Some Alternative Therapies May Ease Pain
Four treatments get a thumbs-up; acupuncture scores highest.
There isn’t much scientific proof that complementary and alternative medicine (CAM) – from aromatherapy to reflexology – help with the pain and disability associated with rheumatoid arthritis (RA), osteoarthritis (OA), fibromyalgia and low back pain. But based on the available evidence, researchers in the United Kingdom, who evaluated clinical studies on 21 CAM therapies for the 4 conditions, concluded that acupuncture, massage, yoga and tai chi work in some cases.
These findings don’t mean that other CAM therapies – defined by this report as any therapy that exists outside normal health care practices – aren’t effective. The researchers stress that, in many cases, there just weren’t enough high-quality data to fully evaluate the therapies. “Where there is no or little evidence, it is very difficult to judge,” says lead author of the report, Gareth Jones, PhD, a senior lecturer in epidemiology in the School of Medicine and Dentistry at the University of Aberdeen in Scotland.
The report is 1 of 2 published recently by Arthritis Research UK, a large medical-research organization. The other report rated supplements in the treatment of OA, RA and fibromyalgia.
To evaluate CAM treatments, the researchers used a 5-point scale to judge the effectiveness of each. A ranking of 1 indicates little to no evidence of efficacy; 5 means there is consistent evidence from high-quality trials that a therapy improved patients’ pain, disability and quality of life.
Researchers also rated treatments’ safety profiles, using green for safe, red for unsafe and amber for somewhere in between.
Overall, acupuncture got high marks for helping in OA, low back pain and fibromyalgia. Massage was deemed effective for fibromyalgia and low back pain. Tai chi helped OA, and yoga was effective for low back pain.
Other CAM therapies that were evaluated – but came up short – included aromatherapy, autogenic training, biofeedback, copper bracelets, craniosacral therapy, healing therapies, hypnotherapy, imagery, magnet therapy, meditation, music therapy, qigong and reflexology.
Here are more details on the findings.
A review of 24 trials testing 9 therapies on slightly more than 1,500 patients found no treatment worked or had enough evidence to support efficacy among those with RA. The highest scores given in this category were a 2 on the 5-point scale – indicating a little evidence – for biofeedback, relaxation therapy and tai chi.
Daniel J. Clauw, MD, a professor of medicine in the division of rheumatology at the University of Michigan in Ann Arbor, says the message to RA patients is: Don’t use CAM therapies instead of conventional treatments, because there are very effective medications on the market to treat RA pain and aggressively address damage to joints. “You could be doing more than wasting time and money while dabbling with CAM therapies if you aren’t also making sure the inflammation is being well controlled,” Dr. Clauw says.
Acupuncture got a top score of 5 in this category, followed by tai chi with 4. Both ratings indicate high levels of efficacy for dealing with the degenerative joint disease.
Massage received 5 and acupuncture 4 in this analysis, based on results of 50 trials that looked at 17 therapies in more than 3,000 patients with fibromyalgia. Tai chi and relaxation therapy both got 3, which indicates there is promising evidence that they may help.
Low back pain
This category had the most studies – 75 in all, featuring more than 11,000 patients testing 14 therapies. Acupuncture and massage each received 5, yoga scored 4 and relaxation therapy, osteopathy and the Alexander technique scored 3. (The Alexander technique teaches people to move, sit and stand with less strain and more ease.)
Only chiropractic and osteopathy received an “amber” rating for safety. These treatments, which involve spinal manipulation designed to relieve pain and discomfort and to increase mobility, were found to have minor side effects such as headache, tiredness, dizziness, nausea and pain.
Jones says it’s important to evaluate these CAM therapies in populations with musculoskeletal conditions, as they likely use the treatments more than others. “People do spend their money on these things, and there’s a need to advise them where the evidence fits so they can make these choices wisely,” he says.
CAM therapies are used by approximately 38 percent of American adults, according to the 2007 National Health Interview Survey.
The evidence is especially clear in favor of acupuncture for OA, fibromyalgia and low back pain. In fact, Jones says its benefits are so well documented that it raises the question of whether acupuncture should continue to be viewed as a CAM therapy. “There’s an argument that maybe this should be part of conventional medicine. When something works, when there is good evidence something works, is it right that it is still a complementary therapy? Probably not,” Jones says, adding that he’d like to see future studies about why CAM therapies work.
Dr. Clauw says he hopes for more high-quality studies comparing the effectiveness of CAM therapies. But he says this is more data than patients have ever had before, which is helpful since CAM therapies often aren’t covered by insurance.
Jones agrees. “Until this came out and synthesized data, there was no guidance. Now there is some. That would be a good place for someone to start if they want to pursue CAM therapies,” Jones says. “Start with the ones that are on the list, but it doesn’t mean that something not on the list won’t work.”
Before you try a CAM therapy, make sure your doctor is supportive, Dr. Clauw says. “The main thing I can help you with is to evaluate if it’s safe,” he explains. “And then it comes down to patient preference. Are they willing to pay out of pocket for a treatment that may or may not work?”
He also recommends trying only one CAM therapy at a time. “Give it a month or two, retain what works and discard what doesn’t,” Dr. Clauw suggests. “If it’s not working after a month or a couple treatments a week, it’s probably best for the patient to check the box saying, ‘This didn’t work,’ and move on.”
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