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Overview of Common Complementary and Integrative Approaches to Managing Chronic Pain: A Guide for Patients With Chronic Pain

      Chronic pain is pain that lasts for more than 3-6 months. It is a complex health condition that is difficult to treat. Chronic pain is stressful, and can lead to serious and costly physical and mental health problems. Many people affected by chronic pain can become addicted to pain medications, like opioids. It can also lead to depression and loss of income from days out of work. The most common causes are low back pain, arthritis, and headaches.
      About 40% of the United States population has chronic pain. Of these, 38% of people use complementary and integrative medicine (CIM) approaches to cope with their pain.
      • Barnes P.M.
      • Bloom B.
      • Nahin R.L.
      Complementary and alternative medicine use among adults and children: United States, 2007.
      People use CIM for pain relief and to reduce the side effects of pain medications. CIM is not a typical medical treatment, so it is not regulated by medical or health care institutes. Common CIM approaches are available in our communities though drugstores, supermarkets, health spas, gyms, and private clinics.
      The goals of CIM therapies are to reduce pain and control the body’s response to pain. It also decreases how much pain interferes with everyday life. People use CIM approaches along with usual medical treatments. Hence, these approaches are integrative. CIM is not recommended as a replacement for usual medical care.
      This guide provides a brief outline of the most common CIM approaches to manage chronic pain that are not nutritional supplements. This guide does not evaluate the usefulness of these CIM approaches. You should talk to your doctor to find out if any CIM approaches may help you. Be aware that your insurance may not pay for these CIM approaches. Contact your health care provider to learn more about the options of including CIM into your treatment plan. Some common CIM approaches that are used for chronic pain are listed below. Many of these approaches are used in combination with other rehabilitation therapies.
      • 1.
        Acupuncture: People in China, Japan, and Korea have used acupuncture for thousands of years to treat pain. Acupuncture uses hair-thin needles inserted into specific areas of the body. This is known to promote the flow of blood. It is one of the most common CIM methods to treat low back pain and headaches.
        • Haake M.
        • Muller H.H.
        • Schade-Brittinger C.
        • et al.
        German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.
        It affects the immune system and the brain chemicals that interpret pain.
        • Vickers A.J.
        • Cronin A.M.
        • Maschino A.C.
        • et al.
        Acupuncture for chronic pain: individual patient data meta-analysis.
        In the United States, the National Certification Commission for Acupuncture and Oriental Medicine certifies acupuncturists.
      • 2.
        Biofeedback: Biofeedback is an ancient practice used by yogis and monks to control breathing and heart rate. More recently, modern technology helps guide the practice by providing real-time feedback. Chronic pain is invisible. Biofeedback makes our experience of the pain visible. A sensor is placed on areas of the body such as fingertips or ear lobe. This sensor measures changes that are not normally visible. Different biofeedback techniques control the body’s responses to experiences, such as pain. With biofeedback, you can learn to control your body, relax muscles, and reduce the effects of stress.
        • Gatchel R.J.
        • Robinson R.C.
        • Pulliam C.
        • Maddrey A.M.
        Biofeedback with pain patients: evidence for its effectiveness.
        As you gain control of your body, your fear of pain decreases, which can reduce the stress caused by pain, and the perception of pain itself. The Biofeedback Certification International Alliance certifies qualified persons to practice and instruct biofeedback.
      • 3.
        Massage: Massage therapy originates from ancient Chinese and Egyptian practices. Massage promotes health and healing. Massage therapy can decrease the sensation of pain and reduce the effects of chronic pain on the body. It relaxes muscles and improves blood flow. It can also decrease emotional stress, anxiety, and improve mood. This helps to minimize the perception of pain.
        • Bauer B.A.
        • Tilburt J.C.
        • Sood A.
        • Li G.X.
        • Wang S.H.
        Complementary and alternative medicine therapies for chronic pain.
        The American Massage Therapy Association licenses qualified therapists in the United States.
      • 4.
        Yoga: Yoga originates from ancient Indian philosophy. This relies on mind-body control through conscious breathing. It is popular in the United States, with more than 36 million adults practicing yoga for health reasons. Yoga reduces the perception of pain by decreasing heart rate and anxiety. Practicing yoga helps the body to restore strength and flexibility.
        • Tilbrook H.E.
        • Cox H.
        • Hewitt C.E.
        • et al.
        Yoga for chronic low back pain randomized trial.
        People with high blood pressure, chronic pain, or movement restrictions must use modified poses that are not physically demanding. The different styles of yoga each have unique benefits. The Yoga Alliance regulates yoga schools and yoga teachers in the United States.
      • 5.
        Tai chi: Tai chi is an ancient Chinese health practice. In Chinese medicine, blockage in the flow of blood or life energy results in pain. Tai chi restores its flow using breathing techniques, mental imagery, and gentle body movements. It decreases chronic pain from arthritis, low back pain, and muscle pain.
        • Hall A.M.
        • Maher C.G.
        • Lam P.
        • Ferreira M.
        • Latimer J.
        Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial.
        Tai chi is very gentle on the body and should not cause any knee or back pain when done properly. Currently, no universal institute certifies tai chi instructors.
      • 6.
        Mindfulness meditation: The monks of China and India practice meditation for spirituality. Mindfulness is non-judgmental awareness of the present moment. Mindfulness meditation focuses the mind on breathing. It also tries to minimize awareness of other thoughts and sensations. This can decrease the experience of pain and increase pain tolerance.
        • Zeidan F.
        • Grant J.
        • Brown C.
        • McHaffie J.
        • Coghill R.
        Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain.
        Meditation also decreases the brain’s activity in areas that process emotions and memories to interpret pain.
        • Grant J.A.
        • Courtemanche J.
        • Duerden E.G.
        • Duncan G.H.
        • Rainville P.
        Cortical thickness and pain sensitivity in zen meditators.
        Currently, no universal institute certifies mindfulness meditation instructors.

