Common use of a variety of health practices that reside outside of mainstream Western medicine, collectively termed complementary and alternative medicine (CAM), has existed for centuries. Complementary approaches are used in addition to conventional medicine, whereas alternative approaches are used in place of conventional medical treatment. An integrative approach combines conventional and CAM treatments that have be found to be safe and effective through rigorous scientific methods (). A large variety of CAM therapies have been identified: mind-body therapies (e.g., yoga and biofeedback), biologically based practices (e.g., vitamins and supplements), manipulative and body-based approaches (e.g., massage and reflexology), energy healing (e.g., reiki and therapeutic touch), and healing systems (e.g., Ayurvedic medicine) (). Today, CAM continues to be increasingly popular in many countries, especially for pain management as individuals try to grapple with ongoing symptoms that are not fully reduced by conventional treatment. Findings from the 2017 National Health Interview Survey conducted by the Centers for Disease Control and Prevention show that the use of CAM modalities, such as yoga, meditation, and seeing a chiropractor, has increased during the past decade with up to 14.3% adult and 8.4% child users (Black et al., 2018Black L.I. Barnes P.M. Clarke T.C. Stussman B.J. Nahin R.L. Use of yoga, meditation, and chiropractors among U.S. children aged 4-19 years.; Clarke et al., 2018Clarke T.C. Barnes P.M. Black L.I. Stussman B.J. Nahin R.L. Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and over.). Pain is the most frequent reason Americans use CAM therapies ().Considering the large number of CAM therapies available and the demographic and clinical complexities of populations experiencing pain, determining the state of the science in a specific area of CAM for pain management can be daunting. Some CAM therapies have been studied and found to be effective or comparable to conventional treatment (Hajihasani et al., 2019Hajihasani A. Rouhani M. Salavati M. Hedayati R. Kahlaee A.H. The influence of cognitive behavioral therapy on pain, quality of life, and depression in patients receiving physical therapy for chronic low back pain: A systematic review.), while others lack efficacy or demonstrate inconsistent findings (Hu et al., 2016Hu C. Zhang H. Wu W. Yu W. Li Y. Bai J. Luo B. Li S Acupuncture for pain management in cancer: A systematic review and meta-analysis.; Jacobson et al., 2016Jacobson A.F. Umberger A.W. Palmieri P.A. Alexander T.S. Myerscough R.P. Draucker C.B. Steudte-Schmiedgen S. Kirschbaum C. Guided imagery for total knee replacement: A randomized, placebo-controlled pilot study.). Other CAM approaches have not been tested in randomized clinical trials, which are still considered the gold standard for establishing the best evidence in both conventional medicine and CAM. Each year, thousands of manuscripts are published in a vast number of health science journals (). With more and more published systematic reviews and meta-analyses of CAM on adult and pediatric acute, chronic, and cancer pain, it is imperative to use rigorous methods to summarize available evidence in these reviews, evaluate the quality of the evidence, and design research that moves knowledge forward. Two tools that can be used to evaluate the quality of evidence in systematic reviews are AMSTAR (A Measuring Tool to Assess Systematic Reviews) (Shea et al., 2017Shea B.J. Reeves B.C. Wells G. Tuku M. Hamel C. Moran J. Moher D. Tugwell P. Welch V Kristjansson E. Henry D.A. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomized or non-randomised studies of healthcare interventions, or both.) and ROBIS (Risk of Bias in Systematic Reviews) (Whiting et al., 2016Whiting P. Savovic J. Higgins J.P.T. Caldwell D.M. Reeves B.C. Shea B. Davies P. Kleijnen J. Churchill R. ROBIS Group
ROBIS: A new tool to assess risk of bias in systematic reviews was developed.). It is crucial that findings be synthesized in a way that gives a clear understanding of the state of the science in your area of scholarship, which is foundational as you think about and plan your research trajectory.The Office of Alternative Medicine in the National Institutes of Health (NIH) was formed in 1992; its primary aim was to study the efficacy and safety of alternative therapies. In 1998, this office evolved into the National Center for Complementary and Alternative Medicine, and in 2015, it became the National Center for Complementary and Integrative Health (NCCIH). Today pain management is a key component of NICCIH's strategic Plan (). Other NIH offices, such as the National Cancer Institute (NCI) and National Institute of Nursing Research (NINR), also fund some CAM research. If you are thinking about embarking on or re-establishing a program of research related to CAM for pain, it is well worth your time to examine these funding bodies to discern priority research areas that can help you plan and design research in your specific area of scholarship. One priority area identified by both NCCIH and NCI is identifying the mechanisms (i.e., biological targets and pathways) by which CAM modalities reduce pain and suffering, especially with persons experiencing chronic pain conditions (; ). An example is the Jacobson et al., 2016Jacobson A.F. Umberger A.W. Palmieri P.A. Alexander T.S. Myerscough R.P. Draucker C.B. Steudte-Schmiedgen S. Kirschbaum C. Guided imagery for total knee replacement: A randomized, placebo-controlled pilot study. study that tested whether biological (i.e., cytokine and cortisol) and psychological (i.e., pain catastrophizing, kinesiophobia, outcome expectancy, and self-efficacy) variables mediated