Complementary Therapies for Arthritis Pain

In the last five years, awareness and use of complementary and alternative therapies has skyrocketed among both patients and practitioners. This study evaluated the use of such therapies in a sample of rheumatological conditions. The conditions included were osteoarthrits, rheumatoid arthritis, and fibromyalgia. The authors state that these conditions are ideal for evaluating complementary and alternative medicine (CAM) since they are, "prevalent, have no known cause or cure, are characterized by chronic pain and a variable disease course, and often adversely affect functional status."

The study consisted a survey that asked 232 patients (who were receiving medical care) about the prevalence and types of CAM use, their motivations for use, its overall effectiveness, and the level of communication about this use with their physician. Keep in mind that the authors define CAM as, "Any intervention not usually prescribed by physicians (for example, herbal remedies, chiropractic manipulations, high-dose vitamins, and elimination diets)." Exercise programs or relaxation techniques were not included in this definition, since they are often prescribed for pain management.

63% of patients had or currently used CAM. 82 currently used them, and 64 had in the past. The table below delineates the number of patients who used a specific therapy, and their perceived level of effectiveness.

Reasons given for using CAM were to help their condition, and get control of the pain. Interestingly, patients in the sample frequently reported that the use of CAM was for, "symptom relief rather than as a cure for their condition." So it is not surprising that patients who had severe pain, had a longer disease duration, and a diagnosis of osteoarthritis were most likely and frequent users of CAM.

Nearly half (45%) of the patients discussed their CAM use with physicians. 92% thought their doctors should know everything about their treatment, and 67% thought their doctors would provide information about potential interactions between the two types of treatment. 71% of the patients' doctors supported their use, and only 15% feared disapproval from the physician.
The authors suggest that future studies, using different samples, should investigate CAM use so medical providers could have a better idea of the patients' perspective. More importantly, the authors suggest that:

"Future studies should describe the natural history of CAM use and its effect on patient-centered outcomes, such as health status, satisfaction with care, and use of health care resources. Such investigations will complement rigorous efficacy trials of CAM and provide a complete picture to health care providers, policymakers, and patients."

Rao J, Mihaliak K, Kroenke K, et al. Use of complementary therapies for arthritis among patients for rheumatologist. Annals of Internal Medicine 1999;131:409-416.