Complementary and alternative medicine (CAM) is increasingly being utilized as part of comprehensive treatment of pain. The NIH National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into five categories (examples of each are included):

1) Alternative Medical Systems – based on complete systems of theory and practice, including Ayurvedic medicine (native to India); homeopathy (developed by a German physician, Samuel Hahnemann); and acupuncture (based on maintaining balanced “chi” or energy in the body).

2) Mind-body interventions – the goal is to enhance the mind’s ability to affect bodily functions. Examples include:

Hypnotherapy – successful pain relief in cases of chronic back pain and for headaches following brain injury has been anecdotally reported; published controlled studies, however, have not used equally credible placebos or minimally effective pain treatment, so conclusions about the effectiveness of hypnotic therapy as an analgesic over and above its effects on patient expectancy are difficult to make (Jensen, 2006).

Meditation – involves “quieting the mind” while focusing on a single stimulus such as breathing or a mantra. A randomized, controlled trial of breath therapy vs. extensive PT demonstrated improved VAS scores, function, and SF-36 scores in both groups, with trends favoring breath therapy at 6-8 wks and favoring PT at 6 months (Mehling, 2005).

A pilot study demonstrated that a 10 wk group outpatient program for patients with fibromyalgia lowered many pain measures, SCL-90-R, Fibromyalgia Impact Questionnaire, and Fibromyalgia Attitude Index scores vs. pre-intervention levels in all patients, with 51% showing moderate to marked improvement (Kaplan, 1993).

Movement therapies – include yoga, Tai chi and dance. Goals include improving kinesthetic ability, posture, range of motion and providing an emotional outlet, while reducing pain.

There are many schools of yoga, which may differ in their emphasis of various aspects of yoga: body alignment, breath/movement coordination, or holding postures. A randomized, controlled trial of yoga (12 wk program), therapeutic exercise (12 wks), and a self-help book in patients with chronic low back pain showed improvement in the yoga group in back-related function above the exercise and book groups at 12 wks, and above the book group at 26 wks (Sherman, 2005).

Tai chi, often translated as “supreme ultimate force,” is typically practiced as a meditative exercise consisting of soft, graceful movements. A Cochrane review of Tai chi for rheumatoid arthritis (RA) concluded that Tai chi does not exacerbate RA symptoms, while ROM in the lower limbs, especially ankles, was improved. Effects on pain were not examined by the studies in the literature reviewed (Han, 2004). A single-blind, randomized study involving 66 subjects reported potential usefulness of tai chi for fibromyalgia (Wang, 2010).

Biofeedback – patients learn to control muscle tension via auditory or visual feedback they receive from a biofeedback device that measures muscle activity via surface EMG electrodes. There are no recent high-grade studies in pain medicine. Trials in the 1980s showed mixed results in terms of long-term efficacy (Bush, 1985; Flor, 1986).

3) Biologically based therapies – examples include: herbals and dietary supplements. High-grade studies for some of the more widely used therapies have
recently been completed or are now underway. Most therapies, however, have only anecdotal support. In the U.S., these substances are not subject to the same FDA regulations as conventional pharmaceuticals.

A Cochrane review found encouraging results in medium to high quality trials supporting the efficacy of Harpagophytum procumbens ( Devil’s claw), Salix alba ( white willow), and Capsicum frutescens ( cayenne pepper) treatments over placebo for low back pain (Gagnier, 2006). Feverfew, a remedy described in folklore to be helpful for headaches and arthritis, contains parthenolide as its main active ingredient, an inhibitor of prostaglandins and leukotrienes. A small double-blinded trial, however, did not demonstrate any benefit of feverfew over placebo for rheumatoid arthritis pain (Pattrick, 1989

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