Complementary and Integrative Medicine in Pain Management


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CIM offers a multimodality treatment approach that can tackle the multidimensional nature of pain with fewer or no serious adverse effects.


  • Management of chronic pain using complementary and integrative medicine;
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This review focuses on the use of CIM in three conditions with a high incidence of chronic pain: It summarizes research on the mechanisms of action and clinical studies on the efficacy of commonly used CIM modalities such as acupuncture, mind-body system, dietary interventions and fasting, and herbal medicine and nutrients. State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally.

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Complementary and Integrative Medicine in Pain Management

For this reason they are written predominantly by US authors. We have read and understood the BMJ policy on declaration of interests and declare the following interests: Skip to main content. Report from the National Stakeholder Panel. Popul Health Manag ; 19 suppl 1: Generational differences in complementary and alternative medicine CAM use in the context of chronic diseases and pain: Baby boomers versus the silent generation. J Am Board Fam Med ; 27 4: Race, pain, and beliefs associated with interest in complementary and alternative medicine among inner city veterans.

Pain Med ; 16 8: Arriving at a working definition. Altern Ther Health Med ; 10 5: Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA ; 9: Massage therapy for osteoarthritis of the knee: A randomized controlled trial. Arch Intern Med ; A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial.

JAMA ; Kligler B, Chesney M. Academic health centers and the growth of integrative medicine. J Natl Cancer Inst Monogr ; The role of academic health centres to inform evidence-based integrative oncology practice. Readers will be able to rely on systematic reviews of the best available evidence. Students will be taught to value and emphasize the truth in their future practice. They will become more ethical physicians less tempted to offer unscientific treatments.

The patients will therefore experience better results with lower costs. Deaths and serious injuries from herbal drugs, acupuncture, and chiropractic manipulation can be prevented by screening out those whose medical condition puts them at high risk for these complications.


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Evidence shows that patients with high risk illness who choose alternative medicine treatments incur higher costs, and have greater morbidity and mortality rates. Relying on patient satisfaction to guide medical care instead of relying on quality care to improve patient satisfaction has also increased morbidity and mortality, and therefore medical costs, including complications. There is an interesting paper in Nature on the effects of electroacupuncture on serum TNF concentrations Reading some responses 'baby and bathwater' come to mind, as well as examples of a curious prevailing tendency to a closed minded approach to methods which work in clinical settings?

It is encouraging the BMJ is prepared to explore treatment modalities which safely enhance patients' experience and their therapeutic pathway. Neuronal networks represent physiological mechanisms, selected by evolution to control inflammation, that can be exploited for the treatment of inflammatory and infectious disorders3. Here, we report that sciatic nerve activation with electroacupuncture controls systemic inflammation and rescues mice from polymicrobial peritonitis. Electroacupuncture at the sciatic nerve controls systemic inflammation by inducing vagal activation of aromatic L-amino acid decarboxylase, leading to the production of dopamine in the adrenal medulla.

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Experimental models with adrenolectomized mice mimic clinical adrenal insufficiency4, increase the susceptibility to sepsis and prevent the anti-inflammatory effects of electroacupuncture. Dopamine inhibits cytokine production via dopamine type 1 D1 receptors. D1 receptor agonists suppress systemic inflammation and rescue mice with adrenal insufficiency from polymicrobial peritonitis. Our results suggest a new anti-inflammatory mechanism mediated by the sciatic and vagus nerves that modulates the production of catecholamines in the adrenal glands. From a pharmacological perspective, the effects of selective dopamine agonists mimic the anti-inflammatory effects of electroacupuncture and can provide therapeutic advantages to control inflammation in infectious and inflammatory disorders.

Responses to the paper by Chen and Michalsen have not mentioned the dangerously ambivalent role of conventional medications, in the management of chronic pain. Against this background of widespread alarm at analgesic overuse and abuse, the possibility of other, safer options being explored, for the control of chronic pain, is one that reasonable people might wish to examine. All the more important that those who take part in the debate are forthcoming about their competing interests and personal agendas. Chen and Michalsen have barely opened the door to shine a crack of light on other options , and to encourage a wider debate.

Their initiative, if not extinguished by the power of Pharma and the narrow interests of our profession, may prompt the occasional open minded doctor to think beyond another quick fix prescription. A doctor decorator, finding a crack in his kitchen wall, may apply successive coats of paint, or layers of wall paper, but still the crack reappears.

Much as his chronic pain patients receive simple analgesics, NSAIDs, amitriptylene, gabapentin, perhaps an SSRI, then tramadol, before starting on the steep slope of opioid use. A builder would explain, too late, that the cracked wall problem could be due to a leaking roof, poor foundations, or any one of twenty problems, in between. A complementary therapist knows that chronic pain, and the sufferer, need to be understood in terms of their life narrative and myriad experiences, before any treatment is offered. It is important that the response from May, Ernst and Ross does not go unremarked.

Their response illustrates those faults that they identify in the paper by Chen and Michalsen. They begin by ridiculing those who create their own terminology.

Management of chronic pain using complementary and integrative medicine | The BMJ

May, Ernst and Ross created their own terminology when they signed a letter in the BMJ containing abusive unprofessional terminology, directed at bona fide colleagues. Have they all moved on, or forgotten? One of the most unbiased sources of post marketing surveillance is the professional indemnity insurance market. A full time complementary therapist can expect to pay a few hundred pounds, and the well established firms who insure complementary therapists regard them as very low risk.

Are May, Ernst and Ross being too judgemental in these respects? Ernst is free to hold controversial opinions, to write books, blogs and opinion pieces, and to accept speaking engagements, to promote his negative views on complementary therapies and integrative medicine.

Paid or voluntary, should these activities be included, as competing interests, in the interests of thoroughness, for your readers? Alternative facts are fashionable in politics these days, so why not also in healthcare? The article by Chen and Michalsen on thebmj. Create your own terminology: Integrated medicine a hotly disputed field already covers complementary and conventional medicine. Pretend to be objective: Chen and Michalsen elaborate on the systematic searches they conducted.

But they omit hundreds of sources which do not support their message, which cherry-picks only evidence for the efficacy of the treatments they promote. For instance, when discussing therapeutic risks, they omit the disturbing lack of post-marketing surveillance: Create an impression of thoroughness: Chen and Michalsen cite a total of references. This apparent scholarly attention to detail masks their misuse of many of they list.

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In fact, it shows nothing of the sort. Back up your message with broad generalisations: The implication is that all the CIMs mentioned in their figure 1 are candidates for pain control — even discredited treatments such as homeopathy. In our view, these authors render us a service: These are entirely voluntary associations and no income is associated.

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Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management
Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management
Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management
Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management
Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management
Complementary and Integrative Medicine in Pain Management Complementary and Integrative Medicine in Pain Management

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