Complementary and Integrative Health in Chronic Pain and Palliative Care

Abstract

Complementary and integrative health encompasses diverse medical and health-care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of MD (medical doctor) and DO (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, nurse practitioners, and registered nurses. The boundaries between complementary health approaches and conventional medicine are not absolute, and specific complementary practices may, over time, become widely accepted. Despite the fact that rigorous, well-designed clinical trials for many complementary health approaches are often lacking and, therefore, the safety and effectiveness of many complementary health approaches are uncertain, complementary health approach use is common, particularly among individuals with chronic pain and advanced illness. This chapter presents evidence regarding selected complementary health modalities in the settings of chronic pain and palliative care. The presentation of the evidence is organized according to the following categories: (1) mind–body practices, (2) manipulative and body-based practices, (3) manipulation of energy fields (biofield therapies), and (4) biologically based therapies. Where sufficient data are available, the evidence is presented in table format. For some modalities, little evidence is available. For these modalities, the existing evidence is described in the text only. Despite many years of complementary health practice and common usage, rigorous scientific research on complementary health approaches has occurred only relatively recently. Complementary health approach research is limited by methodologic and ethical issues. Gaps in research are thus the norm, and the current evidence base is insufficient.