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NIH review: Yoga, tai chi, acupuncture effective in pain management

Complementary health treatments such as yoga, tai chi, acupuncture, massage therapy and relaxation techniques were found to be effective in managing common pain conditions, according to researchers from the NIH National Center for Complementary and Integrative Health.

“The most recent national estimate suggests that 126 million adults experience some pain in a given year, with about one-third (40 million adults) having severe pain,” Richard L. Nahin, PhD, MPH, lead epidemiologist at the NIH NCCIH, and colleagues wrote in Mayo Clinic Proceedings. “… Among the many pharmacological and nonpharmacological approaches that have been incorporated into pain management strategies are complementary health approaches…. In 2007, for example, about 14.3 million adults used a complementary health approach for their back pain, about 5 million used these approaches for their neck pain, and 3.1 million for their arthritis.”

To analyze the clinical evidence for the efficacy and safety of several widely used complementary approaches, the researchers conducted an online review of 105 U.S.-based randomized controlled trials from the past 50 years. The review focused on seven approaches — acupuncture, spinal and osteopathic manipulation, massage therapy, relaxation techniques, selected natural product supplements, tai chi and yoga — used for one or more of five common pain conditions — back pain, osteoarthritis, neck pain, fibromyalgia and severe headaches and migraine.

Positive trials were defined as those in which the approaches provided statistically significant improvements in pain severity or pain-related disability or function, compared with the control group. Negative trials were defined as those in which no difference was reported between the groups.

According to the researchers, the preponderance of the positive trials, vs. the negative trials, suggests that the following complementary treatments may help certain patients manage their pain:

• Acupuncture and yoga for back pain;
• Acupuncture and tai chi for osteoarthritis of the knee;
• Massage therapy for neck pain, with adequate doses and for short-term benefit; and
• Relaxation techniques for severe headaches and migraine.

Weaker evidence suggested massage therapy, spinal manipulation and osteopathic manipulation may also benefit patients with back pain, and relaxation techniques and tai chi may help those with fibromyalgia.

In addition, although the overall reporting on safety information was low, none of the trials reported significant side effects due to the approaches.

“These data can equip providers and patients with the information they need to have informed conversations regarding nondrug approaches for treatment of specific pain conditions,” David Shurtleff, PhD, NCCIH deputy director, said in a press release. “It’s important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.