Complementary Medicine Research Articles

Traditional and Complementary Medicine in Health Tourism: Cupping and Leech Therapy Case from Kayseri

The primary objective of this research is to investigate the potential of traditional and complementary medicine (T&CM) practices, especially cupping and leech therapy, in the context of health tourism. The research aims to ascertain the extent of tourist mobility on national and international levels related to these two practices and identify potential future trends in this field. First, a literature review was undertaken to figure out the role of cupping and leech therapies in health tourism, which informed the development of the qualitative study research design. Subsequently, a semi-structured interview was employed to collect data from twelve health professionals, mostly working in T&CM units within hospitals in Kayseri. Findings obtained after content analysis, demonstrate a growing interest in cupping and leech therapy as T&CM practices in health tourism, particularly after the COVID-19 pandemic. However, the study noted that most health tourists coming to Kayseri for these therapies are expatriates or regional tourists rather than international tourists traveling specifically for these treatments. Based on findings, the study suggests that growth in this area depends on better promotion of these therapies which can also be seen as intangible cultural heritage. Additionally, the findings indicate that T&CM practices, including acupuncture, ozone therapy, homeopathy, and phytotherapy, could have significant potential to contribute to the future development of health tourism.

Optimal traditional Chinese medicine formulas in treating ulcerative colitis: Choose one or take it all?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity, especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease. Traditional Chinese medicine (TCM) has emerged as a promising complementary therapy for UC. Based on the latest research, our editorial explored the current issues and potential essential research directions for TCM in treating UC. We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

Utilization of complementary and alternative medicine by patients undergoing maintenance hemodialysis for chronic kidney disease in Taiwan: a descriptive investigation.

Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of chronic illness, holistic care, and counteracting the adverse effects of conventional therapies. This study aims to determine the prevalence of CAM use and its associated factors among patients undergoing hemodialysis (HD) in Taiwan. This quantitative study was conducted from August 2022 to July 2024 in the HD unit at Kaohsiung Chang Gung Memorial Hospital in Taiwan. Face-to-face questionnaire-based interviews were held with 154 of 163 eligible patients (response rate, 94.5%) at the bedside during HD. The completed questionnaires were entered into a secure computer database. Data was performed by descriptive analysis, Chi-square, and Fisher tests. More than half of the patients were CAM users (n = 86; 56%), and women was associated with significantly more usage of CAM. Fifty-six CAM users took Chinese herbal medicine (CHM), 52.3% (n = 45) used dietary supplements, and 19.8% (n = 17) used acupuncture. The benefit in the effectiveness of CAM was the main reason for use, the need of CAM to improve the well-being and HD-related complication was high. 32.7% of patients had used CAM based on recommendation from their family and friends. More than one-third (33.7%) of patients did not disclose their use of CAM to their doctors, most of them think it is unnecessary. The use of CAM by patients with maintenance HD was relatively frequent. Of these, most used CHM, of which are shown to the trend into routine HD care is inevitable by high coverage and utilization in Taiwanese national health insurance system. These findings indicate that it is important for health care providers working in dialysis to assess CAM use.

Effects of chamomile oil inhalation on sleep quality in young adults with insomnia: A randomized controlled trial.

Insomnia is characterized by difficulty falling asleep, staying sleep, or both. Aromatherapy is a commonly used complementary and alternative medicine practice by persons with insomnia. Previous studies have shown that use of chamomile oil during massage therapy improves the quality of sleep (QoS). However, to our knowledge, no randomized controlled trials have examined the effects of chamomile oil inhalation on the treatment of insomnia. The present study evaluated the effect of chamomile oil inhalation on QoS and insomnia severity in persons with insomnia. A total of 80-participants ages 18-35 with insomnia were randomly allocated to aromatherapy group (AG; n = 40) or a control group (CG; n = 40). Those in the AG group received chamomile oil inhalation, while those in the CG engaged in their normal routine for 10minutes a day, daily for 15 days. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were administered before and after the intervention. Within-group analysis showed a significant reduction both in PSQI and ISI scores among those in the AG (P < 0.001 for both scores), whereas the CG reported a significant reduction in PSQI score (P = 0.033) and no significant changes in ISI score (P = 0.068). The between groups analysis after the intervention demonstrated a significant reduction in PSQI and ISI scores in the AG group (P < 0.001 for both) compared to the CG. No participant in either group reported adverse events during or after the study. Fifteen days of chamomile oil inhalation before bedtime reduced insomnia severity and enhanced the quality of sleep for young adults suffering from insomnia. Further studies are needed to replicate the results of this study using an active control group.

