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  • Aldrin V. Gomes

Alternative and Complementary Medicine in Reducing Musculoskeletal pain

Updated: Oct 21, 2022




Musculoskeletal pain, that is pain 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 can 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. When a non-mainstream practice is used in combination with conventional medicine, it is considered “complementary.” When non-mainstream medicine is used in place of conventional medicine, it is called “alternative medicine.” Integrative medicine is health care that applies to all appropriate conventional and non-mainstream therapeutic approaches within a framework focused on health, therapeutic relationships and the whole person. 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 acupuncture, homeopathy, cupping and oriental remedies (3). These remedies have been practiced around the world for centuries.

  • Body Practices: Touch have been used in medicine since the dawn of medicine. 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 other parts to optimal health, allowing the body to focus entirely on healing the injured or diseased area. These include; Chiropractic, massage, hypnotherapy, Tai chi, and yoga (4-8).

Let’s take a closer look at complementary and alternative medicine that is used to treat musculoskeletal pain.


Acupuncture

Acupuncture is a Chinese medical technique, which originated in the Taoist tradition around 8000 years ago. It involves the insertion of metal 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


Homeopathy is a medical system based on the belief that the body can cure itself. It was developed in the late 1700s in Germany. It`s common in many European countries. It is defined as using tiny amounts of natural substances, like plants and minerals to stimulate the healing process.A basic belief behind homeopathy is “like cures like.” In other words, something that brings on symptoms in a healthy person can (in a very small dose) treat an illness with similar symptoms. This is meant to trigger the body`s natural defenses. It is used to treat Arthritis, allergies, asthma, depression. A systematic review by Qutubuddin M et al. 2019 suggested that homeopathy reduced pain when compared to placebo (10).


Cupping

Cupping is an alternative 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 overall blood flow, and promotes cell repair. Cupping has two types. Dry cupping is a suction-only method, and wet cupping can include both suction and controlled medical bleeding. It is used to relieve muscle soreness by improving blood flow and promoting cell repair. 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).


Massage


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 Swedish, Thai, Deep Tissue and Sport. It relaxes tissues, reduces pressure on nerves, improves circulation, helps reduce stress, relieves pain and muscle tension, and improves immune function. 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).


Chiropractic


Most people looking for alternative ways to relieve back pain choose chiropractic care. This includes manual manipulation of the spine. The theory is that proper 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, bones, and connective tissues, or in combination with conventional medicine. 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).


Hypnotherapy (Hypnosis)


Using induced relaxation, concentration, and concentration to enter a heightened state of consciousness is sometimes referred to as a trance. Hypnosis is generally viewed as an adjunct to psychotherapy. Hypnosis can be used in two ways:

  1. Suggestion Therapy: Being in a state of hypnosis makes you more responsive to suggestions. Therefore, hypnotherapy may help change certain behaviors, such as quitting smoking or biting nails. It also helps alter perceptions and sensations, especially in treating pain.

  2. Analysis: This approach uses the relaxed state to explore potential psychological 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.


Conclusion


Complementary and alternative medicines have been used for a very long time and have 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 medications, have bleeding disorders, who are pregnant, or breast feeding. A patient should always inform the healthcare practitioner if he/she is using any of complementary and alternative medicine treatments. Patients should always consult their physician before using any complementary and alternative medicine treatment.


Written by Hamzah Magableh, a fourth-year medical student and edited by Aldrin V. Gomes, PhD

References

1. WHO https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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).

3. https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine/

4. NHS https://www.nhs.uk/conditions/complementary-and-alternative-medicine/

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.

7. WebMD https://www.webmd.com/balance/guide/what-is-alternative-medicine/

8. WebMD https://www.webmd.com/mental-health/mental-health-hypnotherapy

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.

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