This issue of the digest summarizes current scientific evidence about mind and body approaches for chronic pain, including fibromyalgia, headache, low-back pain, neck pain, osteoarthritis, and rheumatoid arthritis.
The scientific evidence to date suggests that some mind and body approaches may provide modest effects that help individuals manage the day-to-day variations in their chronic pain symptoms. While some complementary approaches do show modest benefit depending on the approach and pain condition, in some instances, though, the amount of evidence is too small to clearly show whether an approach is useful.
Conditions and Summary of Current Evidence
Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms. Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive-behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.
Results of research on mind and body practices such as relaxation training, biofeedback, acupuncture, and spinal manipulation for headaches suggests that these approaches may help relieve headaches and may be helpful for migraines.
For patients with chronic low-back pain, recent evidence-based clinical practice guidelines from the American College of Physicians gave a strong recommendation based on moderate-quality evidence that clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or mindfulness-based stress reduction. The guidelines also strongly recommend, based on low-quality evidence, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.
Available evidence indicates that acupuncture for neck pain may provide better pain relief compared to no treatment. There is some evidence that spinal manipulation may help relieve neck pain, but much of the research has been of low quality.
In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee. The guidelines conditionally recommend tai chi, along with other nondrug approaches such as self-management programs and walking aids, for managing knee OA. Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but can’t or won’t undergo the procedure.
Results from clinical trials suggest that some mind and body practices—such as relaxation, mindfulness meditation, tai chi, and yoga—may be beneficial additions to conventional treatment plans, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.