Efficacy of electrical stimulation of the zygomaticus muscle in complete facial paralysis: evidence from facial grading and automated image analysis

Surface Functional Electrical Stimulation (FES) is a well-studied intervention for multiple muscular disorders. However, it is still controversially discussed as a complementary therapy for complete facial paralysis. The aim of this intervention is to test a daily home-based ES concept as a pilot study regarding safety, feasibility, and effects on facial functionality and symmetry. In a prospective single-centre pilot study, 10 patients (median 61 years, denervation 130 d) with complete peripheral facial paralysis performed home-based FES of the affected lateral mouth region Stimulation parameters, facial paralysis scores and standardised photographs were assessed in monthly follow-ups. No serious adverse events appeared. Stimulation parameters could be constantly increased indicating effective muscle training while subjectively perceived functionality of the face improved. Thus, smile angle of the paralysed side improved as well. FES is a safe therapy model for application in facial nerve paralysis patients. A feasible stimulation protocol could be applied, which improved the functionality and symmetry of the stimulated facial region. A future controlled, randomised and double-blind follow-up study is needed to investigate these initial results in a further evolved replicable setting.

Prevalence and Determinants of Complementary and Alternative Medicine Use among Children living with Epilepsy in Port Harcourt, Nigeria

Introduction: Epilepsy is a common neurologic disorder in children with its management centered on the use of anti-seizure medications (ASM). However, many children do not achieve seizure control despite being on the appropriate ASM. Hence, caregivers may seek complementary and alternative medicines (CAMs) therapies. The aim of this study is to investigate the prevalence and types of CAM used by children with epilepsy in a tertiary hospital in Port Harcourt, Nigeria, and the factors that determines their use. Methods: A descriptive cross-sectional study was conducted among children diagnosed with epilepsy and their caregivers. Participants were recruited using a convenient sampling method, a structured questionnaire was used to collect data. Descriptive statistic was performed using IBM SPSS while Pearson’s chi-square test was used to identify significant associations. Results: The prevalence of CAM use was found to be 84.3%, the use of CAM is a risk for poor adherence to ASM. Family members were the main influencers in the decision to use CAM, and the majority of parents/caregivers did not consult their children’s healthcare providers before incorporating these therapies. Significant factors influencing the use of CAM includes: being a male (P=0.01), higher seizure frequency (P=0.002), multiple ASM use (P=0.01), and the presence of comorbidities (P=0.04). The most common CAMs used were prayers, kernel or crude oil and scarifications. Conclusion: CAM use among children with epilepsy is common and is a cause of poor adherence to ASMs with its untoward effects. It is crucial for healthcare providers to proactively inquire about the use of CAM with caregivers during the management of childhood epilepsy and to educate them on the possible risks specifically regarding drug adherence, compliance and poor seizure control.

Self-rated costs and benefits of conventional and alternative adult ADHD treatments.

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.

Use of complementary and alternative medicine by cancer patients attending Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

This study aimed to determine the prevalence and patterns of complementary and alternative medicine use among cancer patients at Jaramogi Oginga Odinga Teaching and Referral Hospital's Oncology and Palliative Care Unit. A cross-sectional study was carried out at the hospital. Seventy-one (71) participants were conveniently sampled. They were eligible to participate if they were at least 18 years old, had a cancer diagnosis, and could comprehend the questions. A questionnaire was used to collect data that was then analysed using STATA 13.0 at a 0.05 level of significance. Participants included 25(35.2%) males and 46(64.8%) females were recruited. About 67.6 per cent of the participants used complementary and alternative medicine. Majority used it for Tumour suppression (n = 25, 52.1%), and most sourced from CAM practitioners (n = 23, 47.9%). Overall, 60.4 per cent of complementary and alternative medicine users experienced side effects, with diarrhoea affecting the greatest percentage (62.1%). The highest level of education was found to be positively associated with the use of complementary and alternative medicine (aOR=3.337). In conclusion, complementary and alternative medicine is widely used by cancer patients attending Jaramogi Oginga Odinga Teaching and Referral Hospital Oncology and Palliative Care Unit. As a result, there is need identify specific herbs taken by cancer patients, evaluate their active constituents, and investigate their potential anticancer mechanisms, as well as assess their knowledge, attitude, and perspective.

Innovative Complementary Cooling Intervention for Women's Multiple Sclerosis Symptoms: A Mixed-Methods Study.

