By Janet Jay
Navigating the landscape of complementary or alternative therapies for chronic pain can be overwhelming.
Not all treatments are created equal in regard to safety, scientific basis, and the likelihood they will help with your individual issues. Add in cost and access, and it’s a lot to research.
Here’s the lowdown on the effectiveness, safety, and theory behind two of the most commonly used complementary treatments: massage and acupuncture.
Acupuncture is a complementary therapy that in recent years has seen greatly increased acceptance in Western medicine, though it has been a standby for centuries in other parts of the world.
Studies have shown acupuncture’s effectiveness for treating pain, reducing inflammation, and increasing the efficacy of other treatments while decreasing their side effects.
“It’s a good additional modality because it has effects on multiple different levels, meaning it can improve mood, reduce pain, and help with sleep and stress,” says Anjana Kundu, MD, anesthesiologist-in-chief at University of Rochester’s Golisano Children’s Hospital and a board-certified pediatric anesthesiologist, pediatric pain, and palliative care physician. She has additional training and board certification in acupuncture and integrative medicine.
Acupuncture is based on the concept of free or unobstructed flow of energy, which Chinese medicine calls qi (pronounced chi), through the body. “Much like we have blood circulation, qi flows through a network of channels in the body, called the meridians,” Kundu explains.
Acupuncture and similar therapies focus on stimulating points throughout the body to restore a normal flow of this energy. Traditional acupuncture involves stimulating these points by placing tiny needles, closer to the size of a hair than the needles used for vaccinations. Acupuncture and related treatment modalities like acupressure, cupping, electroacupuncture, and magnetic or laser treatments are just some of the options that manipulate these specific points with the aim of restoring balance and re-establishing the free flow of this energy.
As Kundu explains, acupuncture needles affect “not only just the acupressure points; they also affect the nerves that carry pain signals to the brain. This unlocks pain pathways by decreasing the intensity of pain, triggering internal healing and pain-fighting substances—our body’s natural opioids.” And while there’s still no way to see these points or this energy on a scan or test, the advent of functional magnetic resonance imaging (FMRI) scans has shown how specific areas of the brain react to the manipulation of these pressure points. The chemicals the brain releases in response can be measured as well.
One reason that acupuncture has seen increasing acceptance in Western medicine, explains Kundu, is “societal change at the individual level,” as patients learn about and want to try acupuncture and related therapies. Today, some insurance companies cover acupuncture, and American doctors are more likely now to suggest it as a possible adjunct treatment than ever before.
There is very little risk involved in acupuncture when the process is done correctly by a licensed professional and with sterile needles, Kundu says. The most likely downside is that it won’t help; but Kundu encourages patients, especially those living with chronic pain, to give it time: “Saying, ‘I tried acupuncture once or twice and it didn’t work,’ is not necessarily the appropriate way to use it.”
In fact, the nature of chronic pain means that acupuncture may take longer to help address the long-term effects on the body. When the method is used to treat acute pain, effects may be seen more quickly, Kundu explains.
Studies have repeatedly shown massage’s role as a safe, effective, non-invasive, non-opioid treatment for a variety of conditions and individuals—from preterm infants in the neonatal intensive care unit (NICU) to patients with incurable cancer in hospice.
The non-pharmaceutical, low-risk nature of massage is a major reason that there has been a sharp increase in recent years in the likelihood of a doctor recommending it as a therapy modality. From her location in West Virginia, massage therapist Angela Barker, LMT—owner of Premier Massage Plus, volunteer engagement committee chair for the American Massage Therapy Association (AMTA), and a past AMTA president—has seen firsthand a nationwide trend. Primary care physicians are increasingly reluctant to treat chronic pain, but referring these patients to the limited number of pain clinics has created months-long wait times and a backlog of patients who “are now asking—and demanding—that they have access to other therapies until they can get to the pain clinic,” Barker says.
She adds, “I find that doctors are now much more receptive, especially to non-opioid therapies like massage. They realize they have to do better.”
Overall, massage is extremely safe, but there are many different techniques. You want someone who can suggest the right strategy for your specific situation, avoiding techniques that may cause pain to flare. Individuals living with chronic pain will want to focus on massage therapists with a clinical background or those who have experience in health care settings with individuals living with chronic conditions or pain.
Researching a possible new treatment and finding the best practitioner for your needs
Some alternative or complementary treatments have more scientific backing than others, and safety, cost, and access are always real concerns. These factors make it vitally important to do your research on the therapy you’re choosing and the specific person you’re going to see. While education and licensing are important, that’s just the beginning: it’s a practitioner’s experience that will truly set them apart.
So how do you find the perfect massage therapist, acupuncturist, or practitioner of another type of alternative medicine?
—Ask a friend. Word of mouth is still one of the best ways to find someone. Even if you don’t know people socially with similar issues, your doctor, physical therapist, or other health care professional may be able to refer you to someone they have worked with before.
—Examine your insurance. If your insurance does cover the therapy—and today, many insurances cover at least in part therapies from acupuncturists, massage therapists, and chiropractors, just to name three—they may only cover certain types of the therapy, or only certain practitioners. Some insurance plans also only cover a certain amount of visits per year. The insurance company may have a list on its website of the practitioners in your area who are covered; otherwise, you may need to make some calls.
—Check their license. Research the minimum requirements to practice the therapy you’re looking into; most licensing groups will have a database you can search.
—Research other achievements. You want more than the bare minimum, though: see if there are any optional higher certifications, licensing, research, or continuing education the practitioner can choose to participate in. For instance, massage therapists who seek out the highest certification possible in their field, National Certification Board For Therapeutic Massage & Bodywork, have shown they have “at least a personal bar to hold themselves to a higher level of excellence and training,” explains Barker.
—See if you connect. If you can, try to schedule a call to talk with the practitioner before your first appointment. Not all practitioners are the right fit for every patient. If you don’t feel like you have found someone you connect with, you should keep looking.
—Trust your gut. “Always remember, you are the boss of that session,” Barker says. “You are the one who makes the decisions, the type of body of work that you want to receive.”
No matter the type of complementary medicine you seek out, you want a practitioner who will “meet you where you are without a preconceived idea of what you’re going to do in that session,” explains Barker. You need someone that you feel you can collaborate with on your treatment, who has enough experience that they can listen to your specific situation and be able to choose the right technique or treatment to be the most effective in helping your pain.
Cost and geographic access continue to be major barriers for individuals with pain seeking complementary and integrative treatment modalities. In the U.S. Pain Foundation’s 2020 Understanding Barriers to Multidisciplinary Care report, those surveyed listed massage therapists and acupuncturists among the top three providers they would like to see more of but cannot because of barriers like cost. Ensuring multimodal therapies are covered by insurance is a major focus of advocacy for U.S. Pain, prompting continued promotion of the dissemination of the Pain Management Task Force Report of 2019.
Learn more: bit.ly/pmtfreport