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In this Q&A, Robert Alan Bonakdar, MD, director of pain management at Scripps Center for Integrative Medication in San Diego, California, goes over tested alternative pain management techniques for pain conditions including the lower back, migraines, and osteoarthritis. The practice of integrative pain management is designed to boost current treatment designs by integrating a variety of nonpharmacological techniques, from acupuncture and massage to mindfulness and yoga, into the routine care of discomfort clients with the objective of decreasing discomfort and enhancing function and lifestyle.
What integrative practices for pain offer the best efficacy in evidence-based studies? Research study on integrative pain care has developed at a rapid pace over the past five to ten years. We have actually seen a number of influential research studies published on yoga, acupuncture, and mindfulness-based stress decrease (MBSR) that have added to our knowledge of effective nonpharmacologic treatments for discomfort, including massage and Tai-chi.
1 For neuropathic discomfort, the research on acupuncture, particularly electroacupuncture, has actually been outstanding, showing improvement in nerve conduction in numerous research studies. 2-4 Research study likewise is emerging on the function of cannabinoids in reducing neuropathic discomfort. 5,6 For postsurgical pain, a current meta-analysis of randomized clinical trials (RCTs) presented moderate-certainty proof that acupuncture and electrical stimulation substantially decreased and delayed opioid intake after overall knee arthroplasty.
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8 Findings from the 18-month Intensive Diet and Workout for Arthritis (IDEA) trial that showed a monitored diet plan and exercise program had a considerably greater effect on enhancing pain and function in knee arthritis than exercise alone. 9 It is clear that for osteoarthritis, the function of diet plan and workout is essential.
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001) in a prospective RCT of 604 clients with symptomatic knee osteoarthritis. 10 Turmeric: A meta-analysis of RCTs supported the effectiveness of turmeric extract (roughly 1,000 mg/day of curcumin) in the treatment of arthritis. Trials with turmeric/curcumin showed a substantial reduction in discomfort visual analogue score (PVAS) in three research studies (mean difference vs placebo: -2.
009), and no substantial mean distinction in PVAS in between turmeric/curcumin and pain medication in five research studies. 11 One of the most underutilizedevidence-based tools for management of migraine disorders, including chronic day-to-day headache, and fibromyalgia is biofeedback.
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12-14 In addition, a variety of nutrientsbased on correcting a shortage, offering mitochondrial assistance, or decreasing oxidative stressappear to enhance headache and fibromyalgia discomfort: Acetyl L-carnitine: This nutrient assists with the conversion of fatty acids into energy. In a RCT comparison of acetyl L-carnitine (1,500 mg/day) to duloxetine (60 mg/day), the nutrient showed positive (nonsignificant) effects on fibromyalgia pain and a substantial enhancement in anxiety (P < 0.
001). 15 Coenzyme Q10 (Co, Q10): Patients with fibromyalgia generally have substantially depressed Co, Q10 levels, which is involved in energy production, compared to controls. 16 Co, Q10 supplements at 300 mg/day has been shown to bring back biochemical criteria and significantly lower fibromyalgia effect based upon the Fibromyalgia Impact Survey, discomfort level, and associated headache (P < 0.
16 Melatonin: People who took 3 mg of melatonin at bedtime considerably minimized headache frequency compared with placebo (P = 0. Responder rates (> 50% reduction in headache frequency) were substantially higher among those taking melatonin than amitriptyline (54.