Adults increasingly used complementary health approaches for pain over past 20 years

Key takeaways:

• The overall use of CHAs increased from 19.2% in 2002 to 36.7% in 2022. Their use for pain increased from 42.3% to 49.2%.
• Researchers said the increases could be due to several factors, such as the need to replace potentially harmful opioids.

The overall use of several complementary health approaches, and their use for pain management specifically, rose substantially over the last couple of decades, researchers found.

According to Richard L. Nahin, MPH, PhD, lead epidemiologist at the National Center for Complementary and Alternative Medicine, and colleagues, 55 million Americans spent $28 million on complementary health approaches (CHAs) in 2012, “comparable to 9% of total out-of-pocket health care expenditures.”

“Previously, the safety and efficacy of many of these approaches lacked rigorous clinical trials,” they wrote in JAMA. “Over the past 2 decades, increasing evidence has supported the safety and efficacy of selected approaches for pain management.”

In the study, Nahin and colleagues assessed 2002, 2012 and 2022 National Health Interview Survey data regarding the use of seven CHAs “consistently captured in all 3 years”: meditation, acupuncture, yoga, naturopathy, guided imagery, progressive muscle relaxation and chiropractic care.

There were 31,044, 34,525 and 27,651 survey participants in 2002, 2012, and 2022, respectively.

Adults reporting use of any of the seven CHAs increased from 19.2% (95% CI, 18.7%-19.7%) in 2002 to 36.7% (95% CI, 36%-37.5%) in 2022.

Yoga saw the highest rise in overall use from 2002 to 2022 — increasing from 5% (95% CI, 4.7%-5.2%) to 15.8% (95% CI, 15.2%-16.3%) — whereas acupuncture increased from 1% (95% CI, 0.9%-1.2%) to 2.2% (95% CI, 2%-2.4%).

Meditation had the highest prevalence of any CHA in 2022, at 17.3% (95% CI, 16.7%-17.9%).

The researchers also found that among adults reporting use of any of the seven CHAs, the percentage that reported its use for pain management rose from 42.3% (95% CI, 40.8%-43.8%) in 2002 to 49.2% (95% CI, 48%-50.3%) in 2022.

The CHA with the largest increase in use for pain management was yoga, rising from 11.4% (95% CI, 9.3%-13.6%) to 28.8% (95% CI, 27.3%-30.4%).

There were some limitations in the study, like decreased survey response rates over time, potential recall bias and the use of cross-sectional data, the researchers said.

Nahin and colleagues explained that the rise in CHA use coincides with increased pain prevalence nationally and could be due to multiple factors, including:

• incorporating CHAs into best practice pain management guidelines;
• randomized clinical trials that have suggested some CHAs provide low-to-moderate pain management; and
• a need to reduce harmful opioids through nonopioid interventions.

“Insurance coverage for acupuncture also increased during this period, expanding patient access,” they wrote.

References:

• Nahin R, et al. JAMA. 2024;doi:10.1001/jama.2023.26775.
• NIH analysis reveals a significant rise in use of complementary health approaches, especially for pain management. https://www.nih.gov/news-events/news-releases/nih-analysis-reveals-significant-rise-use-complementary-health-approaches-especially-pain-management. Published Jan. 31, 2023. Accessed Feb. 1, 2023.