Complementary Approaches to Tackling Pain

How do massage, tai chi and other alternative treatments stack up in treating chronic pain?

By Greg Breining, Contributing Writer

Millions of Americans suffer from long-lasting pain. Pain from joints, back, overworked muscles and headaches costs U.S. businesses more than $61 billion each year in absenteeism and lost productivity.

Conventional medicine is often only partly effective against chronic pain. As a result, many people turn to complementary and alternative therapies that are now described by the National Institutes of Health to include various treatments and practices. A survey of more than 400 patients at a clinic for chronic pain revealed that nearly 40 percent tried one of these therapies.

But are complementary and alternative treatments effective? Studies say they may provide relief for some ailments. For example, the American Pain Society and American College of Physicians recommends that doctors should consider complementary treatments for patients whose low-back pain does not improve with self-care. These treatments include spinal manipulation, acupuncture, massage therapy, yoga, cognitive-behavioral therapy and progressive relaxation.

Here’s a discussion of these treatments and the research on their effectiveness.

Acupuncture

Acupuncture is an ancient practice of traditional Chinese medicine. It is the stimulation of the skin usually with needles, but in modern times, with electricity. In the United States, it will often be used with conventional medicine like analgesic drugs and physical therapy. More than 3 million Americans have reported trying acupuncture in the previous year.

According to Chinese medicine theory, acupuncture regulates the flow of the vital energy known through body "meridians". The biomechanical aspects of acupuncture are unclear, but research continues. Neuroimaging is being used to determine how acupuncture affects the brain.

Studies suggest acupuncture shows promise for easing chronic low-back pain. It may also be effective for osteoarthritis of the knee. However, according to the National Center for Complementary and Alternative Medicine, "differences in the design, size and protocol of the studies make it hard to draw any definite conclusions from the body of research." Likewise, there is some evidence that acupuncture can ease neck pain, but studies are limited by small samples.

Acupuncture has been tried as a treatment for other painful conditions, including:

Evidence that acupuncture is effective for all of these disorders is limited. Acupuncture is considered safe when done correctly, according to the National Center for Complementary and Alternative Medicine.

Chiropractic Spinal Manipulation and Osteopathic Manipulative Treatment

Approximately 18.9 million Americans see chiropractors each year, according to NCCAM. Chiropractic manipulation of joints, also known as spinal manipulation, may complement other pain treatment.

One NCCAM-funded study suggests spinal manipulation is at least as effective as conventional treatment in providing relief from low-back pain for up to 18 months.

Spinal manipulation (as well as home exercise) was shown to be more effective than medication for treating acute to sub-acute neck pain, according to a recent NCCAM-funded study published in the Annals of Internal Medicine. Compared with people receiving only drugs, more participants who got spinal manipulation treatments or exercised at home showed reductions in pain of at least 50 percent. The results continued at 26 and 52 weeks.

Chiropractic treatment may help several other sources of pain as well, according to a 2010 review of research. These include:

The review failed to find much evidence that spinal manipulation was effective in treating fibromyalgia, mid-back pain, premenstrual syndrome, sciatica and jaw disorders.

Spinal manipulation may cause discomfort in the treated area. The NCCAM says serious complications are rare. But according to a 2011 study at St. Joseph’s Hospital and Medical Center in Phoenix, chiropractic manipulation of the neck vertebrae can cause arterial "dissections". Those are tears in the wall of the blood vessels that can lead to disability or death.

Osteopathic manipulation is a kind of spinal manipulation performed by osteopathic physicians. They often combine it with conventional treatment. According to a 2005 study, osteopathic manipulative treatment significantly reduced low-back pain for three months or more. A 1999 study found that osteopathic manipulation treated sub-acute low-back pain as effectively as standard medical care, but with fewer drugs.

Massage

Massage has been used as therapy for thousands of years. There has been some research done to determine how effective it can be in reducing pain.

Massage takes many forms. Swedish massage consists of long strokes, kneading and circular movements. Sports massage is similar with the addition of deeper pressure to help muscles recover from injury and improve joint mobility. Deep tissue manipulation, myofascial release and trigger point massage styles focus on painful muscle "knots".

A 2011 study published in the Annals of Internal Medicine showed that massage could be useful in treating chronic low-back pain. The study indicated that, compared with those who received usual care, people getting massages were better able to go about their daily routine. They were more active. They spent less time in bed. And they used less medication. Some benefits persisted for six months.

Studies have also shown that massage relieves chronic neck pain better than advice in a self-care book. Massage can reduce pain and improve the mood of people with advanced cancer, studies have shown.

The biomechanisms by which massage might relieve pain are still unclear. Massage is known to cause the release of the brain’s own morphine-like chemicals. That may contribute to relaxation and pain relief. Massage therapy poses few risks if administered by a trained therapist, according to NCCAM.

Relaxation

Relaxation techniques attempt to trigger the body’s natural relaxation response. Methods include:

Physiological changes include slower breathing and a decrease in blood pressure and oxygen consumption. There’s limited evidence these techniques can relieve tension and migraine headaches, or reduce abdominal pain and pain from surgery.

Relaxation techniques are viewed as safe, but there’s some concern they may worsen symptoms of epilepsy or various psychiatric conditions. Hypnosis therapy should be performed by trained experts familiar with these risks.

Tai Chi and Qigong

The ancient Chinese practices of tai chi and qigong show promise for a range of health benefits, including cardiopulmonary fitness, balance and bone health. There’s some evidence these closely related rhythmic exercises also help reduce pain, especially of knee osteoarthritis and fibromyalgia.

In a NCCAM-funded study at Tufts Medical Center, subjects with knee osteoarthritis assigned to a tai chi group showed improvements in measures of pain, physical function, confidence, depression and general health, compared with a control group. The differences were significant at 12, 24 and 48 weeks.

Tai chi and qigong may also relieve the symptoms of fibromyalgia, according to a NCCAM-funded study published in the New England Journal of Medicine. Compared with a control group, subjects who practiced tai chi reported achieved significantly lower scores on the Fibromyalgia Impact Questionnaire at 12 and 24 weeks. The scores reflected improvements in sleep quality, mood and quality of life.

Tai chi and qigong seem to pose no serious side effects. Research is still needed to determine how the exercises might work to reduce pain.

Yoga

The stretching and movement associated with yoga have been shown to reduce lower back pain in many people.

A 2011 study in the Archives of Internal Medicine divided 228 adults with moderate and persistent back pain into three groups. The first was a self-help group instructed to exercise at home. The second group was assigned to weekly stretching exercises. The third group attended yoga classes for patients with back pain. After 12 and 24 weeks, participants in the yoga and stretching classes reported less pain, less use of pain medications, and greater ability to move than the patients who treated themselves.

A similar study in Great Britain published in the Annals of Internal Medicine compared 12 weeks of yoga to "usual care", such as consultation with a doctor and medications. The yoga led to greater improvements in back function. Unlike the results of the American study, pain remained about the same. In both studies, a small percentage of patients complained of pain after their classes.

A NCCAM-funded researcher at West Virginia University provided similar results. Compared with the control group, a yoga group showed greater improvements in functional disability, pain, and depression at 12 weeks, 24 weeks and six months.