A Systematic Review of Practiced-Based Research of Complementary and Integrative Health Therapies as Provided for Pain Management in Clinical Settings: Recommendations for the Future and a Call to Action

Abstract

Objective The goal of this systematic review was to evaluate practice-based, real-world research of individualized complementary and integrative health (CIH) therapies for pain as provided in CIH outpatient clinics. Methods A systematic review was conducted on articles in PubMed, Ovid, Cochrane, Web of Science, Scopus, and Embase published through December 2020. The study was listed in the PROSPERO database (CRD42020159193). Major categories of variables extracted included study details and demographics, interventions, and outcomes. Results The literature search yielded 3,316 records, with 264 assessed for full-text review. Of those, 23 studies (including ∼8,464 patients) were specific to pain conditions as a main outcome. Studies included chiropractic, acupuncture, multimodal individualized intervention/programs, physiotherapy, and anthroposophic medicine therapy. Retention rates ranged from 53% to 91%, with studies offering monetary incentives showing the highest retention. The 0–10 numerical rating scale was the most common pain questionnaire (n = 10; 43% of studies), with an average percent improvement across all studies and time points of 32% (range: 18–60%). Conclusions Findings from this systematic review of practice-based, real-word research indicate that CIH therapies exert positive effects on various pain outcomes. Although all studies reported beneficial impacts on one or more pain outcomes, the heterogeneous nature of the studies limits our overall understanding of CIH as provided in clinical settings. Accordingly, we present numerous recommendations to improve publication reporting and guide future research. Our call to action is that future practice-based CIH research is needed, but it should be more expansive and conducted in association with a CIH scientific society with academic and health care members.

Evaluation of a Distance Reiki Program for Frontline Healthcare Workers’ Health-Related Quality of Life During the COVID-19 Pandemic

“…Although nearly half of the participants did not take the post measures, this attrition rate is within normal range for observational studies of integrative and complementary medicine programs. 58,59 It is not possible to ascertain why some participants did not complete the post measures, although time constraints of the frontline health professionals could be 1 reason. Regardless, there were no significant differences in pre-scores between participants that completed the post measures and those who did not, nor by occupation type.…”

“…Furthermore, there was no compensation for participating in the study, and integrative medicine studies with monetary incentives tend to show higher retention rates. 58,59 Therefore, future work will include compensation for questionnaire completion to increase participant retention. Lastly, the MYMOP was modified to include pre-established symptoms, which can be seen to limit its validity.…”

Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine

“…Applications of IHM in the ambulatory setting have been well-studied in the medical literature, from uses in the treatment of chronic pain [ 3 ] and symptom palliation [ 4 , 5 ] to stress and anxiety reduction [ 6 ]. For example, a 2018 meta-analysis of 39 trials involving 20,827 patients found that acupuncture was superior to sham and/or no acupuncture treatment controls (p < 0.001) in the treatment of nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain, with only a 15% decrease in effect at one year after treatment [ 7 ].…”

“…Other common chief complaints included stress (12.7%), anxiety (11.3%), and headache/migraine (8.9%). Median [IQR] encounter engagement volume among patients was 2[1][2][3][4][5][6] encounters, with the most common IHM modality being massage (35.8%) followed by acupuncture (28.2%), chiropractic (27.5%), IMC (23.1%), and OMT (13.0%).…”