the effect of guided imagery on pain and function in persons undergoing total knee replacement. Embedding evidence-based mediating or moderating biological, cognitive-behavioral, demographic, and clinical variables into research models not only advances knowledge by discovering whether a CAM modality is efficacious, but also how it produces its effect. Adopting longitudinal designs when studying effects of CAM approaches with persons experiencing pain is needed with attention to a range of outcomes meaningful to improved health, such as well-being and quality of life (). Well-designed longitudinal studies on CAM for certain acute pain conditions can further provide insight into progression of acute to chronic pain and whether treatment choices play a role in this process.The Helping to End Addiction Long-term Initiative (HEAL Initiative) was launched in 2018 and is comprised of multiple agencies across NIH and community partnerships. , Shea et al., 2017Shea B.J. Reeves B.C. Wells G. Tuku M. Hamel C. Moran J. Moher D. Tugwell P. Welch V Kristjansson E. Henry D.A. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomized or non-randomised studies of healthcare interventions, or both. it is committed to “speed scientific solutions to stem the national opioid public health crisis” (, para. 1). Understanding the biopsychosocial underpinnings of chronic pain and testing alternatives to opioids for the management of acute and chronic pain are core components of the HEAL Initiative's mission (). This initiative provides rich opportunities for nurses to learn more about pain and addiction and for funding to study the efficacy of CAM treatments in pain management and opioid use. There is also emphasis on designing translational studies and clinical trials to examine interactions between CAM and pharmacologic treatment for possible additive effects or synergy, and potential safe reduction of opioids or other analgesics in persons experiencing pain (NCCIH, 2002). For instance, an interprofessional team recently funded study by the HEAL Initiative is currently evaluating the long-term benefits of a combination of complementary treatments for patients with chronic musculoskeletal pain in a 24-week clinical trial (). Subjects in two arms of the study are receiving web-based cognitive behavioral therapy (i.e., relaxation, guided imagery, stress management techniques, and lifestyle changes) and the antidepressant, duloxetine; subjects in one of these two arms are receiving phone-based motivational interviewing by a registered nurse. The third arm is receiving only the antidepressant, duloxetine. The study is designed to advance the state of the science by teasing out the additive and synergistic effects of CAM, motivational interviewing, and medication, and determining long-term outcomes. It is anticipated that findings from this study will improve treatment outcomes in primary care settings where many pain patients are treated.On World Health Day 2021, the World Health Organization initiated a campaign to advocate for health equity throughout the world by studying root causes and implementing solutions (). Advancing health equity in relation to knowledge of and access to CAM modalities is a high research priority for both the and . NINR provides five “research lenses” that guide scholarship related to investigation of health-related questions and translation of evidence into practice. Health equity is one lens; it states that nursing research “is ideally positioned to produce evidence needed to reduce and ultimately eliminate the systemic and structural inequities that place some population groups at a disadvantage in attaining their full health potential” (, para. 3). According to Ludwick et al., 2020Ludwick A. Corey K. Meghani S. Racial and socioeconomic factors associated with the use of complementary and alternative modalities in cancer outpatients: An integrative review., who conducted an excellent integrative review of the literature exploring the prevalence of CAM use for cancer-related pain among minorities, acknowledgment of the dearth of CAM research that addresses racial and ethnic differences in CAM use was discussed in detail. By using interprofessional teams with research and clinical experts in CAM, pain, and health equity, the state of the science can move forward to increase our understanding of these interrelated constructs with the goal of improving outcomes for all persons experiencing pain. Now is the time for nursing to take the lead in contributing to scholarship that addresses health equity issues, especially in areas related to the use of CAM for pain management.

In this issue of Pain Management Nursing, nursing scholarship related to the use of CAM, such as acupressure, hypnosis, meditation, and music, with persons experiencing a wide variety of pain conditions is showcased, along with other pertinent scholarship, including a position statement related to acute perioperative pain management among patients undergoing orthopedic surgery and clinical practice recommendations for procedural pain management from the American Society of Pain Management Nursing. We are committed to share scholarship that stimulates further research questions and ideas that will advance the state of the science in all areas related to nurses’ management of pain, enhance clinical practice, and improve pain, function, and quality of life for all persons experiencing pain.

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Article InfoPublication History

Published online: April 30, 2022

Identification

DOI: https://doi.org/10.1016/j.pmn.2022.04.001

Copyright

© 2022 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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