A Systematic Review of Practiced-Based Research of Complementary and Integrative Health Therapies as Provided for Pain Management in Clinical Settings: Recommendations for the Future and a Call to Action
Open accessAbstract
Objective: The goal of this systematic review was to evaluate practice-based, real-world research of individualized complementary and integrative health (CIH) therapies for pain as provided in CIH outpatient clinics. Methods: A systematic review was conducted on articles in PubMed, Ovid, Cochrane, Web of Science, Scopus, and Embase published through December 2020. The study was listed in the PROSPERO database (CRD42020159193). Major categories of variables extracted included study details and demographics, interventions, and outcomes. Results: The literature search yielded 3,316 records, with 264 assessed for full-text review. Of those, 23 studies (including ∼8,464 patients) were specific to pain conditions as a main outcome. Studies included chiropractic, acupuncture, multimodal individualized intervention/programs, physiotherapy, and anthroposophic medicine therapy. Retention rates ranged from 53% to 91%, with studies offering monetary incentives showing the highest retention. The 0–10 numerical rating scale was the most common pain questionnaire (n = 10; 43% of studies), with an average percent improvement across all studies and time points of 32% (range: 18–60%). Conclusions: Findings from this systematic review of practice-based, real-word research indicate that CIH therapies exert positive effects on various pain outcomes. Although all studies reported beneficial impacts on one or more pain outcomes, the heterogeneous nature of the studies limits our overall understanding of CIH as provided in clinical settings. Accordingly, we present numerous recommendations to improve publication reporting and guide future research. Our call to action is that future practice-based CIH research is needed, but it should be more expansive and conducted in association with a CIH scientific society with academic and health care members.
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A number of non-opioid pain treatments have demonstrated efficacy.
“A number of non-opioid pain treatments have demonstrated efficacy.9,10”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [9]
The 88.8% completion rate is similar to the highest retention rates reported in a systematic review of research of complementary and integrative health therapies for pain management.
“Our 88.8% completion rate is similar to the highest retention rates reported in a systematic review of research of complementary and integrative health therapies for pain management. 9”
From Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont (2024) · cites this paper as [9]
Cites
Lakens, D. (2013) · Frontiers in Psychology · doi:10.3389/fpsyg.2013.00863 · Cited by 10,303 · see citing works
Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31678-6 · Cited by 7,253 · see citing works
Jaeschke, R., Singer, J., & Guyatt, G. H. (1989) · Controlled Clinical Trials · doi:10.1016/0197-2456(89)90005-6 · Cited by 4,982 · see citing works
How many subjects does it take to do a regression analysis
Green, S. B. (1991) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2603_7 · Cited by 3,916 · cited 1× · see citing works
“However, on the basis of others’ recommendations [69], if the sample size of a study is at least 100, we advocate for inclusion of multivariate analysis to help identify how various baseline characteristics (e.”
BackgroundQaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & for the Clinical Guidelines Committee of the American College of Physicians* (2017) · Annals of Internal Medicine · doi:10.7326/m16-2367 · Cited by 3,234 · see citing works
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr6501e1 · Cited by 2,697 · see citing works
Practice-based research--“Blue Highways” on the NIH roadmap
Westfall, J. M., Mold, J., & Fagnan, L. (2007) · JAMA · doi:10.1001/jama.297.4.403 · Cited by 1,209 · see citing works
Trends in the Use of Complementary Health Approaches Among Adults in the United States
Jackson, C. (2015) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000088 · Cited by 1,174 · see citing works
(2015) · PubMed · Cited by 926 · see citing works
Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis
Vickers, A. J., Vertosick, E., Lewith, G. T., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., & Linde, K. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.11.005 · Cited by 908 · see citing works
Chou, R., Deyo, R. A., Friedly, J. L., Skelly, A. C., Weimer, M. B., Fu, R., Dana, T., Kraegel, P., Griffin, J. C., & Grusing, S. (2017) · Annals of Internal Medicine · doi:10.7326/m16-2458 · Cited by 877 · see citing works
Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J., et al. (2017) · Annals of Internal Medicine · doi:10.7326/m16-2459 · Cited by 855 · see citing works
Minimal Clinically Important Difference
McGlothlin, A. E., & Lewis, R. J. (2014) · JAMA · doi:10.1001/jama.2014.13128 · Cited by 709 · see citing works
Olsen, M. F., Bjerre, E. D., Hansen, M. D., Hilden, J., Landler, N. E., Tendal, B., & Hróbjartsson, A. (2017) · BMC Medicine · doi:10.1186/s12916-016-0775-3 · Cited by 498 · see citing works
Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care
Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R. A., Simmons, S., Glick, R. M., Ratner, E. F., Lemmon, R., Wayne, P. M., & Zador, V. (2018) · EXPLORE · doi:10.1016/j.explore.2018.02.001 · Cited by 388 · see citing works
Ending the Opioid Epidemic — A Call to Action
Murthy, V. H. (2016) · New England Journal of Medicine · doi:10.1056/nejmp1612578 · Cited by 294 · see citing works
An effect size primer: A guide for clinicians and researchers.
