Complementary and Alternative Medicine in Back Pain Utilization Report

Santaguida PL, Gross A, Busse J, Gagnier J, Walker K, Bhandari M, Raina P.

Objectives: This systematic review was undertaken to evaluate which complementary and alternative medicine (CAM) therapies are being used for persons with back pain in the United States.

Data Sources: MEDLINE^®, EMBASE^®, CINAHL^® and Cochrane Central^® and a variety of CAM specific databases were searched from 1990 to November 2007. A grey literature search was also undertaken, particularly for clinical practice guidelines (CPG) related to CAM.

Review Methods: Standard systematic review methodology was employed. Eligibility criteria included English studies of adults with back pain, and a predefined list of CAM therapies.

Results: A total of 103 publications were evaluated; of these 29 did not present CAM therapy use stratified for back pain. There were a total of 65 utilization studies, 43 of which were American. Four publications evaluated the concurrent use of four or more CAM therapies and these suggest that chiropractic/manipulation is the most frequently used modality followed by massage and acupuncture. A limited number of publications evaluated utilization rates within multiple regions of the back and show that CAM was used least for treating the thoracic spine and most for the low back. However, rates of use of massage were similar for neck and lower back regions. Concurrent use of different CAM or conventional therapies was not well reported.

From 11 eligible CPG, only one (for electro-acupuncture) provided recommendations for frequency of use for low back pain of all acuity levels.

Eighteen cost publications were reviewed and all but one publication (cost-effectiveness) were cost identification studies. There is limited information on the impact of insurance coverage on costs and utilization specific to back pain.

Conclusions: There are few studies evaluating the relative utilization of various CAM therapies for back pain. For those studies evaluating utilization of individual CAM therapies, the specific characteristics of the therapy, the providers, and the clinical presentation of the back pain patients were not adequately detailed; nor was the overlap with other CAM or conventional treatments.

Evidence Report/Technology Assessment No. 177 – full text

Filed under: Alternative therapies, Manual therapy, Massage, Spine

Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia

A report by the Arthritis Research Campaign (UK)

This report is written and produced by the Arthritis Research Campaign is an evidence-based report on the use of complementary and alternative medicines for arthritis and musculoskeletal conditions. It uses evidence from randomised controlled trials and aims to help people with arthritis or fibromyalgia select which complementary medicines may be beneficial for them.  The report scores medicines according to their effectiveness with 1 indicating that the available evidence suggests that the compound is not effective and 5 indicating that there is consistent evidence that the compound is effective. Effectiveness is measured by improvements in pain, movement, or general well-being.  The report also grades the medicines according to safety, providing traffic light classifications for each.
The authors of the report focused on compounds taken by mouth or applied to the skin. They did not look at therapies such as acupuncture and chiropractic massage, which have been commonly used for arthritis and musculoskeletal conditions. The role of these will be considered in a subsequent report.
Despite the number of complementary medicines available and used, this report found only 40 with evidence available from randomised controlled trials
- the type of studies that give the best evidence on whether a treatment is effective or not. Even for those, which had been studied, many had been tested in only a single or just a few studies. This makes it difficult to be sure whether they work or not.
Rheumatoid arthritis
For people with rheumatoid arthritis (RA) the medicines researched score poorly, with 13 out of 21 complementary medicines (62 per cent) scoring just 1 point i.e. the available evidence suggests that the compound is not effective.  At the other end of the scale, fish body oil scores a maximum 5 for effectiveness among people with RA, offering real benefits. It also receives a green light for safety.
Osteoarthritis
Alternative medicines appear to be more promising for people with osteoarthritis (OA) with only 6 out of 27 approaches (22 per cent) scoring 1 point.
Found to be safe to use and scoring well are the herbal preparation phytodolor and nutritional supplement SAMe, both receiving a 4 for effectiveness. Capsaicin gel, made from chilli peppers, proved the most effective for OA, scoring the full 5 points.
Glucosamine is one of the most widely taken products and there have been many trials conducted. The evidence however is mixed, many trials show benefit while some do not. The evidence is stronger for glucosamine sulphate (which scored 3) compared to glucosamine hydrochloride (which scored 1).
Fibromyalgia
Only four products were assessed for fibromyalgia but none of them were highly effective with three medicines scoring just 2 out of 5, and the fourth an ineffective 1.

In terms of safety, there is much less information available for complementary medicines in comparison to conventional medicines. However for approximately one quarter of the compounds considered we gave them an “amber” safety classification indicating there were important side effects which had been reported. A “red” safety classification was issued against thunder god vine.

The research studies used in the report are referenced so that you can find out more information on individual medicines should you wish to.

The compleate report is availble here in PDF

Filed under: Alternative therapies, Arthritis, Osteoarthritis, Rheumatoid arthritis