Integrative Medicine for Chronic Pain

June 12, 2022 Joe Brady
Beyond the Toolbox

With over 100,000 deaths in the US, last year from opioid drugs the drugs we use to control pain have become a major cause of death in the country. Fortunately, much modern scientific research has shown that controlling pain is not just about drugs and surgery. When it comes to treating chronic pain these days people have many evidence-based treatments available.

Summary of some of the research

  • A 2017 review looked at complementary approaches with the opioid crisis in mind, to see which ones might be helpful for relieving chronic pain and reducing 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 there evidence that the technique could reduce a patient’s need for opioids. 
  • A 2017 evaluation of the research on acupuncture found evidence that it has a small beneficial effect on acute low-back pain and a moderate beneficial effect on chronic low-back pain. Based on this evaluation, 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 management of both acute and chronic low-back pain.
  • Massage therapy might provide short-term relief from low-back pain, but the evidence is not of high quality. Massage has not been shown to have long-term benefits for low-back pain. The 2017 ACP guideline included massage therapy as an option for acute but not chronic low-back pain.
  • A 2017 research review concluded that mindfulness-based stress reduction is associated with improvements in pain intensity and physical functioning in low-back pain, compared to usual care, but the effect may be small and short term. The 2017 ACP guideline included mindfulness-based stress reduction as an option for chronic but not acute low-back pain.
  • There is some evidence that progressive relaxation may help relieve low-back pain, but studies on this topic have been small and not of the highest quality. The 2017 ACP guideline included progressive relaxation as an option for chronic but not acute low-back pain.
  • Spinal manipulation appears to be as effective as other therapies commonly used for chronic low-back pain, such as physical therapy, exercise, and standard medical care. The 2017 ACP guideline included spinal manipulation as an option for both acute and chronic low-back pain.
  • A 2018 evaluation of the research on yoga for low-back pain by the Agency for Healthcare Research and Quality (AHRQ) found that it improved pain and function in both the short term (1 to 6 months) and intermediate term (6 to 12 months). The effects of yoga were similar to those of exercise. The 2017 ACP guideline included yoga as an option for chronic but not acute low-back pain.
  • A 2016 evaluation of the research on herbal products for low-back pain found evidence that cayenne, administered topically (applied to the skin) can reduce pain. Two other herbal products used topically, comfrey and lavender essential oil, and two herbs used orally, white willow bark and devil’s claw,may also be helpful, but the evidence for these herbs is not as strong as that for cayenne.
  • Studies of prolotherapy (a treatment involving repeated injections of irritant solutions) for low-back pain have had inconsistent results.
  • For more information, see the National Center for Complementary and Integrative Health (NCCIH) webpage on low-back pain.

Watch the video below for a Video of the Grand Rounds from Harvard Medical School.

VIDEO: Integrative Medicine for Chronic Pain: Beyond the Toolbox

Grand rounds Osher Center for Integrative medicine, Harvard Medical School

Description: Imagine being 18 years old and disabled by a post-viral syndrome and complex connective tissue disorder. You experience overwhelming fatigue and diffuse, chronic myofascial pain, coupled with migraine headaches that render you disabled; unable to attend school, work or maintain a social life. Your symptoms are managed with a growing portfolio of medications including narcotics and antidepressants. You often feel hopeless.

When the Osher Clinical team met Joy, this was her condition. Joy was seeking ways to relieve her pain and restore her vitality and function. Just as importantly, she wanted to get off medications.

The Osher clinical team follow Joy’s journey over the past 11 years as she combines conventional and integrative approaches to manage her fatigue, and especially her chronic migraines and widespread myofascial pain. Some of the clinicians who have worked with her will discuss their approach and Joy will describe her experience.

This clinical case presentation will explore the elusive nature and the ever-changing face of chronic pain and some of the components of an integrative approach to manage and relieve the suffering that so often accompanies chronic pain.

Presenters: Donald Levy, MD and Matthew Kowalski, DC
Discussants: Victor Wang, MD, Leigh de Chaves, PT, OCS
Patient will share her experience

Presenter Bios

Donald Levy, MD
Dr. Donald B. Levy is board certified internist who has been the Medical Director of the Osher Clinical Center for Integrative Medicine at Brigham and Women’s Hospital since 2003. Dr. Levy is an integrative medicine consultant. He cares for patients seeking an integrative medicine approach to the medical management of problems such as allergies, anxiety, arthritis, chronic fatigue, depression, fibromyalgia, headache, hypertension, insomnia, irritable bowel, multiple sclerosis, nutritional and dietary supplement counseling and other disorders. He also sees patients who need a global health assessment and assistance in choosing one or more of the various therapies offered at the Osher Clinical Center.

Matthew Kowalski, DC
Dr. Kowalski practices at the of the Osher Clinical Center at Brigham and Women’s Hospital where he also serves at the Associate Clinical Director. His practice focuses on the evaluation and treatment of patient suffering with headaches, spinal disorders, myofascial pain syndromes and other non-operative musculoskeletal conditions. Doctor Kowalski’s care combines manually applied procedures, rehabilitation, lifestyle counseling and ergonomic modifications. His integrative approach to practice bridges conventional and integrative healthcare.

Victor Wang, MD
Dr. Victor Wang is a neurologist in Boston, Massachusetts and is affiliated with multiple hospitals in the area, including Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital. He is board certified in both neurology and pain medicine by the American Board of Psychiatry and Neurology.

Leigh de Chaves, PT, OCS
Leigh de Chaves is board certified in orthopedics by the American Board of Physical Therapy Specialties. She started her career working in private practice focusing on Sports Medicine Rehabilitation. Leigh joined Brigham and Women’s Hospital as the Clinical Supervisor in 2001. She is the Physical Therapy Site Coordinator of Clinical Education. Leigh has training in manual therapy and Dry Needling. Her clinical interests are the treatment of orthopedic conditions and post-operative care.