What’s the Bottom Line?
How much do we know about the effectiveness of complementary health approaches for chronic pain?
- A growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.
What do we know about the safety of complementary health approaches for chronic pain?
- Although the psychological and/or physical approaches (e.g., acupuncture, meditation, yoga, massage) studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches. If you’re considering nutritional approaches such as dietary supplements, remember that natural doesn’t always mean safe and that some dietary supplements may have side effects or interact with medications.
What Is Chronic Pain and Why Is It Important?
Chronic pain is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2019 National Health Interview Survey (NHIS) show that:
- About 20.4 percent of U.S adults had chronic pain (defined as pain on most days or every day in the past 3 months).
- About 7.4 percent of U.S. adults had high-impact chronic pain (defined as chronic pain that limited their life or work activities on most days or every day for the past 3 months).
More Information
What the Science Says About Complementary Health Approaches for Chronic Pain
The scientific evidence suggests that some complementary health approaches may help people manage chronic pain.
A comprehensive description of scientific research on all the complementary approaches that have been studied for chronic pain is beyond the scope of this fact sheet. This section highlights the research status of some approaches used for common kinds of pain.
Chronic Pain in General
Back and Neck Pain
Osteoarthritis
Rheumatoid Arthritis
Headaches
Fibromyalgia
Irritable Bowel Syndrome
Less-Studied Complementary Approaches
What the Science Says About Safety and Side Effects
As with any treatment, it’s important to consider safety before using complementary health approaches. Safety depends on the specific approach and on the health of the person using it. If you’re considering or using a complementary approach for pain, check with your health care providers to make sure it’s safe for you.
Safety of Psychological and Physical Approaches
Safety of Nutritional Approaches
Guidelines for the Treatment of Chronic Pain Conditions
National health professional organizations have issued guidelines for treating several chronic pain conditions that address the use of complementary health approaches.
More Information
NCCIH-Funded Research
NCCIH is part of the National Institutes of Health (NIH) Pain Consortium, which coordinates pain research across NIH. NCCIH-supported studies are helping to build an evidence base on the effectiveness and safety of complementary modalities for treating chronic pain.
NCCIH is also the lead agency in the Pain Management Collaboratory, an initiative jointly supported by NIH, the Department of Defense, and the U.S. Department of Veterans Affairs. The Collaboratory is conducting clinical trials of nondrug approaches for the management of pain and co-occurring conditions in the military and veterans health care systems.
NCCIH is playing a major role in the Helping to End Addiction Long-term Initiative®, or NIH HEAL Initiative®, an NIH-wide effort focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management. NCCIH is leading or co-leading several NIH HEAL Initiative programs that focus on pain management.
NCCIH is leading the Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM) program within the NIH HEAL Initiative. PRISM supports pragmatic trial research projects embedded in health care systems. These trials will determine the effectiveness of multiple nonpharmacologic and nonopioid interventions for treating pain and assess the impact of implementing interventions or guidelines to improve pain management and reduce reliance on opioids.
More About NCCIH-Funded Pain Research
If You’re Considering Complementary Health Approaches for Chronic Pain
- Don’t use an unproven product or practice to postpone seeing a health care provider about chronic pain or any other health problem.
- Learn about the product or practice you are considering, especially the scientific evidence on its safety and whether it works.
- Talk with the health care providers you see for chronic pain. Tell them about the product or practice you’re considering and ask any questions you may have. They may be able to advise you on its safety, use, and likely effectiveness.
- If you’re considering a practitioner-provided complementary health approach such as spinal manipulation, massage, or acupuncture, ask a trusted source (such as your health care provider or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. Ask whether the practitioner has experience working with your pain condition.
- If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider. To learn more, visit NCCIH’s webpage on dietary supplements.
For More Information
NCCIH Clearinghouse
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
Telecommunications relay service (TRS): 7-1-1
Website: https://www.nccih.nih.gov
Email: info@nccih.nih.gov(link sends email)
Know the Science
NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.
Explaining How Research Works (NIH)
Know the Science: How To Make Sense of a Scientific Journal Article
National Institute of Neurological Disorders and Stroke (NINDS)
NINDS conducts and supports research on how the brain and nervous system function and on treatments for neurological diseases.
Toll-free in the U.S.: 1-800-352-9424
Website: https://www.ninds.nih.gov/
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
Toll-free in the U.S.: 1-877-22-NIAMS
Website: https://www.niams.nih.gov
PubMed®
A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Practices on PubMed.
Complementary Health Approaches for Chronic Pain—Randomized Controlled Trials
Website: https://pubmed.ncbi.nlm.nih.gov/
Cochrane Database of Systematic Reviews
The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews produced by the Cochrane Library, an international nonprofit organization. The reviews summarize the results of clinical trials on health care interventions. Summaries are free; full-text reviews are by subscription only.
Website: https://www.cochranelibrary.com/Link to External Link Policy
Key References
- Cheng C-A, Chiu Y-W, Wu D, et al. Effectiveness of tai chi on fibromyalgia patients: a meta-analysis of randomized controlled trials. Complementary Therapies in Medicine.2019;46:1-8.
- Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Annals of Internal Medicine. 2017;166(7):493-505.
- Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic nonspecific neck pain: a systematic review and meta-analysis for an appropriateness panel. Pain Physician. 2019;22(2):E55-E70.
- Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR. Morbidity and Mortality Weekly Report.2022;71(3):1-95.
- Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;(9):CD001929. Accessed at cochranelibrary.comLink to External Link Policy on November 8, 2022.
- Garza-Villareal EA, Pando V, Vuust P, et al. Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis. Pain Physician. 2017;20(7):597-610.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press website. Accessed at nap.edu/catalog/13172/relieving-pain-in-america-a-blueprint-for-transforming-prevention-careLink to External Link Policy on November 8, 2022.
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72(2):220-233.
- Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. American Journal of Gastroenterology. 2021;116(1):17-44.
- Lin Y-C, Wan L, Jamison RN. Using integrative medicine in pain management: an evaluation of current evidence. Anesthesia and Analgesia. 2017;125(6):2081-2093.
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.
- Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headache. 2019;59(4):532-542.
- Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. Journal of Pain. 2018;19(5):455-474.
Other References
Acknowledgments
NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2023 update of this publication.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.
Original Article – https://www.nccih.nih.gov/health/chronic-pain-and-complementary-health-approaches-usefulness-and-safety