Ferguson, C. J. (2015) · American Psychological Association eBooks · doi:10.1037/14805-020 · Cited by 289 · see citing works
Askew, R. L., Cook, K. F., Revicki, D. A., Cella, D., & Amtmann, D. (2016) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2015.08.035 · Cited by 212 · see citing works
Crawford, C., Boyd, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., Zhang, W., & the Evidence for Massage Therapy (EMT) Working Group (2016) · Pain Medicine · doi:10.1093/pm/pnw099 · Cited by 178 · see citing works
Yuan, Q., Wang, P., Liu, L., Sun, F., Cai, Y., Wu, W., Ye, M.-L., Ma, J., Xu, B.-B., & Zhang, Y. (2016) · Scientific Reports · doi:10.1038/srep30675 · Cited by 174 · see citing works
Meta-Analysis of Massage Therapy on Cancer Pain
Lee, S., Kim, J. Y., Yeo, S., Kim, S., & Lim, S. (2015) · Integrative Cancer Therapies · doi:10.1177/1534735415572885 · Cited by 170 · see citing works
Systematic review and meta-analysis of acupuncture to reduce cancer-related pain
Chiu, H. Y., Hsieh, Y., & Tsai, P.-S. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12457 · Cited by 134 · see citing works
Why do we need observational studies of everyday patients in the real-life setting?: Table 1
Cohen, A. T., Goto, S., Schreiber, K. I., & Torp-Pedersen, C. T. (2015) · European Heart Journal Supplements · doi:10.1093/eurheartj/suv035 · Cited by 127 · see citing works
Kumar, S., Beaton, K., & Hughes, T. (2013) · International Journal of General Medicine · doi:10.2147/ijgm.s50243 · Cited by 117 · see citing works
Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials
Choi, T., Lee, M. S., Kim, T., Zaslawski, C., & Ernst, E. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1432-9 · Cited by 115 · see citing works
Pain signalling pathways: From cytokines to ion channels
Okuse, K. (2006) · The International Journal of Biochemistry & Cell Biology · doi:10.1016/j.biocel.2006.11.016 · Cited by 107 · see citing works
Goertz, C., Long, C. R., Hondras, M., Petri, R. P., Delgado, R. E., Lawrence, D. J., Owens, E. F., & Meeker, W. C. (2012) · Spine · doi:10.1097/brs.0b013e31827733e7 · Cited by 88 · see citing works
Lisi, A. J. (2010) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2009.07.0095 · Cited by 86 · see citing works
Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials
Chaibi, A., & Russell, M. B. (2014) · The Journal of Headache and Pain · doi:10.1186/1129-2377-15-67 · Cited by 86 · see citing works
Blanchette, M., Stochkendahl, M. J., Silva, R. B. D., Boruff, J. T., Harrison, P., & Bussières, A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0160037 · Cited by 82 · see citing works
Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis
Kong, L. J., Zhan, H. S., Cheng, Y. W., Yuan, W. A., Chen, B., & Fang, M. (2013) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2013/613279 · Cited by 76 · cited 1× · see citing works
“Numerous systematic reviews and meta-analyses of randomized controlled trials (RCTs) of CIH therapies have reported efficacy for the treatment and management of pain and pain-related health conditions, including, but not limited to, chiropractic, massage, and acupuncture for chronic low back pain [16–20], neck pain [1…”
BackgroundElectroacupuncture treatment for pancreatic cancer pain: A randomized controlled trial
Chen, H., Liu, T.-Y., Kuai, L., Zhu, J. Y., Wu, C.-J., & Liu, L.-M. (2013) · Pancreatology · doi:10.1016/j.pan.2013.10.007 · Cited by 73 · see citing works
Cost-Effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
Haas, M., Sharma, R. L., & Stano, M. (2005) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2005.08.006 · Cited by 66 · see citing works
Acupuncture for Cancer Pain and Symptom Management in a Palliative Medicine Clinic
Miller, K., Patel, J. N., Symanowski, J. T., Edelen, C., & Walsh, D. (2018) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909118804464 · Cited by 62 · see citing works
Chiropractic spinal manipulation for neck pain: a systematic review
Ernst, E. (2003) · Journal of Pain · doi:10.1067/s1526-5900(03)00735-1 · Cited by 60 · see citing works
Nyiendo, J., Haas, M., & Goodwin, P. (2000) · Journal of Manipulative and Physiological Therapeutics · doi:10.1067/mmt.106100 · Cited by 58 · see citing works
Massage Therapy for Pain and Function in Patients With Arthritis
Nelson, N. L., & Churilla, J. R. (2017) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000712 · Cited by 57 · see citing works
Spinal manipulations for tension-type headaches: A systematic review of randomized controlled trials
