Chronic Pain: What You Need To Know

October 25, 2023 Joe Brady
Posted by Joe Brady on

Pain is the most common reason for seeking medical care. It is also a common reason why people turn to complementary and integrative health approaches. If you are considering such an approach for pain, this information can help you talk with your healthcare provider.

NCCIH supports and conducts pain research at the NIH labs in Bethesda, Maryland, and by funding research and grants around the country. We also provide information for both consumers and health professionals.

A growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.

Psychological and Physical Approaches

  • Acupuncture may help relieve osteoarthritis pain.
  • A small amount of evidence suggests that massage therapy may be helpful.
  • Participating in tai chi may improve pain, stiffness, and joint function in people with knee osteoarthritis. Qi gong may have similar benefits, but less research has been done on it.

A 2012 combined analysis of data from several studies indicated that acupuncture can be helpful and a reasonable option to consider for OA pain. A 2013 analysis using different statistical methods also concluded that acupuncture may help relieve knee OA pain. After these analyses were completed, a 2014 Australian study showed that both needle and laser acupuncture were modestly better at relieving knee pain from OA than no treatment but not better than simulated (sham) laser acupuncture. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving OA pain. A 2016 review of U.S. studies found evidence that acupuncture, as practiced in the United States, may help some patients with knee OA manage their pain.

How acupuncture works to relieve pain is unclear. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

What do we know about the safety of complementary health approaches for chronic pain?

Although the psychological and/or physical approaches (e.g., acupuncture, meditation, yoga, massage) studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches. If you’re considering nutritional approaches such as dietary supplements, remember that natural doesn’t always mean safe and that some dietary supplements may have side effects or interact with medications.

What Is Chronic Pain and Why Is It Important?

Chronic pain is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2019 National Health Interview Survey (NHIS) show that:

  • About 20.4 percent of U.S adults had chronic pain (defined as pain on most days or every day in the past 3 months).
  • About 7.4 percent of U.S. adults had high-impact chronic pain (defined as chronic pain that limited their life or work activities on most days or every day for the past 3 months).

What the Science Says About Complementary Health Approaches for Chronic Pain

The scientific evidence suggests that some complementary health approaches may help people manage chronic pain. 

A comprehensive description of scientific research on all the complementary approaches that have been studied for chronic pain is beyond the scope of this fact sheet. This section highlights the research status of some approaches used for common kinds of pain.

Some recent research has looked at the effects of complementary approaches on chronic pain in general rather than on specific painful conditions. 

  • A 2017 review looked at complementary approaches with the opioid crisis in mind, to see which ones might help relieve chronic pain and reduce the need for opioid therapy to manage pain. There was evidence that acupuncture, yoga, relaxation techniques, tai chi, massage, and osteopathic or spinal manipulation may have some benefit for chronic pain, but only for acupuncture was their evidence that the technique could reduce a patient’s need for opioids.
  • Products containing substances from cannabis (marijuana), which typically include both tetrahydrocannabinol (THC) and cannabidiol (CBD), have been tested for their effects on chronic pain in short-term studies. Oral products with high THC/CBD ratios and sublingual (under-the-tongue) products with roughly equal amounts of THC and CBD may reduce chronic pain in the short term. Still, they may also have side effects including dizziness and sleepiness. Not much is known about other cannabinoid formulations or the products of long-term use.
  • Hypnosis may reduce chronic pain if patients participate in enough sessions (at least eight), according to a few studies.
  • Studies on chronic pain showed that mindfulness-based interventions and cognitive behavioral therapy are both helpful in decreasing pain intensity and improving physical functioning, with no important difference between the two approaches. Cognitive behavioral therapy is the prevailing psychological intervention for chronic pain.
  • Studies have shown that music-based interventions can reduce self-reported pain and depression symptoms in people with chronic pain. Effects were more significant when the patient, rather than the researcher, chose the music.

A large review of individual data from multiple studies showed that acupuncture was more effective than either no treatment or sham (fake) acupuncture for back or neck pain. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. A 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for the management of both acute and chronic low-back pain.

Tai chi, either alone or in addition to physical therapy, may decrease the intensity of pain and improve everyday function in people with low-back pain. The ACP guideline includes tai chi as an option for the treatment of chronic low-back pain.

Acknowledgments

NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2023 update of this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your healthcare provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.Last Updated: January 2023

For More Information See

https://www.nccih.nih.gov/health/chronic-pain-what-you-need-to-know

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