Purpose: This mixed-methods study examined the relationship between multiple sclerosis symptoms to perceived severity, frequency of Uhthoff's phenomenon, the effectiveness of complementary cooling therapy on women's symptom clusters, and quality of life. This study explored the experiences of women with multiple sclerosis when using the Opal Cool Wrap related to heat intolerance, a complementary alternative therapy. Methods: Quantitative analysis of results from surveys from 62 women and seven qualitative semi-structured interviews with a subset of women who completed the surveys validated and illustrated the quantitative findings. Findings: Significant improvement in perceived severity for health transition, physical functioning, role-physical, bodily pain, and social functioning based on pre-/post-cooling therapy use. Three themes emerged from seven interviews: (1) being overheated impacts the quality of life; (2) cool wrap, a helpful tool for managing heat symptoms; and (3) strategies to remain cool. Conclusion: This study provides a comprehensive mixed-methods lens on the unique challenges women with multiple sclerosis face and information for disease management. Heat-related multiple sclerosis symptom clusters and Uhthoff's phenomenon women experience are common and impact safety, independence, health, and quality of life. Identifying complementary strategies such as cool showers and a cooling device to prevent and manage heat-related symptoms is a priority.

Assessment of Indigenous Medicinal Plants Used to Cure Common Illnesses in the Community: Basis for Conservation and Domestication

There is a lack of necessary medications during emergencies. In a post-disaster scenario, readily available remedies like herbs function as an alternative medicine to react swiftly. To meet these demands and the needs of rural residents who utilize wild-crafted herbs as a staple therapy for a range of ailments in their community, a thorough investigation was carried out. Because people are unaware of their use, the presence and quantity of these plants swiftly decline. This study aims to evaluate the locally grown medicinal plants in Pilar, Capiz. Primary data came from seventy-two key informants. Secondary data were acquired by means of a field survey employing the transect walk approach and the visual encountered method. Plants were gathered from backyard and roadside gardens. The primary informants made the identification on the spot, and it was confirmed by documents that had been released. Sambong, lagundi, yerba Buena, malunggay, tawa-tawa, luya, alusiman, atis, bayabas, bunga, kataka-taka, bunga, kugon, makabuhay, oregano, taglad, and tuba are the sixteen species of herbal plants that have been identified. It was customary to use leaves to treat cuts and wounds. There was the most tawa-tawa. Oregano, kataka, and bayabas were the most often used herbs, with a Use-Value Index of 0.99 and the greatest fidelity level of 99%.

A systematic review: enhancing stroke recovery through complementary interventions—Clinical outcomes and neural activity insights

The growing interest in complementary interventions for stroke recovery necessitates the need for neural insights to aid in making evidence-based clinical decisions. This systematic review examined the brain activation effects of complementary therapies, including acupuncture (n = 5), motor imagery therapy (MIT) (n = 5), music (n = 3), and virtual reality (VR) interventions (n = 3), on clinical outcomes and neural activity in stroke patients. All therapies engaged motor and sensory networks, frontal regions, parietal regions, and temporal regions, suggesting their potential to improve motor control, attention, memory, and cognitive function. Acupuncture activated motor areas in both hemispheres, while MIT stimulated frontoparietal regions in both sides of the brain, supporting whole-body integration in recovery. In contrast, VR therapy exhibited ipsilesional lateralization, while music therapy showed left-lateralization. The review also found that increased interhemispheric connectivity between motor regions, along with intrahemispheric ipsilesional connectivity between motor, cognitive, and sensory areas, is key to achieving better clinical outcomes.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier (ID: CRD42023455192).

Participants' perspectives on a multimodal stress management and comprehensive lifestyle modification program for patients with Crohn's disease-A qualitative interview study.

Crohn's disease (CD) is a type of inflammatory bowel disease (IBD) that is prevalent worldwide and associated with reduced quality of life for patients. Multimodal therapy approaches, which emphasize lifestyle modifications such as mindfulness and stress reduction, can be promising in enhancing health-related quality of life for IBD patients. However, research on multimodal therapy approaches for CD remains insufficient. This qualitative interview study is part of a mixed-methods approach that is embedded in a randomized controlled trial. It investigates the impact of a comprehensive 10-week day clinic lifestyle modification program on the health condition and quality of life of CD patients. Telephone interviews (n = 19) were conducted three months after the program to examine individuals' viewpoints on the intervention, including perceived changes and transfer of elements into daily life. Reflexive thematic analysis was performed using MAXQDA software. The results indicate that CD can have very individual and comprehensive impacts (psychological, physical, social), leading to reduced perceived quality of life and well-being. By participating in the program, patients wanted to find self-help options to complement conventional pharmacotherapy and actively manage their disease. Patients expressed high satisfaction with the program, feeling it provided valuable support for daily disease management. They were able to integrate adequate therapy elements into their routines to complement their care. Patients recognized significant improvements in various domains, mainly in the psychological domain, e.g., improved self-efficacy, symptom management, and, also partly physical/symptomatic and social improvements. A multimodal stress reduction and lifestyle modification day clinic appears to be beneficial as a complementary therapy for CD patients. It offers additional options and helps patients to address individual symptoms and needs, improve their understanding of the disease and their quality of life. Although promising, further research is needed to assess its long-term effects. ClinicalTrials.gov, identifier: NCT05182645.

