Clinical Evidence of Safety and Efficacy

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Systematic reviews carried out under the Cochrane Collaboration are widely regarded as authoritative and highly respected evidence for treatment effects. Reviews have recently been conducted looking at several CAM modalities. A search of the Cochrane Library group for reviews on ("complementary medicine" and "chronic pain" (search date 3 Dec 2007) found 78 published reviews. Reviews for conditions such as irritable bowel syndrome, Crohn- s disease, venous or arterial insufficiency and complications, dysmenorrhea and for therapies described as "behavioral interventions" were excluded. Eleven reviews were selected, including three on low back pain, two on osteoarthritis, and two on headache (including migraine); herbal remedies were the focus of four reviews, two were on acupuncture and two were on massage. The results are summarized in Table 13.3.

A recent review of omega-3 fatty acid supplementation for inflammatory joint pain found these supplements to be "attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease and dysmen-norhea" [28].

Table 13.3 Cochrane Library systematic reviews of CAM treatments for chronic pain conditions, by year of publication.

Disease Intervention Year Number Results Reference of trials

Low back pain Herbal medicine 2006 10

Mechanical neck Massage disorders

Osteoarthritis Glucosamine

Chronic/ recurrent headache

Idiopathic headache

Noninvasive physical treatments

Feverfew

Migraine prevention

Low back pain Massage

2006 19

2005 20

Low back pain Acupuncture and 2005 35 dry-needling

2004 22

2004 5

2002 8

Acupuncture 2001 26

Chronic pelvic All interventions 2000 14 pain

Osteoarthritis Herbal medicine 2000 5

Harpagophytum procumbens, [17] Salix alba and Capsicum frutescens seem to reduce pain more than placebo

No practice recommendations [18]

made

Improvement in pain was noted [19] for one (Rotta) preparation but not for others; no effect on WOMAC pain and functional outcomes

For chronic low-back pain, [20]

acupuncture more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only

Spinal manipulation may be [21]

effective for migraine and chronic tension-type headache.

Both spinal manipulation and neck exercises may be effective for cervicogenic headache

No convincing evidence of [22]

efficacy

Massage may be beneficial for [23]

subacute and chronic low back pain

Evidence supportive of [24]

acupuncture

Writing therapy and static [25]

magnetic field therapy show some evidence of short-term efficacy

Convincing evidence for avocado- [26] soybean unsaponifiables

Rheumatoid Herbal medicine 2000 11

arthritis

Some potential benefit for the [27]

use of GLA

13.4 Clinical Evidence of Safety and Efficacy | 159

Music therapy has been evaluated for pain relief in 51 studies involving a variety of pain conditions including procedural pain (28 studies), post-operative pain (14 studies), chronic noncancer pain (3 studies), cancer (2 studies), experimental pain (2 studies), and labor pain (2 studies) [29]. Listening to music reduces pain by an average of 0.5 on a 10 point scale (95% CI 0.2-0.9), and increases likelihood of 50% pain relief by 70% (NNT = 5). Post-operative opioid requirements were also reduced.

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