      Resources

      Authorship

      This page was developed by Shilpa Krishnan, PT, PhD (e-mail address: [email protected] ); Dustin Anderson, MD; Sophia Chan, DPT, LAc; Sonya Kim, CRC, PhD; Timothy Reistetter, PhD, OTR; Pallavi Sood, MS; Marianne H. Mortera, PhD, OTR/L; Justin M. Heesakker, MS, LAc; Patricia C. Heyn, PhD, FGSA, FACRM; and the Complementary Integrative Rehabilitation Medicine Networking Group from the American Congress of Rehabilitation Medicine.

      Disclaimer

      This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.

      References

        • Barnes P.M.
        • Bloom B.
        • Nahin R.L.
        Complementary and alternative medicine use among adults and children: United States, 2007.
        Natl Health Stat Report. 2008; 10: 1-23
        • Haake M.
        • Muller H.H.
        • Schade-Brittinger C.
        • et al.
        German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.
        Arch Intern Med. 2007; 167: 1892-1898
        • Vickers A.J.
        • Cronin A.M.
        • Maschino A.C.
        • et al.
        Acupuncture for chronic pain: individual patient data meta-analysis.
        Arch Intern Med. 2012; 172: 1444-1453
        • Gatchel R.J.
        • Robinson R.C.
        • Pulliam C.
        • Maddrey A.M.
        Biofeedback with pain patients: evidence for its effectiveness.
        Pain Med. 2003; 1: 55-66
        • Bauer B.A.
        • Tilburt J.C.
        • Sood A.
        • Li G.X.
        • Wang S.H.
        Complementary and alternative medicine therapies for chronic pain.
        Chin J Integr Med. 2016; 22: 403-411
        • Tilbrook H.E.
        • Cox H.
        • Hewitt C.E.
        • et al.
        Yoga for chronic low back pain randomized trial.
        Ann Intern Med. 2011; 155: 569-578
        • Hall A.M.
        • Maher C.G.
        • Lam P.
        • Ferreira M.
        • Latimer J.
        Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial.
        Arthritis Care Res. 2011; 63: 1576-1583
        • Zeidan F.
        • Grant J.
        • Brown C.
        • McHaffie J.
        • Coghill R.
        Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain.
        Neurosci Lett. 2012; 520: 165-173
        • Grant J.A.
        • Courtemanche J.
        • Duerden E.G.
        • Duncan G.H.
        • Rainville P.
        Cortical thickness and pain sensitivity in zen meditators.
        Emotion. 2010; 10: 43