Friday, May 7, 2010

Who Seeks Alternative Medicine for Pain Relief?

In The News A new study appearing in the journal Pain Medicine highlights the important role of complementary and alternative medicine (CAM) among patients with chronic pain. Along with this, however, there may be concerns about CAM safety and effectiveness, and the fact that patients often do not inform their healthcare providers of CAM use.

The study, from the University of Michigan Health System, retrospectively examined data from 5,750 patients collected during 1994 to 2000 [Ndao-Brumblay and Green 2010]. Investigators found that 1 out of 3 participants with chronic pain reported using CAM therapies for chronic pain relief: specifically, 8.3% used acupuncture, 13.0% used biofeedback/relaxation, and 24.9% used manipulation techniques (eg, chiropractic or physical therapy procedures). A number of trends also were reported:
  • Overall, whites used alternative modalities more frequently than blacks. In particular, blacks used less biofeedback/relaxation and manipulation treatments than whites.
  • Elderly adults had a higher frequency of using CAM therapies than younger adults. Increasing age was related to more acupuncture use, but less use of biofeedback/relaxation.
  • Higher education levels and perceived pain control were positively associated with use of all 3 CAM modalities.
  • Women marginally used more biofeedback/relaxation services than men, and depressive symptoms in men or women were not related to CAM therapies utilization.
COMMENTARY: As we have previously cautioned, retrospective analyses such as this of somewhat older data can have inherent limitations and biases. That aside, according to a news report [Hasouris 2010], a coauthor of the study, Carmen R. Green, MD, suggested that this pattern of CAM utilization may be due to such therapies usually attracting individuals with higher education levels and income, or the pattern could be a result of differences in insurance coverage. Also, as people age, there is a greater chance that they will be faced with chronic pain and this may influence their use of CAM. Green stressed that it is important for healthcare providers to know if patients are using these therapies so any risks or side effects associated with them can be minimized. However, it must be considered that patients often do not report the use of CAM to their healthcare providers unless they are specifically asked.

REFERENCES:
> Hasouris T. Use of Alternative Medicine for Pain Relief Increases With Age and Wealth. Health & Medicine for Senior Citizens [online]. 2010(Apr 29) [
available here].
> Ndao-Brumblay SK, Green CR. Predictors of Complementary and Alternative Medicine Use in Chronic Pain Patients. Pain Med. 2010;11(1):16-24 [
abstract here].