Pain Medicine 2016; 17: 1181–1182 doi: 10.1093/pm/pnw102
INTEGRATVIVE MEDICINE SECTION Introductory Editorial
Integrative Medicine as Standard Care for Pain Management: The Need for Rigorous Research Funding source: Dr. Mao is supported in part by the National Institutes of Health / National Cancer Institute Cancer Center Support Grant P30 CA008748. According to a recent study using data from the 2012 National Health Interview Survey, chronic or severe pain affects roughly 30% of U.S. adults and is one of the most common reasons for seeking medical care [1,2]. Considering health care expenses and lost productivity, chronic pain is estimated to cost the U.S. $100 billion annually [3]. While medications and surgical techniques are important tools in the management of pain, many individuals may not have adequate pain relief from these approaches alone. In recent years, the epidemic of opioid abuse and overuse has made management of pain particularly challenging for clinicians and patients [4]. Thus, many individuals with pain seek complementary and alternative medicine [1,5,6]. The field of complementary and alternative medicine, originally defined as therapies and practices not taught in U.S. medical schools or available to U.S. hospitals, is evolving into the field of integrative medicine [7] or complementary and integrative health. With increased research funding from both private sectors and the National Center for Complementary and Integrative Health, a center within the National Institutes of Health, increasing evidence demonstrates that integrative therapies such as acupuncture [8], massage [9], yoga [10], and mindfulness-based stress reduction [11] can decrease pain intensity, improve function, and promote better coping with chronic pain. Over 60 academic health centers, including Harvard University, Duke University, the University of California at San Francisco, and the Memorial Sloan Kettering Cancer Center, have joined the Consortium of Academic Health Centers for Integrative Medicine [12,13] to promote rigorous research, medical and interprofessional education, and the evidence-based integration of complementary therapies into conventional care. We are excited to announce a new section on Integrative Medicine in the Pain Medicine journal. This section is particularly timely, as the U.S. is experiencing an epidemic of chronic pain and opioid overuse and abuse. Clinicians and patients need safe and effective treatments to manage pain so that fewer individuals
presenting with acute pain transition into managing chronic pain. The American public also requires evidence of the effectiveness of nonpharmacological interventions to augment the existing medical treatments for pain and to improve pain management, quality of life, and functional wellbeing. To accelerate the rapid development of evidence-based integrative pain management, with the creation of this section, we hope to connect researchers with clinicians and to bring research findings to the bedside, outpatient clinics, and community. We seek manuscripts that are relevant to integrative pain management. For example, those studies that employ qualitative and mixed-methods research techniques can offer important insight into patients’ and clinicians’ attitudes and beliefs about, and experiences of, utilizing integrative therapies for pain management. In this issue, Dresner et al. elicited participant experiences after attending integrative medicine group visits in an urban and underserved setting [14]. Participants reported improved self-monitoring, self-regulation, and increased mindfulness, in addition to experiencing social support and learning about health knowledge and coping strategies. These novel findings can not only help clinicians further refine a clinical program for the management of chronic pain and other health issues in an underresourced setting for minority patients, but also set the stage for larger prospective studies to definitively evaluate the impact of such a program for patient experiences and outcomes. Another manuscript, by Sahebkar et al., utilizing systematic review and meta-analyses, found that curcuminoids, a popular natural product, may be safe and effective in reducing pain. The review also highlighted important methodological limitations and provided an estimated effect size as a basis for conducting future rigorous clinical trials [15]. To provide patient-centered and evidence-based integrative medicine for pain management, we would like to attract manuscripts using diverse but rigorous methodologies that answer important clinical questions. For example, we are interested in health service research using quantitative, qualitative, and mixed methods approaches that evaluate practice patterns, understand health beliefs and attitudes, and evaluate access
C 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected] V
1181
Mao and Dusek barriers to integrative health therapies in diverse populations and settings. We welcome submissions of clinical trials to evaluate the safety and efficacy of specific interventions or comprehensive integrative intervention packages for pain management for specific (e.g., cancer, veterans) or general populations. We are interested in translational research to uncover the potential biological and behavioral mechanisms of interventions for pain management, including correlative studies in the setting of clinical trials. Finally, we would appreciate submission of systematic reviews and meta-analyses of interventions that are of interest to practicing pain clinicians. It is our hope that with rigorous research, patients will have more evidence-based therapeutic options to manage acute and chronic pain safely and effectively. Ultimately, with increased insurance coverage and changes in societal and cultural norms, integrative medicine will become the standard for pain management across the United States. JUN J. MAO, MD, MSCE* and JEFFERY A. DUSEK, PHD† *The Bendheim Center for Integrative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA † Penny George Institute for Health and Healing Allina Health, Minneapolis, Minnesota, USA
References 1 Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain 2015;16(8): 769–80. 2 Johannes CB, Le TK, Zhou X, et al. The prevalence of chronic pain in United States adults: Results of an Internet-based survey. J Pain 2010;11(11):1230–9. 3 Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Collection: Reports funded by National Institutes of Health; 2011. 4 Clarke JL, Skoufalos A, Scranton R. The American opioid epidemic: Population health implications and potential solutions. Report from the National Stakeholder Panel. Popul Health Manag 2016;19(suppl 1):S1–10.
