Management of chronic pain using complementary and integrative medicine

Chen, Lucy; Michalsen, Andreas

doi:10.1136/bmj.j1284

Cited by 150 publications

(77 citation statements)

References 82 publications

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“…Complementary and integrative medicine including acupuncture, dietary supplements, and mind-body systems are being increasingly used for treating chronic pain partly to reduce complications of longterm opioid use. 95 We found that electro-acupuncture without anesthesia in awake BERK sickle mice led to a variable analgesic response, categorized into high, moderate, and low responses. 96 These effects were correlative to a reduction in inflammatory cytokines, SP, and neurogenic inflammation in the periphery and signaling pathways of nociception in the spinal cord, thus influencing the sickle microenvironment as well as nociception centrally.…”

Section: Nonpharmacologic Interventionsmentioning

confidence: 88%

Targeting novel mechanisms of pain in sickle cell disease

Tran

Gupta

2017

Hematology

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Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vaso-occlusive crises (VOCs) characterized by episodic, recurrent, and unpredictable episodes of acute pain. Microvascular obstruction during a VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress, and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents up-to-date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of “top-down” mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD.

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Section: Nonpharmacologic Interventionsmentioning

confidence: 88%

Targeting novel mechanisms of pain in sickle cell disease

Tran

Gupta

2017

Hematology

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“…The top 4 CMs most often perceived as being useful were also the most recommended (Osteopathic treatment, acupuncture, yoga, and therapeutic massage). Interestingly, all four CM treatments have shown some effect in the treatment of chronic or recurrent LBP [ 9 , 14 , 16 ]. These treatments, among others, were already recommended in the ACP’s 2007 guidelines as second-line treatments [ 18 ] and appear in the 2017 guidelines as first-line options [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organization (WHO) defines CM as “a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system”. Some studies suggest that CM non-pharmacologic therapies such as acupuncture [ 7 – 9 ], yoga [ 10 , 11 ], Tai-Chi [ 12 ], Mindfulness-based stress reduction [ 13 ], osteopathy [ 14 ] and hypnosis [ 15 ] might be useful treatment options for patients suffering from chronic LBP [ 16 ], although more studies are needed.…”

Section: Introductionmentioning

confidence: 99%

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

et al. 2018

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ObjectiveRecent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior.DesignAn exploratory cross-sectional study.Setting and participantsPrimary care physicians of the French-speaking part of Switzerland.Main outcome measuresPrimary care physicians’ perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths.Results533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general.ConclusionOur results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented.

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“…Current evidence does not substantiate that the choice of needle points or the type of acupuncture affects efficacy, but more sessions and more needle applications are associated with more favourable outcomes in adults [ 15 ]. Acupuncture is considered safe when offered by trained practitioners, both when used in adults [ 13 , 16 ] and in children [ 17 ]. Acupuncture for children has gained some acceptance in Western medicine, even though the evidence supporting the use of acupuncture in small children is sparse [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Skjeie

Skonnord

Brekke

et al. 2018

Scandinavian Journal of Primary Health Care

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ObjectiveNeedle acupuncture in small children has gained some acceptance in Western medicine. It is controversial, as infants and toddlers are unable to consent to treatment. We aimed to assess its efficacy for treating infantile colic.DesignA systematic review and a blinding-test validation based on individual patient data from randomised controlled trials. Primary end-points were crying time at mid-treatment, at the end of treatment and at a 1-month follow-up. A 30-min mean difference (MD) in crying time between acupuncture and control was predefined as a clinically important difference. Pearson’s chi-squared test and the James and Bang indices were used to test the success of blinding of the outcome assessors [parents].Eligibility criteria and data sourcesWe included randomised controlled trials of acupuncture treatments of infantile colic. Systematic searches were conducted in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, and in the Chinese language databases CNKI, VIP, Wang fang, SinoMed and Chinese Clinical Trial Registry.ResultsWe included three randomised controlled trials with data from 307 participants. Only one of the included trials obtained a successful blinding of the outcome assessors in both the acupuncture and control groups. The MD in crying time between acupuncture intervention and no acupuncture control was −24.9 min [95% confidence interval, CI −46.2 to −3.6; three trials] at mid-treatment, −11.4 min [95% CI −31.8 to 9.0; three trials] at the end of treatment and −11.8 min [95% CI −62.9 to 39.2; one trial] at the 4-week follow-up. The corresponding standardised mean differences [SMDs] were −0.23 [95% CI −0.42 to −0.06], −0.10 [95% CI −0.29 to 0.08] and −0.09 [95% CI −0.48 to 0.30]. The heterogeneity was negligible in all analyses. The statistically significant result at mid-treatment was lost when excluding the apparently unblinded study in a sensitivity analysis: MD −13.8 min [95%CI −37.5 to 9.9] and SMD −0.13 [95%CI −0.35 to 0.09]. The registration of crying during treatment suggested more crying during acupuncture [odds ratio 7.7; 95% CI 2.7–20.6; one trial]. GRADE-Moderate quality evidence.ConclusionsPercutaneous needle acupuncture treatments should not be recommended for infantile colic on a general basis.Systematic review registrationPROSPERO 2015:CRD42015023253Key pointsThe role of acupuncture in the treatment of infantile colic is controversial. Available trials are small and present conflicting results.There were no clinically important differences between infants receiving acupuncture and no acupuncture control in this IPD meta-analysis of randomised controlled trials.The data indicate that acupuncture induces some treatment pain in many of the children.The study results indicate that percutaneous needle acupuncture should not be recommended for treatment of infantile colic on a general basis.

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Management of chronic pain using complementary and integrative medicine

Cited by 150 publications

References 82 publications

Targeting novel mechanisms of pain in sickle cell disease

Targeting novel mechanisms of pain in sickle cell disease

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

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