Integrative medicine approaches for pain treatment—can they be an alternative to opioids?

Can acupuncture and yoga help to fight the opioid epidemic? These and other integrative medicine approaches have shown at least preliminary evidence of effectiveness in pain management, according to an article in the December issue of Anesthesia & Analgesia—a special thematic issue addressing the opioid crisis.

"In the current opioid crisis era, many integrative medical therapies can be used as complements to mainstream medicine to address pain and reduce opioid abuse and addiction-related disease," write Yuan-Chi Lin, MD, MPH, and colleagues of Harvard Medical School. In the special issue, they and other anesthesia and pain medicine physicians share evidence on this and other potentially effective strategies to reducing reliance on opioids to treat chronic and postoperative pain.

Complementary Medicine as Alternatives to Opioids - What's the Evidence?

Dr. Lin and coauthors reviewed and analyzed current evidence on integrative medicine therapies—also called complementary and alternative medicine—for the treatment of pain. "Integrative medicine for pain can play a major role in reducing the frequency and amount of opioid usage," the researchers write.

The analysis included a total of 32 studies evaluating seven different types of integrative medicine therapies for pain. Acupuncture was the treatment showing the strongest evidence for effectiveness in reducing pain. Overall there was "strong positive evidence" showing a beneficial effect of acupuncture for the treatment of chronic pain. There were also studies showing that acupuncture reduced the dose of opioids needed to control pain after surgery, with reduction in opioid-related side effects.

Most of the other therapies studied showed "positive preliminary evidence" of effectiveness in pain treatment. These included yoga, relaxation techniques (such as mindfulness meditation), tai chi, massage therapy, and spinal manipulation. Few of these studies addressed the effects on use of prescription medications in general or opioids in particular. There was conflicting evidence on the pain-reducing effectiveness of the supplements glucosamine and chondroitin for knee pain.

The authors acknowledge some important limitations of the current evidence on integrative therapies for pain. The studies in the review varied in terms of the methods used and the types of pain studied, in addition to the special challenges of studying the effectiveness of alternative therapies (such as controlling for the placebo effect). While emphasizing the need for additional studies, Dr. Lin and coauthors conclude: "The consensus and results of this review suggest that complementary health approaches can help to improve pain and reduce opioid use."

The special issue also includes current evidence reviews on topics of special interest, including other types of medications that may provide alternatives to opioids for treatment of chronic pain; new types of pain medications under development, including opioid and non-opioid drugs; strategies to help reduce the risk of chronic opioid use after surgery; and opioid-sparing strategies to reduce the need for opioids after surgery.

Anesthesiology and pain medicine specialists play a critical role in developing effective strategies for responding to the opioid crisis. according to an introductory article by Guest Editors Honorio T. Benzon, MD, of Northwestern University Feinberg School of Medicine, Chicago, and T. Anthony Anderson, MD, PhD, of Stanford University School of Medicine "We wanted to show to the medical community that we, anesthesiologists, can play an active role in identifying and solving the issues," the Guest Editors write. "We are the leaders in opioid prescription...and should take the lead in solving the problem."