The use of complementary and alternative medicine among surgical patients: a cross-sectional study.

The use of complementary and alternative medicine (CAM) has increased substantially around the world; various global studies have documented the use of CAM by surgical patients in the preoperative period, with rates of herbal medications and other nonherbal treatments ranging from 12 to 69%. This study aimed to identify the prevalence of CAM and its patterns of use among surgical patients. From December 2020 to April 2021, a descriptive cross-sectional study was undertaken in Palestine. A face‒to-face interview questionnaire was used. The participants were asked questions regarding sociodemographics, clinical information, CAM usage, reasons for its use, and opinions on its efficacy. Among the 300 surgical patients who were interviewed in this study, 252 (84.0%) reported that they had ever used CAM, while a total of 122 (48.4%) had used CAM before their surgery, 81.7% of the respondents used herbal methods, and 64.7% of them used nonherbal methods. CAM use among our study population was not linked to specific demographics or other characteristics, except health insurance (p = 0.004). The most commonly used herbs among surgical patients are Salvia officinalisL. (Sage) (84.1%) and Pimpinella anisumL. (Anise) (75.5%). The highest percentage wasfound among patients with university qualifications (73.2%), who used more than three methods (p < 0.001). In addition, 59.4% of the females used more than three therapies, whereas 45.9% of the males did (p = 0.032). The herbal methods used are common among surgical patients in Palestine and are consistent with the enormous increase in the use of CAM. Therefore, awareness should be raised among the public regarding the risks and benefits of CAM use.

Knowledge, Attitude, and Practice Regarding Dietary Supplements: Community Pharmacies -Based Cross-Sectional Study in Yefren, Libya

Dietary supplements (DS) are the most prevalent subcategory of complementary and alternative medicine (CAM), which is a classification of a variety of healthcare and medicinal items that aren't typically included in standard medications. The aim of the study is to assess the knowledge, attitude, and practice of Yefren community pharmacies (Libya) about dietary supplements. Methods: A cross-sectional study was designed to collect responses from 100 participants in community pharmacies in Yefren in March 2024 through a knowledge, attitude, and practice (KAP) survey. Result: This study used a validated questionnaire consisting of four parts, knowledge, attitude, and practice regarding dietary supplements. Conclusion: all the participants in the community pharmacies in Yefren had good knowledge, attitude, and practices for dietary supplements.

Antioxidant Potential of Medicinal Plants in the Treatment of Scabies Infestation

Oxidative stress, characterized by an overproduction of reactive oxygen species that overwhelm the body’s physiological defense mechanisms, is a key factor in the progression of parasitic diseases in both humans and animals. Scabies, a highly contagious dermatological condition caused by the mite Sarcoptes scabiei var. hominis, affects millions globally, particularly in developing regions. The infestation leads to severe itching and skin rashes, triggered by allergic reactions to the mites, their eggs, and feces. Conventional scabies treatments typically involve the use of scabicidal agents, which, although effective, are often associated with adverse side effects and the increasing threat of resistance. In light of these limitations, there is growing interest in the use of medicinal plants as alternative therapeutic options. Medicinal plants, rich in bioactive compounds with antioxidant properties, offer a promising, safer, and potentially more effective approach to treatment. This review explores the role of oxidative stress in scabies pathogenesis and highlights how medicinal plants can mitigate this by reducing inflammation and oxidative damage, thereby alleviating symptoms and improving patient outcomes. Through their natural antioxidant potential, these plants may serve as viable alternatives or complementary therapies in the management of scabies, especially in cases where resistance to conventional treatments is emerging.

