Complementary Health Approaches for Pain Management Increasing in Popularity

The use of complementary health approaches (CHAs) among patients in the US increased between 2002 and 2022 parallel to an increase of reported pain prevalence, according to findings published in JAMA.¹

In recent years, there has been a growing body of evidence to support the safety and efficacy of CHAs for pain management, such as acupuncture, guided imagery and/or progressive muscle relaxation, massage, naturopathy, and yoga. These approaches are designed to be used alongside standard medical care to further improve a patient’s overall health and wellbeing.

In 2012, the total amount of money spent on CHAs ($28.3 billion) accounted for 9% of total annual out-of-pocket health care expenditures.¹

To assess national trends associated with CHAs, investigators assessed CHA use among US adults over a 20-year period, with data being collected in 2002, 2012, and 2022. Data were gleaned from the National Health Interview Survey (NHIS), an annual nationally representative, cross-sectional household interview survey.

Investigators examined 7 CHAs across all 3 time points: use of acupuncture, guided imagery and/or progressive muscle relaxation, massage, naturopathy, chiropractic care, meditation, and yoga. However, they noted that differences in questionnaire items in 2012 prevented comparisons with 2002 and 2022 data for chiropractic care and meditation.

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Across 2002, 2012, and 2022, there were 31,044, 34,525, and 27,651 NHIS participants, respectively. An increase in adults reporting the use of any of the 7 CHAs increased significantly from 19.2% (95% CI, 18.7%-19.7%) in 2002 to 36.7% (95% CI, 36.0%-37.5%) (P < .001) in 2022.

Among those using CHAs, the percentage identifying pain management as a reason for use increased significantly from 42.3% (95% CI, 40.8%-43.8%) in 2002 to 49.2% (95% CI, 48.0%-50.3%) in 2022. Chiropractic care emerged as the CHA with the highest use for pain management (85.7% [95% CI, 84.2%-87.2%] in 2022).

The biggest jump in use among the 7 CHAs assessed was seen for yoga, which increased in utilization from 5.0% (95% CI,4.7%-5.2%) in 2002 to 15.8% (95% CI, 15.2%-16.3%) in 2022.

Meditation was the most widely used CHA, with 17.3% (95% CI, 16.7%-17.9%) of adults reporting its use in 2022. Interestingly, the use of acupuncture increased from 1.0% (95% CI, 0.9%-1.2%) in 2002 to 2.2% (95% CI, 2.0%-2.5%) in 2022 alongside an increase in insurance coverage that expanded access to the service.

Investigators noted that the rise in use of CHAs could be due to several factors, including evidence suggesting that some CHAs provide low to moderate levels of pain management, incorporation of CHAs into pain management guidelines, and the search for nonopioid alternatives to potentially harmful opioids.¹

The growing popularity of CHAs could also signal a broader shift towards integrative medicine, which emphasizes a holistic approach to healing and wellbeing through spiritual, emotional, mental, environmental, and physical means.² Yoga, for instance, can address emotional and spiritual distress in a way that standard care practices, which often focus on relieving physical pain, might not.

Integrative medicine’s use of CHAs can be particularly appealing to patients seeking natural and non-invasive approaches to improve their health. The approach has been an especially important topic of research among cancer patients, whose conventional treatments are often limited.²

Study limitations include decreasing NHIS response rates over the 3 time points, possible recall bias, use of cross-sectional data, and differences in query methods across survey years.

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References

1. Nahin RL, Rhee A, Stussman B. Use of complementary health approaches overall and for pain management by US adults. JAMA. 2024;331(7):613–615. doi:10.1001/jama.2023.26775

2. Gannotta R, Malik S, Chan AY, Urgun K, Hsu F, Vadera S. Integrative medicine as a vital component of patient care. Cureus. 2018;10(8):e3098. Published 2018 Aug 4. doi:10.7759/cureus.3098