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Pain Med. 2019 May 9. pii: pnz068. doi: 10.1093/pm/pnz068. [Epub ahead of print]

Synthesizing the Strength of the Evidence of Complementary and Integrative Health Therapies for Pain.

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VA Palo Alto Healthcare System, Center for Innovation to Implementation, Menlo Park, California.
Stanford University, Stanford, California.
VA Greater Los Angeles Healthcare System, Los Angeles, California.
RAND Corp, Santa Monica, California.
VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California.
UCLA, Los Angeles, California, USA.



Pain and opioid use are highly prevalent, leading for calls to include nonpharmacological options in pain management, including complementary and integrative health (CIH) therapies. More than 2,000 randomized controlled trials (RCTs) and many systematic reviews have been conducted on CIH therapies, making it difficult to easily understand what type of CIH therapy might be effective for what type of pain. Here we synthesize the strength of the evidence for four types of CIH therapies on pain: acupuncture, therapeutic massage, mindfulness techniques, and tai chi.


We conducted searches of English-language systematic reviews and RCTs in 11 electronic databases and previously published reviews for each type of CIH. To synthesize that large body of literature, we then created an "evidence map," or a visual display, of the literature size and broad estimates of effectiveness for pain.


Many systematic reviews met our inclusion criteria: acupuncture (86), massage (38), mindfulness techniques (11), and tai chi (21). The evidence for acupuncture was strongest, and largest for headache and chronic pain. Mindfulness, massage, and tai chi have statistically significant positive effects on some types of pain. However, firm conclusions cannot be drawn for many types of pain due to methodological limitations or lack of RCTs.


There is sufficient strength of evidence for acupuncture for various types of pain. Individual studies indicate that tai chi, mindfulness, and massage may be promising for multiple types of chronic pain. Additional sufficiently powered RCTs are warranted to indicate tai chi, mindfulness, and massage for other types of pain.


Complementary and Alternative Medicine; Complementary and Integrative Health; Pain; Systematic Reviews


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