Posadzki, P., & Ernst, E. (2011) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2011.12.001 · Cited by 51 · see citing works
Effects of Integrative Medicine on Pain and Anxiety Among Oncology Inpatients
Johnson, J. R., Crespin, D., Griffin, K. H., Finch, M. D., & Dusek, J. A. (2014) · JNCI Monographs · doi:10.1093/jncimonographs/lgu030 · Cited by 50 · see citing works
Self-citationInpatient Acupuncture at a Major Cancer Center
Garcia, M., Cohen, L. G., Spano, M., et al. (2017) · Integrative Cancer Therapies · doi:10.1177/1534735416685403 · Cited by 50 · see citing works
Elwy, A. R., Johnston, J. M., Bormann, J. E., Hull, A. E., & Taylor, S. L. (2014) · Medical Care · doi:10.1097/mlr.0000000000000228 · Cited by 45 · see citing works
Yeganeh, M. M., Baradaran, H. R., Qorbani, M., Moradi, Y., & Dastgiri, S. (2016) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2016.11.012 · Cited by 45 · see citing works
Johnson, J. R., Crespin, D., Griffin, K. H., Finch, M. D., Rivard, R. L., Baechler, C. J., & Dusek, J. A. (2014) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-14-486 · Cited by 41 · see citing works
Self-citationThe BraveNet prospective observational study on integrative medicine treatment approaches for pain
Abrams, D. I., Dolor, R. J., Roberts, R., Pechura, C. M., Dusek, J. A., Amoils, S., Amoils, S., Barrows, K., Edman, J. S., Frye, J., et al. (2013) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-13-146 · Cited by 38 · see citing works
Self-citationLee, M. K., Schalet, B. D., Cella, D. F., Yost, K. J., Dueck, A. C., Novotny, P. J., & Sloan, J. A. (2020) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-020-00271-0 · Cited by 38 · see citing works
Schliesser, J. S., Kruse, R. A., & Fallon, L. F. (2003) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2003.08.009 · Cited by 33 · see citing works
Lopez, G., Garcia, M. K., Liu, W., et al. (2018) · Journal of Cancer · doi:10.7150/jca.26527 · Cited by 33 · see citing works
The Use of Complementary Health Approaches Among U.S. Adults with a Recent Cancer Diagnosis
Clarke, T. C. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0182 · Cited by 32 · see citing works
Hays, R. D., Spritzer, K. L., Sherbourne, C. D., Ryan, G. W., & Coulter, I. D. (2018) · Spine · doi:10.1097/brs.0000000000002902 · Cited by 28 · see citing works
Elwy, A. R., Taylor, S. L., Zhao, S., McGowan, M. G., Plumb, D. N., Westleigh, W., Gaj, L., Yan, G. W., & Bokhour, B. G. (2020) · Medical Care · doi:10.1097/mlr.0000000000001357 · Cited by 26 · see citing works
Cancer Pain Relief After Healing Touch and Massage
Gentile, D., Boselli, D. M., O'Neill, G., Yaguda, S. I., Bailey-Dorton, C. M., & Eaton, T. A. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0192 · Cited by 25 · see citing works
Secor, E. R., Markow, M. J., Mackenzie, J., et al. (2004) · The Journal of Alternative and Complementary Medicine · doi:10.1089/1075553041323704 · Cited by 24 · see citing works
Dusek, J. A., Abrams, D. I., Roberts, R., Griffin, K. H., Trebesch, D., Dolor, R. J., Wolever, R. Q., McKee, M. D., & Kligler, B. (2015) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-016-1025-0 · Cited by 24 · see citing works
Self-citationDusek, J. A., JaKa, M. M., Wallerius, S., Fairchild, S., Victorson, D. E., Rivard, R. L., & Betzner, A. E. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.01.012 · Cited by 24 · see citing works
Self-citationNew perspectives for chronic pain treatment: a patent review (2010-2016)
Pina, L. T. S., Gouveia, D. N., Costa, J. S., Quintans, J. D. S. S., Quintans‐Júnior, L. J., Barreto, R. D. S. S., & Guimarães, A. G. (2017) · Expert Opinion on Therapeutic Patents · doi:10.1080/13543776.2017.1297425 · Cited by 23 · see citing works
Patient-reported Outcomes of Acupuncture for Symptom Control in Cancer
Thompson, L. M. A., Osian, S. R., Jacobsen, P. B., et al. (2015) · Journal of Acupuncture and Meridian Studies · doi:10.1016/j.jams.2015.04.002 · Cited by 22 · see citing works
Acupuncture Clinical Pain Trial in a Military Medical Center: Outcomes
Niemtzow, R. C., Burns, S. M., Cooper, J., et al. (2008) · Medical Acupuncture · doi:10.1089/acu.2008.0594 · Cited by 22 · see citing works
Hamre, H. J. (2009) · Journal of Pain Research · doi:10.2147/jpr.s5922 · Cited by 22 · see citing works
Gibson, C. J., Grasso, J. R., Li, Y., Purcell, N., Tighe, J., Zamora, K. A., Nicosia, F. M., & Seal, K. H. (2020) · Pain Medicine · doi:10.1093/pm/pnaa003 · Cited by 22 · see citing works