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5 Ho TF, Rowland-Seymour A, Frankel ES, et al. Generational differences in complementary and alternative medicine (CAM) use in the context of chronic diseases and pain: Baby boomers versus the silent generation. J Am Board Fam Med 2014;27(4): 465–73. 6 Goldstein JN, Ibrahim SA, Frankel ES, Mao JJ. Race, pain, and beliefs associated with interest in complementary and alternative medicine among inner city veterans. Pain Med 2015;16(8):1467–74. 7 Boon H, Verhoef M, O’Hara D, et al. Integrative healthcare: Arriving at a working definition. Altern Ther Health Med 2004;10(5):48–56. 8 Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA 2014;311(9):955–6. 9 Perlman AI, Sabina A, Williams A, et al. Massage therapy for osteoarthritis of the knee: A randomized controlled trial. Arch Intern Med 2006;166(22):2533–8. 10 Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med 2011;171(22):2019–26. 11 Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA 2016;315(12):1240–9. 12 Kligler B, Chesney M. Academic health centers and the growth of integrative medicine. J Natl Cancer Inst Monogr 2015 2014;(50):292–3. 13 Mao JJ, Saper RB, Chesney MA. The role of academic health centres to inform evidence-based integrative oncology practice. Nat Rev Cancer 2015; 15(4):247. 14 Dresner D, Barnett KG, Resnick K, et al. Listening to their words: A qualitative analysis of integrative medicine group visits in an urban underserved medical setting. Pain Med 2016;17(6):1183–91. 15 Sahebkar A, Henrotin Y. Analgesic efficacy and safety of curcuminoids in clinical practice: A systematic review and meta-analysis of randomized controlled trials. Pain Med 2016;17(6):1192–202.
INTEGRATVIVE MEDICINE SECTION Introductory Editorial
Integrative Medicine as Standard Care for Pain Management: The Need for Rigorous Research Funding source: Dr. Mao is supported in part by the National Institutes of Health / National Cancer Institute Cancer Center Support Grant P30 CA008748. According to a recent study using data from the 2012 National Health Interview Survey, chronic or severe pain affects roughly 30% of U.S. adults and is one of the most common reasons for seeking medical care [1,2]. Considering health care expenses and lost productivity, chronic pain is estimated to cost the U.S. $100 billion annually [3]. While medications and surgical techniques are important tools in the management of pain, many individuals may not have adequate pain relief from these approaches alone. In recent years, the epidemic of opioid abuse and overuse has made management of pain particularly challenging for clinicians and patients [4]. Thus, many individuals with pain seek complementary and alternative medicine [1,5,6]. The field of complementary and alternative medicine, originally defined as therapies and practices not taught in U.S. medical schools or available to U.S. hospitals, is evolving into the field of integrative medicine [7] or complementary and integrative health. With increased research funding from both private sectors and the National Center for Complementary and Integrative Health, a center within the National Institutes of Health, increasing evidence demonstrates that integrative therapies such as acupuncture [8], massage [9], yoga [10], and mindfulness-based stress reduction [11] can decrease pain intensity, improve function, and promote better coping with chronic pain. Over 60 academic health centers, including Harvard University, Duke University, the University of California at San Francisco, and the Memorial Sloan Kettering Cancer Center, have joined the Consortium of Academic Health Centers for Integrative Medicine [12,13] to promote rigorous research, medical and interprofessional education, and the evidence-based integration of complementary therapies into conventional care. We are excited to announce a new section on Integrative Medicine in the Pain Medicine journal. This section is particularly timely, as the U.S. is experiencing an epidemic of chronic pain and opioid overuse and abuse. Clinicians and patients need safe and effective treatments to manage pain so that fewer individuals
presenting with acute pain transition into managing chronic pain. The American public also requires evidence of the effectiveness of nonpharmacological interventions to augment the existing medical treatments for pain and to improve pain management, quality of life, and functional wellbeing. To accelerate the rapid development of evidence-based integrative pain management, with the creation of this section, we hope to connect researchers with clinicians and to bring research findings to the bedside, outpatient clinics, and community. We seek manuscripts that are relevant to integrative pain management. For example, those studies that employ qualitative and mixed-methods research techniques can offer important insight into patients’ and clinicians’ attitudes and beliefs about, and experiences of, utilizing integrative therapies for pain management. In