Chronic Pain and Complementary Health Approaches: What You Need To Know
On this page:
- What’s the Bottom Line?
- What Is Chronic Pain and Why Is It Important?
- What the Science Says About Safety and Side Effects
- What the Science Says About Complementary Health Approaches for Chronic Pain
- Guidelines for the Treatment of Chronic Pain Conditions
- NCCAM-Funded Research
- If You Are Considering Complementary Health Approaches for Chronic Pain
- Key References
- For More Information
What’s the Bottom Line?
Are complementary health approaches for chronic pain safe?
- There’s no simple answer to this question. Although many of the complementary approaches studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.
Are any complementary health approaches for chronic pain effective?
- The currently available evidence is not strong enough to allow definite conclusions to be reached about whether complementary approaches are effective for chronic pain. However, a growing body of scientific evidence suggests that some of these approaches, such as massage, spinal manipulation, and yoga, may help to manage some painful conditions.
What Is Chronic Pain and Why Is It Important?
Chronic pain is pain that lasts a long time. It’s a very common problem. More than 100 million U.S. adults have chronic pain conditions.
What the Science Says About Safety and Side Effects
Although many of the complementary approaches studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and other treatments (such as medication) may affect the safety of complementary approaches. If you are considering or using a complementary approach for pain, check with your health care providers to make sure that it is safe for you and compatible with your conventional treatment.
Here are some safety considerations for specific approaches:
Side effects from spinal manipulation—a technique performed by trained practitioners that involves using their hands or a device to apply a controlled force to a joint of the spine—can include physical discomfort in the parts of the body that were treated, temporary headaches, or tiredness. There have been rare reports of more serious problems; for details, see the National Center for Complementary and Alternative Medicine (NCCAM) fact sheets Headaches and Complementary Health Approaches and Spinal Manipulation for Low-Back Pain.
Yoga, a mind and body practice that combines physical activity or postures, breathing exercises, and meditation, has been studied for pain conditions such as chronic low-back pain and arthritis. Overall, those who practice yoga have a low rate of side effects. However, injuries from yoga, some of them serious, have been reported. People with health conditions may need to modify or avoid some yoga poses to prevent side effects. If you have a health condition, you should talk with your health care provider before starting yoga, and inform your yoga instructor about your health issues. For further information on the safety of yoga, see the NCCAM fact sheet Yoga for Health.
Some herbal products studied for painful conditions (in particular, thunder god vine (Tripterygium wilfordii), which is sometimes used for rheumatoid arthritis) may have serious side effects. NCCAM’s Herbs at a Glance fact sheets have information about the potential side effects and drug interactions of specific herbs.
Glucosamine and chondroitin
Studies in people have not found safety issues with the dietary supplements glucosamine or chondroitin. However, a study in rats raised the possibility that high doses of glucosamine might harm the kidneys. Studies in people indicate that glucosamine or chondroitin may interact with the anticoagulant (blood-thinning) drug warfarin.
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. In most instances, though, the amount of evidence is too small to clearly show whether an approach is useful.
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.
- Studies of acupuncture for back pain that compared people who received acupuncture with those who did not receive it generally showed better relief in the acupuncture group. However, in back pain studies that compared actual or true acupuncture with simulated or sham acupuncture (procedures designed to mimic acupuncture by using needles that don’t penetrate the skin, penetrate it only slightly, or put the needles in places different from those used in actual acupuncture), there has been only a small difference in pain relief, if any, between people in the two groups.
- Massage may be helpful for chronic low-back pain.
- There is some evidence that progressive relaxation may help relieve low-back pain, but studies on this topic have not been of the highest quality.
- Spinal manipulation can provide relief from low-back pain and appears to work at least as well as other treatments.
- Studies have shown that yoga can be helpful for low-back pain.
- A 2006 systematic review of research on herbal remedies for low-back pain found preliminary evidence that short-term use of three herbs—devil’s claw and white willow bark (taken by mouth) and cayenne (applied on the skin)—might be helpful for low-back pain, but it is not known whether these herbs are safe or effective when used for longer periods of time.
- Studies of prolotherapy (a treatment involving repeated injections of irritant solutions) for low-back pain have had inconsistent results.
- Studies of acupuncture for osteoarthritis have shown that people who receive acupuncture report better pain relief than those who don’t receive acupuncture, and people who receive actual acupuncture report better pain relief than those who receive simulated acupuncture. However, the difference between actual and simulated acupuncture is much smaller than the difference between acupuncture and no acupuncture.
- A small amount of research on massage and tai chi suggests that both practices might help to reduce osteoarthritis pain.
- Numerous natural products, including glucosamine, chondroitin, dimethyl sulfoxide (DMSO), methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe), and a variety of herbs, have been studied for osteoarthritis, but there is little conclusive evidence of benefit for symptoms.
More information on complementary health approaches for osteoarthritis
- Research results suggest that some mind and body practices, such as relaxation, mindfulness meditation, tai chi, and yoga, may be beneficial additions to treatment plans, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.
