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" .
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
Chronic/ recurrent headache
Noninvasive physical treatments
Low back pain Massage
Low back pain Acupuncture and 2005 35 dry-needling
Acupuncture 2001 26
Chronic pelvic All interventions 2000 14 pain
Osteoarthritis Herbal medicine 2000 5
Harpagophytum procumbens,  Salix alba and Capsicum frutescens seem to reduce pain more than placebo
No practice recommendations 
Improvement in pain was noted  for one (Rotta) preparation but not for others; no effect on WOMAC pain and functional outcomes
For chronic low-back pain, 
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 
effective for migraine and chronic tension-type headache.
Both spinal manipulation and neck exercises may be effective for cervicogenic headache
No convincing evidence of 
Massage may be beneficial for 
subacute and chronic low back pain
Evidence supportive of 
Writing therapy and static 
magnetic field therapy show some evidence of short-term efficacy
Convincing evidence for avocado-  soybean unsaponifiables
Rheumatoid Herbal medicine 2000 11
Some potential benefit for the 
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) . 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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