INTEGRATIVE ONCOLOGY AS A PROMISING VECTOR FOR THE TREATMENT OF CANCER TREATMENT

The article presents an analysis of the possibilities for early diagnosis, treatment, and rehabilitation of patients with cancer within the framework of integrative oncology. Introduction. Oncological diseases remain one of the most pressing medical challenges of our time, driven by a steady increase in incidence, late-stage diagnoses, and unsatisfactory treatment outcomes. WHO experts predict that by 2050, the number of new cancer cases will rise by 77% compared to 2022. Despite significant advancements in diagnostics and conventional treatments, including surgery, chemotherapy, and radiotherapy, there remains a need for a more holistic approach. This approach would not only target tumor control but also aim to enhance the overall quality of life for patients. Discussion. Timely and accurate diagnosis is a crucial aspect of the fight against cancer. Early detection can significantly improve the chances of successful treatment and patient survival. However, conventional cancer treatments are often aggressive, leading to complications, side effects, and patient disability. Integrative oncology combines traditional therapies with complementary approaches, focusing on maintaining overall patient health, reducing side effects, facilitating restorative rehabilitation, and enhancing quality of life. This comprehensive, integrative approach broadens and strengthens the options for cancer treatment, offering a more holistic care strategy. Conclusion. Integrative oncology represents a promising direction in cancer treatment by providing a comprehensive approach to addressing the disease. The combination of conventional treatments with complementary therapies not only enhances treatment effectiveness but also significantly improves patient quality of life, an essential aspect in the ongoing battle against cancer.

Biochemistry and Future Perspectives of Antibiotic Resistance: An Eye on Active Natural Products

Antibiotic resistance poses a serious threat to the current healthcare system, negatively impacting the effectiveness of many antimicrobial treatments. The situation is exacerbated by the widespread overuse and abuse of available antibiotics, accelerating the evolution of resistance. Thus, there is an urgent need for novel approaches to therapy to overcome established resistance mechanisms. Plants produce molecules capable of inhibiting bacterial growth in various ways, offering promising paths for the development of alternative antibiotic medicine. This review emphasizes the necessity of research efforts on plant-derived chemicals in the hopes of finding and creating novel drugs that can successfully target resistant bacterial populations. Investigating these natural chemicals allows us to improve our knowledge of novel antimicrobial pathways and also expands our antibacterial repertoire with novel molecules. Simultaneously, it is still necessary to utilize present antibiotics sparingly; prudent prescribing practices must be encouraged to extend the effectiveness of current medications. The combination of innovative drug research and responsible drug usage offers an integrated strategy for managing the antibiotic resistance challenge.

A REVIEW ON EFFECTIVENESS OF AROMATHERAPY ON MENTAL HEALTH AND WELL-BEING

Aromatherapy has been used as an alternative medicine and complementary therapy, for the effective treatment of mental health and well-being. Essential oil is the main agents, which is abstracted from the flower, bark, roots, leaves or certain parts of plants which contains aromatic molecules in the cells of the plants (Steflitsch &amp; Steflitsch, 2008). Objectives: this study aims to know the effectiveness of aromatherapy on mental health and well-being. Aromatherapy may be utilized to provide advantages through inhalation, topical application, and baths. Aromatherapy can treat depression, indigestion, headaches, sleeplessness, muscular discomfort, respiratory problems, skin illnesses, swollen joints, and urinary issues (Ali, et al, 2015). Aromatherapy can be benefited by adopting a balanced and healthy diet, as well as taking precautions recommended by health specialists and aromatherapist. This review paper is based on secondary data collected through literature searches in electronic journals and book reviews, which were analyse and assess articles from certain journals utilizing Google Scholar, PubMed, Academia, Science Direct, Web of Science, and the Library Search.

The Therapeutic Management of Chemical and Herbal Medications on Uric Acid Levels and Gout: Modern and Traditional Wisdom

Background: Gout is a chronic inflammatory condition characterized by elevated uric acid levels in the blood, which can precipitate acute gout attacks in individuals with genetic susceptibility, existing medical conditions, and dietary influences. Genetic predispositions, comorbid medical conditions, nutritional choices, and environmental factors increasingly recognize the multifactorial etiology of the disease. Methods: Recent research has highlighted the potential of phytochemicals, particularly flavonoids, saponins, and alkaloids, to manage hyperuricemia (HUA) and its associated complications. Results: Plant’s natural compounds have garnered attention for their anti-inflammatory, antioxidant, and uric acid-lowering properties, suggesting their role in alternative and complementary medicine. Phytochemicals have demonstrated promise in mitigating gout symptoms and potentially modifying the disease course by addressing different aspects of hyperuricemia and inflammation. Herbal remedies, with their complex phytochemical profiles, offer a unique advantage by potentially complementing conventional pharmacological treatments. The integration of herbal therapies with standard medications could lead to enhanced therapeutic outcomes through synergistic effects, optimizing disease management, and improving patient quality of life. Conclusions: This review examines the current understanding of the multifaceted etiology of gout, explores the role of phytochemicals in managing hyperuricemia, and discusses the potential benefits of combining herbal remedies with conventional treatments to improve patient care and therapeutic efficacy.

Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial.

First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment. We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain. Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07). These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.