- Omega-3 fatty acids of the types found in fish oil may have modest benefits in relieving symptoms in rheumatoid arthritis. No other dietary supplement has shown clear benefits for rheumatoid arthritis, but there is preliminary evidence for a few, particularly gamma-linolenic acid and the herb thunder god vine. However, serious safety concerns have been raised about thunder god vine.
More information on complementary health approaches for rheumatoid arthritis
- Relaxation training may help to relieve chronic headaches and prevent migraines.
- Biofeedback may be helpful for migraines and tension-type headaches.
- Studies of acupuncture for headache have found that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency and severity; the difference in effectiveness between acupuncture and no acupuncture was greater than the difference between actual and simulated acupuncture.
- Spinal manipulation may help people suffering from chronic tension-type or cervicogenic (neck-related) headaches and may also be helpful in preventing migraines.
- Several dietary supplements, including riboflavin, coenzyme Q10, and the herbs butterbur and feverfew, have been studied for migraine, with some promising results in preliminary studies.
More information on complementary health approaches for headache
- Acupuncture hasn’t been studied as extensively for neck pain as for some other conditions such as back pain. However, the available evidence indicates that people who receive acupuncture for neck pain have better pain relief than those who don’t receive acupuncture. The small number of studies that have compared actual acupuncture with simulated acupuncture show that patients receiving actual acupuncture had better pain relief than those receiving simulated acupuncture.
- There is some evidence that spinal manipulation or mobilization (movement imposed on joints and muscles) may help to relieve neck pain, but much of the research on these techniques has been of low quality.
- It is uncertain whether acupuncture is helpful for fibromyalgia.
- Some evidence suggests that tai chi may be helpful for fibromyalgia pain and other symptoms, but the amount of research on tai chi has been small.
- Studies have found improvements in fibromyalgia symptoms from various meditation techniques, but much of the research on this topic has not been of the highest quality.
- There is insufficient evidence that any natural products can help to relieve fibromyalgia pain.
- Studies of homeopathy have not demonstrated that it is beneficial for fibromyalgia.
More information on complementary health approaches for fibromyalgia
Irritable bowel syndrome
- Although no complementary health approach has definitely been shown to be helpful for irritable bowel syndrome, some research results for hypnotherapy and probiotics have been promising.
- A study of mindfulness meditation has indicated that it may help reduce the severity of irritable bowel syndrome in women.
- Studies on peppermint oil have suggested that it may be helpful, but the quality of much of the research is poor.
- Studies of acupuncture for irritable bowel syndrome have not found actual acupuncture to be more helpful than simulated acupuncture.
More information on complementary health approaches for irritable bowel syndrome
Other types of pain
- Various complementary approaches have also been studied for other types of chronic pain, such as facial pain, nerve pain, chronic prostatitis/chronic pelvic pain syndrome, menstrual cramps, elbow pain, pain associated with endometriosis, carpal tunnel syndrome, and cancer pain. There is promising evidence that some complementary approaches may be helpful for some of these types of pain, but the evidence is insufficient to clearly establish the effectiveness of any of the approaches.
Other complementary approaches
- It has been suggested that vitamin D may be helpful for chronic pain, but there has been only a small amount of research on this topic, and much of the research has been of poor quality.
- Music may help to relieve pain and decrease the need for pain-relieving drugs, but research indicates that its effects are small.
- There is a lack of high-quality research to definitively evaluate whether Reiki is of value for pain relief.
- Although static magnets are widely marketed for pain control, the evidence does not support their use.
Complementary health approaches that have been studied for pain:
- Spinal manipulation
- Massage therapy
- Relaxation techniques
- Tai chi
Guidelines for the Treatment of Chronic Pain Conditions
National health professional organizations have issued guidelines for treating several chronic pain conditions. Some mention ways in which certain complementary health approaches can be incorporated into treatment plans. Others discourage the use of certain complementary approaches.
For example, the guideline for treating back pain issued by the American College of Physicians and the American Pain Society states that nondrug approaches should be considered in patients who do not improve with self-care. Some of the suggested nondrug approaches, such as exercise therapy and cognitive-behavioral therapy, are conventional; others, including acupuncture, massage therapy, spinal manipulation, and progressive relaxation, are complementary.
Another example is the guideline for treating osteoarthritis of the knee and hip issued by the American College of Rheumatology. For osteoarthritis of the knee, the guidelines mention tai chi as one of several nondrug approaches that might be helpful. The same guidelines, however, discourage using the dietary supplements glucosamine and chondroitin for osteoarthritis of the hip or knee.
For more information, see the list of clinical practice guidelines on NCCAM’s Web page on Pain.
NCCAM is part of the National Institutes of Health (NIH) Pain Consortium, which coordinates pain research across NIH. NCCAM-supported studies are helping to build an evidence base on the effectiveness and safety of complementary modalities for treating chronic pain.
More about NCCAM-funded pain research
NCCAM-supported studies in progress are investigating:
- The mechanisms by which manual and movement-based complementary approaches may help relieve low-back pain.
- The effectiveness of a hospital-based integrative care clinic in helping patients with chronic low-back pain.