this issue, Dresner et al. elicited participant experiences after attending integrative medicine group visits in an urban and underserved setting [14]. Participants reported improved self-monitoring, self-regulation, and increased mindfulness, in addition to experiencing social support and learning about health knowledge and coping strategies. These novel findings can not only help clinicians further refine a clinical program for the management of chronic pain and other health issues in an underresourced setting for minority patients, but also set the stage for larger prospective studies to definitively evaluate the impact of such a program for patient experiences and outcomes. Another manuscript, by Sahebkar et al., utilizing systematic review and meta-analyses, found that curcuminoids, a popular natural product, may be safe and effective in reducing pain. The review also highlighted important methodological limitations and provided an estimated effect size as a basis for conducting future rigorous clinical trials [15]. To provide patient-centered and evidence-based integrative medicine for pain management, we would like to attract manuscripts using diverse but rigorous methodologies that answer important clinical questions. For example, we are interested in health service research using quantitative, qualitative, and mixed methods approaches that evaluate practice patterns, understand health beliefs and attitudes, and evaluate access
C 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected] V
1181
Mao and Dusek barriers to integrative health therapies in diverse populations and settings. We welcome submissions of clinical trials to evaluate the safety and efficacy of specific interventions or comprehensive integrative intervention packages for pain management for specific (e.g., cancer, veterans) or general populations. We are interested in translational research to uncover the potential biological and behavioral mechanisms of interventions for pain management, including correlative studies in the setting of clinical trials. Finally, we would appreciate submission of systematic reviews and meta-analyses of interventions that are of interest to practicing pain clinicians. It is our hope that with rigorous research, patients will have more evidence-based therapeutic options to manage acute and chronic pain safely and effectively. Ultimately, with increased insurance coverage and changes in societal and cultural norms, integrative medicine will become the standard for pain management across the United States. JUN J. MAO, MD, MSCE* and JEFFERY A. DUSEK, PHD† *The Bendheim Center for Integrative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA † Penny George Institute for Health and Healing Allina Health, Minneapolis, Minnesota, USA
References 1 Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain 2015;16(8): 769–80. 2 Johannes CB, Le TK, Zhou X, et al. The prevalence of chronic pain in United States adults: Results of an Internet-based survey. J Pain 2010;11(11):1230–9. 3 Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Collection: Reports funded by National Institutes of Health; 2011. 4 Clarke JL, Skoufalos A, Scranton R. The American opioid epidemic: Population health implications and potential solutions. Report from the National Stakeholder Panel. Popul Health Manag 2016;19(suppl 1):S1–10.
1182
5 Ho TF, Rowland-Seymour A, Frankel ES, et al. Generational differences in complementary and alternative medicine (CAM) use in the context of chronic diseases and pain: Baby boomers versus the silent generation. J Am Board Fam Med 2014;27(4): 465–73. 6 Goldstein JN, Ibrahim SA, Frankel ES, Mao JJ. Race, pain, and beliefs associated with interest in complementary and alternative medicine among inner city veterans. Pain Med 2015;16(8):1467–74. 7 Boon H, Verhoef M, O’Hara D, et al. Integrative healthcare: Arriving at a working definition. Altern Ther Health Med 2004;10(5):48–56. 8 Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA 2014;311(9):955–6. 9 Perlman AI, Sabina A, Williams A, et al. Massage therapy for osteoarthritis of the knee: A randomized controlled trial. Arch Intern Med 2006;166(22):2533–8. 10 Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med 2011;171(22):2019–26. 11 Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA 2016;315(12):1240–9. 12 Kligler B, Chesney M. Academic health centers and the growth of integrative medicine. J Natl Cancer Inst Monogr 2015 2014;(50):292–3. 13 Mao JJ, Saper RB, Chesney MA. The role of academic health centres to inform evidence-based integrative oncology practice. Nat Rev Cancer 2015; 15(4):247. 14 Dresner D, Barnett KG, Resnick K, et al. Listening to their words: A qualitative analysis of integrative medicine group visits in an urban underserved medical setting. Pain Med 2016;17(6):1183–91. 15 Sahebkar A, Henrotin Y. Analgesic efficacy and safety of curcuminoids in clinical practice: A systematic review and meta-analysis of randomized controlled trials. Pain Med 2016;17(6):1192–202.
