Alternative and Complementary Medicine in Reducing Musculoskeletal pain
Updated: Apr 12
Musculoskeletal pain, that is pain that originates in bones, cartilage, ligaments, muscles and tendons, is one of the most common pains that occurs when we get older. Acute or chronic musculoskeletal pain are often disabling and may prevent individuals from doing routine day to day activities, resulting in economic and family burdens. Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability in 160 countries. Approximately 1.7 billion people have musculoskeletal problems worldwide (1).
A lot of mainstream treatments are used to reduce acute or chronic musculoskeletal conditions. Depending on the degree of pain the treatment could involve drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) or steroids that could be introduced orally or via injection into the area of inflammation (2). Surgical treatment is considered in chronic cases, especially in patients who cannot take drugs due to other medical conditions or for patients who continue to have pain after all noninvasive treatments. Some mainstream treatments have failed to offer long-term relief; new studies have shown that ibuprofen when used to treat chronic back pain increased the magnitude of pain a few years later.
Complementary and alternative medicine is a treatment outside the scope of general health care. Complementary medicine When a non-mainstream practice is used in combination with conventional medicine.Alternative medicine it is considered when non-mainstream medicine is used in place of conventional medicine. Integrative medicine is health care that applies to all appropriate conventional and non-mainstream therapeutic approaches. Integrative medicine is a holistic approach that emphasizes preventative measures and a healthy lifestyle. It stimulates the body's natural healing powers and rationally combines the right treatments to find the best options.
Traditional and Alternative Medicine: This field includes more popular and recognized treatments such as cupping, homeopathy, acupuncture and oriental remedies (3). These remedies have been practiced around the world for centuries.
Body Practices: Healing by touch is based on the idea that illness or injury in one part of the body can affect any part of the body. Manual manipulation restores optimal health to some body parts, allowing the body to focus entirely on healing the injured area. These include; massage, chiropractic hypnotherapy, and yoga (4-8).
Let’s take a closer look at complementary and alternative medicine that is used to treat musculoskeletal pain.
Acupuncture is a Chinese medical tradition which started around 8000 years ago. It involves the insertion of needles through the skin to the underlying tissues on specific points of the body over 12 basic meridians each associated with a major visceral organ and functional body system. A 2020 meta-analysis (analysis of many previous studies combined) found that acupuncture reduces pain up to 3 months for several musculoskeletal pains, and up to 6 months for pains in the cervical and lumbar spine (9). One theory about how it works is that these needles help release endorphin causing pain relief. Stress relief, Smoking cessation, chronic pain such as back pain, sciatica and migraines.
Homeopathy is a medical system developed in the late 1700s in Germany. It is defined as using natural substances, like plants and minerals to stimulate the healing process.A basic belief behind homeopathy is “like cures like.” In other words, a small dose of a remedy that can cause symptoms in a healthy population can be utilized as a treatment in others. This is meant to activate the body`s natural defenses. It is used to treat allergies, asthma, andarthritis. A systematic review by Qutubuddin M et al. 2019 suggested that homeopathy reduced pain when compared to placebo (10).
Cupping is another therapy that originated in China. Place the cup on the skin and apply suction to increase blood flow to the area where the cup is placed. This reduces muscle tension, improves blood circulation, and promotes the repair of damaged cells. Cupping has two types. Dry cupping is a suction-only method, and wet cupping can include both suction and controlled bleeding. It is used to relieve muscle soreness by improving blood flow which promotes healing. A clinical study showed that cupping therapy (alone or combined with other interventions) was better than medications (or other interventions alone) for pain associated with some diseases, one of which is low back pain (11).
According to the American Massage Therapy Association, about 19% of Americans had a massage of some kind in 2018. There are a variety of massage styles including Thai, Swedish, Deep Tissue and Sport. It relaxes tissues which reduces pressure on nerves, improves circulation, helps reduce stress, relieves pain and muscle tension, and improves immune system defences. A 2013 review of 12 studies of massage for neck pain (757 total participants) found that massage therapy was more effective for both neck and shoulder pain when compared to inactive therapies but was not more effective than other active therapies (12).
A lot of people looking for alternative ways to relieve back pain choose chiropractic care due to its simple approach. This includes manual manipulation of the spine. The theory behind chiropractic is that alignment of the body's musculoskeletal system, especially the spine, allows the body to heal naturally without surgery or medication. Chiropractic treatment is used primarily as an alternative therapy to relieve pain in muscles, joints, and bones. A study that reviewed the literature on the effectiveness of different manual therapies for relieving pain found that spinal manipulation was effective for neck pain (13). Effectiveness was also found for acute whiplash injuries especially when combined with exercise (13).
Using induced relaxation, and concentration to enter a state of trance which is a heightened state of consciousness. Hypnosis is generally used in combination with psychotherapy. Hypnosis can be used in two ways:
Suggestion Therapy: Being in a state of hypnosis makes you more responsive to suggestions, which changes certain behaviors, such as quitting smoking. It also helps alter sensations, such as in treating neuropathic pain.
Analysis: This approach uses the relaxed state to explore the patients root causes of disorders or symptoms such as Post-traumatic anxiety and grief.
Hypnotherapy proved to be effective in reducing pain associated with medical interventions and was also effective in the treatment of Irritable bowel syndrome (14). Hypnosis is not suitable for people with psychotic symptoms such as hallucinations or delusions, or for people using drugs or alcohol.
improved the lives of many by reducing their pain. Nevertheless, more research is needed more complementary and alternative medicine to be evidence based and to provide more information about its mechanism of actions, uses and side effects. Complementary and alternative medicine should be used with caution in people who are taking anticoagulants such as warfarin or patients whosuffer from bleeding disorders, and in pregnancy or during breastfeeding. A patient should always inform the healthcare practitioner if they are using any of complementary and alternative medicine treatments. And it is the physician’s responsibility to study these treatments and give guidance to their patients on proper and safe suage of these treatments.
Written by Hamzah Magableh, a fourth-year medical student and edited by Aldrin V. Gomes, PhD
2. Parisien, M. et al. (2022) Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med 11;14 (644).
5. MSD manual professional version: https://www.msdmanuals.com/professional/special-subjects/integrative-complementary-and-alternative-medicine/
6. Alrowais, NA, Alyousefi, NA. The prevalence extent of Complementary and Alternative Medicine (CAM) use among Saudis. Saudi Pharm J. 2017, 25(3):306-318.
9. Lenoir, D., De Pauw, R., Van Oosterwijck, S., Cagnie, B., and Meeus, M. Acupuncture versus sham acupuncture: a meta-analysis on evidence for longer-term effects of acupuncture in musculoskeletal disorders. Clin. J. Pain, 2020, 36, 533–549.
10. Qutubuddin M, Singh S, M, Nayak C, Koley M, Saha S: A Systematic Review of Controlled Trials of Homeopathy in Bronchial Asthma. Complement Med Res 2019;26:111-117.
11. Cao, H, Han, M, Zhu, X, Liu, J. An overview of systematic reviews of clinical evidence for cupping therapy. Journal of Traditional Chinese Medical Sciences, 2015, 2 (1), 3-10.
12. Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M. Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013;2013:613279.
13. Bronfort G, Haas M, Evans R, Leiniger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.
14. Häuser W, Hagl M, Schmierer A, Hansen E. The Efficacy, Safety and Applications of Medical Hypnosis. Dtsch Arztebl Int. 2016, 113(17):289-96.