- The use of complementary approaches as part of pain management for hospital inpatients.
- The use of acupuncture for chronic pain within an integrated health plan.
In addition, NCCAM’s Division of Intramural Research focuses on the role of the brain in perceiving, modifying, and managing pain. This focus complements the efforts of other ongoing NIH intramural neuroscience, imaging, and mental and behavioral health research programs.
Research projects include investigating the role of the brain in pain processing and control, and how factors such as emotion, attention, environment, and genetics affect pain perception. The program is also exploring how chronic pain produces changes in the brain that can modify how the brain reacts to pain medications such as opioids.
In light of the human and economic costs of chronic pain, as well as evidence that many people who have chronic pain turn to complementary health approaches for relief, NCCAM places a high priority on pain-related research. Researchers in this area face unique challenges: much remains to be understood about the nature of chronic pain and about the best ways of studying its many causes, people’s different responses, and the value of various treatment approaches—complementary and conventional. The ultimate goal is to build an evidence base that can guide pain management decisions tailored to individuals. These decisions often involve combining treatment approaches in cost-effective ways that do the best possible job of helping people minimize pain, carry out everyday activities, and improve their quality of life.
While building an evidence base to help people with chronic pain and their health care providers make decisions about pain management, research on complementary health approaches is also helping to close gaps in our basic understanding of pain mechanisms.
If You Are Considering Complementary Health Approaches for Chronic Pain
- Do not use an unproven product or practice to replace conventional care or 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 are considering and ask any questions you may have. They may be able to advise you on its safety, use, and likely effectiveness.
- If you are considering a practitioner-provided complementary health practice 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 are considering. Ask whether the practitioner has experience working with your pain condition.
- If you are 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 you take. Your health care provider can advise you. If you are pregnant or nursing a child, or if you are considering giving a child a dietary supplement, it is especially important to consult your (or your child’s) health care provider. To learn more, visit NCCAM’s Web page on dietary supplements.
Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary health approaches, see NCCAM’s Time to Talk campaign.
1 Certain chronic conditions, several of which cause pain, may occur together; some individuals have two or more of these problems. These conditions include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, temporomandibular joint dysfunction, and vulvodynia (chronic vulvar pain). It is not known whether these disorders share a common cause.
For More Information
The NCCAM Clearinghouse provides information on NCCAM and complementary 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.
National Institute of Neurological Disorders and Stroke (NINDS)
The mission of NINDS is to reduce the burden of neurological diseases—a burden borne by every age group, every segment of society, and people all over the world. To accomplish this goal NINDS supports and conducts research, both basic and clinical, on the normal and diseased nervous system, fosters the training of investigators in the basic and clinical neurosciences, and seeks better understanding, diagnosis, treatment, and prevention of neurological disorders.
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.
A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.
The 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.
NIH Clinical Research Trials and You
The National Institutes of Health (NIH) has created a Web site, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
Information on chronic pain
- Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal. 2008;8(1):213–225.
- Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews. 2004;(3):CD001878 [edited 2009]. Accessed at www.thecochranelibrary.com on February 18, 2013.
- Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain. A randomized, controlled trial. Annals of Internal Medicine. 2011;155:1–9.
- Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine. 2007;147(7):492–504.
- Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2008;(4): CD001929 [edited 2010]. Accessed at www.thecochranelibrary.com on February 18, 2013.
- Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evidence-Based Complementary and Alternative Medicine. 2012;2012:953139.
- Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. American Journal of Gastroenterology. 2011;106(9):1678–1688.
- Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain. Cochrane Database of Systematic Reviews. 2010;(1):CD004249. Accessed at www.thecochranelibrary.com on February 18, 2013.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press Web site. Accessed at www.nap.edu/catalog.php?record_id=13172 on July 16, 2012.
- Kozasa EH, Tanaka LH, Monson C, et al. The effects of meditation-based interventions on the treatment of fibromyalgia. Current Pain and Headache Reports. June 21, 2012. Epub ahead of print.
- Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2012;(5):CD005111. Accessed at www.thecochranelibrary.com on February 18, 2013.
- Miller KL, Clegg DO. Glucosamine and chondroitin sulfate. Rheumatic Diseases Clinics of North America. 2011;37(1):103–118.
- Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325–332.
- Ritchie ML, Romanuk TN. A meta-analysis of probiotic efficacy for gastrointestinal diseases. PLoS One. 2012;7(4):e34938.
- Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. 2012;172(19):1444–1453.
- Wang C, Schmid CH, Hibberd PL, et al. Tai chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis & Rheumatism. 2009;61(11):1545–1553.
- Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010;363(8):743–754.
All Other References
NCCAM thanks Gert Bronfort, D.C., Ph.D., Northwestern Health Sciences University; Scott Haldeman, D.C., M.D., Ph.D., University of California, Irvine; John Kusiak, Ph.D., National Institute of Dental and Craniofacial Research, NIH; Karen Sherman, Ph.D., M.P.H., Group Health Research Institute; Dennis Turk, Ph.D., University of Washington; and John Glowa, Ph.D., NCCAM for their contributions to the 2013 update of this publication.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.