work in the body, and its cost-effectiveness for patients. The investigators subsequently applied for, and received, a grant to conduct a larger trial based on this dose-response study.2

Spinal Manipulative Therapy
Scientific evidence indicates that spinal manipulation may provide mild-to-moderate relief from low-back pain. It is theorized that adhesions develop in the zygapophyseal (Z) joints after injury or prolonged inactivity. A Z joint is a synovial joint between two vertebras. Largely due to the mechanical nature of their function, they undergo degenerative changes with the wear and tear of age, particularly in the lumbar spine. It is thought that spinal adjustments separate (or “gap”) the Z joints, breaking adhesions and resorting motion.

One ARRA grant combined technologies from the fields of acoustics and MRI imaging to study the mechanisms involved in spinal manipulative therapy (SMT). The investigators sought to validate methods to quantify and relate two phenomena associated with SMT: 1) cavitation (an audible release that occurs during therapy) and 2) the simultaneous gapping of the lumbar Z joint spaces. Understanding this relationship is important for ensuring that this form of therapy is used appropriately for people with low-back pain. The project determined location and distribution of cavitations in the lumbar Z joints that were targeted by SMT. They also found that Z joints of men gapped more than those of women and that cavitation indicated that a joint had gapped but not how much a joint had gapped.3

Contributing NIH Institutes & Centers

  • National Center for Complementary and Alternative Medicine (NCCAM)

  1. 1RC1AT005715-01, http://www.ncbi.nlm.nih.gov/pubmed/20105061 - AICKIN, MIKEL G - UNIVERSITY OF ARIZONA - TUCSON - AZ
  2. 1R01AT004623-01, http://www.ncbi.nlm.nih.gov/pubmed/22347369 - PERLMAN, ADAM ISRAEL - UNIV OF MED/ DENT OF NJ-SCH/HLTH REL PRO - NEWARK - NJ
  3. 3R01AT000123-06S2, http://www.ncbi.nlm.nih.gov/pubmed/21986305, http://www.ncbi.nlm.nih.gov/pubmed/22902194 - CRAMER, GREGORY D - NATIONAL UNIVERSITY OF HEALTH SCIENCES - LOMBARD - IL