Classification of CAM

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The US-based National Center for Complementary and Alternative Medicine has classified CAM into five major categories (see Table 13.1) [1]. This classification of CAM into whole systems and four domains is a convenient approach to what can be a bewildering array of treatment approaches. However by breaking down CAM into biological, body-based, energy-based and mind-body approaches, such a schema obscures the fact that many of these therapies have at their core a holistic approach to wellness which makes many CAM therapies more similar than discrete. Defining and classifying CAM is also transitory; several therapeutic approaches that were once considered CAM are now considered part of mainstream pain medicine; these approaches include biofeedback, massage therapy and even, to some extent, needling techniques.

Chronic pain is a common reason for the use of CAM. Table 13.2 shows a summary of the prevalence of, and reasons for, CAM use, as well as the main modalities used, in several pain populations. Several broad trends emerge from these studies. CAM use is positively associated with younger age, being married, a higher level of education, and a higher household income. In addition, CAM use

Table 13.1 NCCAM classification of CAM.




Whole medical systemsa|

Built upon complete system of theory and practice

Traditional Chinese medicine, Ayurvedic medicine, homoeopathy, naturopathic medicine

Mind-body medicine

Techniques designed to enhance the mind's capacity to affect bodily function and symptoms

Meditation, prayer, music therapy (previously cognitive behavior, biofeedback)

Biologically-based practices

Use substances found in nature

Herbs, foods, vitamins, essential oils

Manipulative and body-based practices

Based on manipulation and/or movement of one or more parts of the body

Chiropractic, osteopathy, massage therapy

Energy medicine

Involves the use of energy fields

Qi Gong, Reiki, therapeutic touch, magnetic fields

a Note this group of systems may include therapeutic approaches from other domains.

a Note this group of systems may include therapeutic approaches from other domains.

Table 13.2 Summary of selected CAM use surveys among patients with chronic pain.


Prevalence of CAM use

Examples of common types of CAM used


TMJ pain


Relaxation, chiropractic


Chronic back pain


Chiropractic, massage, acupuncture




Vitamins, celery, fish oil


Spinal cord injury


Acupuncture, massage, chiropractic





Peripheral neuropathy


Megavitamins, magnets, acupuncture


is negatively associated with pain intensity and positively associated with greater analgesic use, depression, and co-morbidity. Most patients appear to use conventional medical services in addition to CAM [10].

Among patients with peripheral neuropathy, CAM users report using magnets and acupuncture (30% each), herbal remedies (22%) and chiropractic (22%) [14]. In this study, CAM use was associated with the presence of diabetic neuropathy and burning pain. Chiropractic and massage are frequently used by patients with chronic low back pain [15]. In a questionnaire study of 170 chronic pain patients attending a pain clinic in Montreal, 96 (56%) had used a CAM modality in the past month, of which the most common were nutritional supplements (34%), massage (11%) and meditation (7%) (Figure 13.1) [16].

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