Pain: Comparison of evidence for conventional western and alternative therapies

Complementary and alternative medicine (CAM) is in widespread use among pain sufferers. Often CAM is used in parallel with conventional pain treatment by both patients and physicians. In addition, in pain medicine the border between conventional and alternative therapies is not well defined.

Here, the evidence for both conventional western as well as CAM for chronic pain is reviewed. Since chronic pain conditions as well as therapies are heterogeneous, only for a few topics and therapies comparable studies exist. The literature search comprises only randomized controlled trials (RCTs) and systematic reviews or guideline publications in which the quality of the included studies is analysed according to predefined criteria. The following pain entities have been selected: cancer pain, neuropathic pain, low back pain, and fibromyalgia.

For cancer pain, very efficient conventional treatment options exist. In comparison, evidence for CAM is limited due to the paucity of rigorous trials. Only one systematic review was found. Despite the scant evidence, CAM is widely used among cancer pain patients. Reasons may be the low rate of adverse effects compared to conventional (opioid) therapy and the combination with a CAM therapy of the malignant disease itself.

For neuropathic pain, good evidence exists for conventional pharmacological treatment. However, conventional treatment options are not uniformly efficacious for all forms of neuropathic pain. For CAM, evidence is limited. For most forms of CAM therapy only single studies of often low quality exist.

For chronic low back pain, only few forms of conventional therapy have proved consistently efficacious in multiple RCTs. Nevertheless many other forms of therapy, especially interventional, continue to be popular among both patients and physicians. The same is true for the diverse forms of CAM, where evidence is conflicting, too. In the treatment of fibromyalgia, the situation is similar.

In summary for many pain conditions evidence is lacking for both conventional and alternative therapies, and conventional therapy is often not sufficiently efficacious. Risk–benefit ratios as well as cost-effectiveness analyses need to be taken into account when integrating all forms of therapy.