Who will get better? Predicting clinical outcomes in a chiropractic practice
Newell, D., & Field, J. R. (2007) · Clinical Chiropractic · doi:10.1016/j.clch.2007.10.003 · Cited by 21 · see citing works
Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2009.10.007 · Cited by 20 · see citing works
Maiers, M., McKenzie, E., Evans, R., & McKenzie, M. (2008) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2008.0225 · Cited by 19 · see citing works
Dunn, A. S., Green, B. N., Formolo, L. R., & Chicoine, D. R. (2011) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2010.10.0202 · Cited by 17 · see citing works
Corcoran, K. L., Dunn, A. S., Formolo, L. R., & Beehler, G. P. (2017) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2017.07.001 · Cited by 16 · see citing works
Lee, H., Peng, W., Steel, A., Reid, R., Sibbritt, D. W., & Adams, J. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.12.023 · Cited by 16 · see citing works
Gedin, F., Dansk, V., Egmar, A., Sundberg, T., & Burström, K. (2018) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2018.02.012 · Cited by 15 · see citing works
Wayne, P. M., Eisenberg, D. M., Osypiuk, K., Gow, B. J., Witt, C. M., Davis, R. B., & Buring, J. E. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0002 · Cited by 15 · see citing works
Wirth, B., Riner, F., Peterson, C. K., Humphreys, B. K., Farshad, M., Becker, S., & Schweinhardt, P. (2019) · Chiropractic & Manual Therapies · doi:10.1186/s12998-018-0225-8 · Cited by 13 · see citing works
Chiropractic Management for Veterans with Neck Pain: A Retrospective Study of Clinical Outcomes
Dunn, A. S., Green, B. N., Formolo, L. R., et al. (2011) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2011.08.009 · Cited by 11 · see citing works
Call to Action: “If Not Now, When? If Not You, Who?”
Schoomaker, E. B., & Buckenmaier, C. C. (2014) · Pain Medicine · doi:10.1111/pme.12385 · Cited by 9 · see citing works
Auricular Acupuncture in Animals: Effects of Opiate Withdrawal and Involvement of Endorphins
Ng, L. K. Y. (1996) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.1996.2.61 · Cited by 9 · see citing works
Burke, J. R. (2014) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2014.07.007 · Cited by 7 · see citing works
Low Back Pain in Changi General Hospital: An Observational Study
Goh, M. R., Po, I. Y. Y., & Olafsdottir, K. (2010) · Proceedings of Singapore Healthcare · doi:10.1177/201010581001900302 · Cited by 4 · see citing works
Short-Term Usual Chiropractic Care for Spinal Pain
Walker, B. F., Hébert, J. J., Stomski, N. J., Losco, B. E., & French, S. D. (2013) · Spine · doi:10.1097/01.brs.0000435032.73187.c7 · Cited by 1 · see citing works
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Plavin, J., Landau, J., Rose, G. L., Ziller, E., Nowak, S., Finley, H., Audy, L., & Porter, J. (2024) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130241271643 · Cited by 4 · see citing works
“9,10 In response to this need, the University of Vermont Medical Center established the Comprehensive Pain Program (CPP) to improve treatment options for people struggling with chronic pain.”
- Authors
- Dyer, N. L., Surdam, J., & Dusek, J. A.
- Affiliations
- University Hospitals of Cleveland (US)
- Corresponding author
- Dusek, Jeffery A
- Venue
- Pain Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-05-02
- Volume
- 23
- Issue
- 1
- Pages
- 189-210
- ISSN
- 1526-2375 (ISSN-L)
- 1526-4637
- PMC
- PMC8932298
- OpenAlex
- W3162950442
- Cited by
- 23
- References
- 74
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 5 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 0.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Pain Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Char and Chuck Fowler Family Foundation and Chris and Sara Connor
- U01 cooperative (AT010598)
- NCT (NCT04880733)
- National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health
- NIH
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Complementary and alternative medicine › Acupuncture Treatment Research Studies
- Keywords
- pain management, practice-based research, real-world evidence, chiropractic, acupuncture, physiotherapy, anthroposophic medicine, multimodal intervention, patient retention, financial incentives, pain outcome measures, reporting quality
- MeSH terms
- Complementary Therapies, Delivery of Health Care, Humans, Pain Management
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