The National Center for Complementary and Integrative Health Care reports in a September 2018 article, chronic pain and ‘high-impact’ chronic pain (daily pain affecting at least one major life activity), are on the rise in specific populations. Providers are encouraged to pay special attention to women, older adults, adults not currently employed, living in poverty, non-Hispanic white adults or adults living in rural settings. These populations have the highest prevalence and may warrant more detailed history and treatment to support more successful outcomes with treatment. Helping patients regain function should be included in all early stage care plans. Active care including exercises, stretches and mind-body awareness to support any manual therapies will produce better outcomes.
On Friday, October 5th, The National Advisory Council for Complementary and Integrative Health (NCCIH) holds the first meeting of Fiscal Year 2019. Potential stakeholders are invited to listen to a livestream session from 9:30AM to 3:20 PM ET. The hearing will be archived for those who are unable to attend. Agenda items feature: Interaction between evidence-based guidelines and NCCIH Research Priorities. Topics include:
- Mechanism Underlying Analgesic and Anti-inflammatory Properties of Terpenes and Minor Cannabinoids
- Emotional Well-Being High-Priority Research Networks
- HEAL Initiatives involving NCCIH
This group meets three times per year and has a goal of advising, consulting with and making recommendation to the Center Director on matters relating to NCCIH’s research activities and functions. Providers are encouraged to submit respectful comments which will be moderated before posting occurs.
According to JAMA Internal Medicine 2018, the use of gabapentinoids (Neurontin, Gralise, Horizant) and pregabalin have climbed from 1.2% in 2002 to 3.9% by 2015. According to Dr. Michael Johansen of the Heritage College of Osteopathic Medicine at Ohio University, “Nearly one in 25 adults takes a gabapentinoid during a year. This matters because we have little data to support much use of this drug class (for chronic pain) and minimal data to support long-term safety of the medications.” This class of drugs has been approved by the FDA to treat seizures and nerve pain of shingles; both short term dosing. Another version of gabapentin has also been approved for restless leg syndrome, fibromyalgia, and some nerve pain related to diabetes and spinal cord injuries. Doctors have begun to use this class of drugs for off-label use of chronic pain. This is controversial because this class of drugs is addictive as well. When you combine the addictive qualities, unknown long-term safety issues and side effects of sedation, dizzinessm and cognitive decline with higher doses, more studies are needed to see if this is a viable alternative to opioids. Researchers continue to offer non-pharmacological options for chronic pain patients, such as acupuncture, physical therapy, yoga, exercise, and mind body techniques. Although this study did not include IH chronic pain treatments, providers would be wise to encourage this population of patients to attempt non-pharmacological options as much as possible.
- Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain
- Treatment effects persist over time and cannot be explained solely in terms of placebo effects
The evidence supports the conclusion that a course of acupuncture is a reasonable option for patients with chronic pain.
A study of 750 active-duty US military service members with low back pain, where half of the patients received chiropractic care in addition to usual care, demonstrated larger reductions in pain and lower related disability than the group receiving only usual care. The chiropractic care patients received could include spinal manipulation, rehabilitation exercise, and treatment with heat or cold. This open access article published in JAMA Network Open concludes, “This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines.”
Approximately 40 million Americans experience severe pain annually, costing more than $14 billion in out-of-pocket expenses. A MEDLINE database search was done for randomized, controlled clinical trials published from 1966 to 2016 and conducted in the United States, with evidence of efficacy, effectiveness and safety. Researchers chose seven, widely used complementary approaches including: acupuncture, spinal manipulation, massage therapy, tai chi and relaxation techniques using meditation. Also included in the search were selected natural products; chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAM-e) and omega-3 fatty acids. The researchers found the following approaches had more positive than negative results. Negative results were minor side effect symptoms, related to supplements and some temporary gastric upset. No trials reported serious adverse events with treatments.
- Acupuncture and yoga for back pain
- Acupuncture and tai chi for osteoarthritis of the knee
- Massage therapy for neck pain – with adequate doses and for short-term benefit.
- Relaxation techniques for severe headaches and migraines.
Weaker evidence was found for:
- Massage therapy, spinal manipulation for back pain
- Relaxation approaches and tai chi for fibromyalgia
Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts published a 2017 JAMA article describing how gut bacteria synthesizes essential vitamins and amino acids to help degrade toxins. From birth, humans coexist with microbes. By adulthood, the number of gut microbes, far outnumbers the roughly 13 trillion human cells. More importantly, gut microbial cells (microbiota), have far more genes than human cells – 250-800 times more! This may affect lifetime body weight because body weight is not affected as much by ingested calories, as by the way they are absorbed. Microbial enzymes from microbiota turns polysaccharides into digestible energy. Various repeated studies suggest microbiota may powerfully affect obesity. Given the increased risk of developing type 2 diabetes with obesity, microbiomes may influence this process. IH providers would do well to investigate gut health with both diabetic and obese patients. Assisting patients with digestive issues may assist in treating diabetic obesity-related problems.
JAMA January 24/31, 2017 Volume 317, Number 4 pg 355
In a May 4, 2018 press release, Utah Southwestern Medical Center research has show that targeting metabolism of growing cells, holds promise for treatment of ‘proliferative’ skin diseases like psoriasis, granuloma annulare and eczema. A research team using mice, demonstrated that inhibiting glucose transport may be a safe and effective treatment for actively dividing cells that are dependent on glucose for growth. Their findings were recently published in ‘Nature Medicine’. People suffering from hyperproliferative skin disorders are at increased risk for other inflammatory diseases such as arthritis, heart disease/hypertension, diabetes, Crohn’s disease, lupus, irritable bowel syndrome, depression, and obesity. Providers are advised to include skin condition inquiries on intake forms and refer or treat in scope, when seeing patients with hyperproliferative skin conditions.
In a May 24, 2018 NCI (National Cancer Institute) study, scientists found a connection between bacteria in the gut and anti-tumor immune responses in the liver. This effectively changes the composition of immune cells of the liver. Tim Greten, M.D. (NCI) (CCR) Center for Cancer Research, led the study, saying, “This is a great example of how what we learn from basic research can give us insight into cancer and possible treatments.”
NCCIH (National Center for Complementary and Integrative Health) May 2019 report gives fact sheet information on using fresh ginger to assist with pregnancy related symptoms of nausea and vomiting as well as arthritic inflammatory conditions. Cautions are listed for side effects of abdominal discomfort, heartburn, diarrhea and gas (temporary) as well as interactions with blood thinners. Ginger can be added to tea, used in a juicer, or added to cooked vegetables. Cooking may alter the effectiveness, requiring higher doses.
The entire report can be found at: https://nccih.nih.gov/health/ginger?nav=govd